Call for action.

AT RCN congress in Bournemouth last month, I presented a resolution calling on council to put pressure on the UK governments to address the crisis in the emergency care service. This was presented on behalf of the East Dorset branch.

Implementation and testing of research infrastructure for practice-based research in hearing and communication disorders.

OBJECTIVE: To describe site capability and experience of the CHEER network (Creating Healthcare Excellence through Education and Research) to rapidly collect descriptive data on patients with tinnitus and dizziness visiting participating CHEER sites. STUDY DESIGN: Prospective observational data collection study over 6 months. SETTING: Twenty one community otology and otolaryngology practices in the United States. SUBJECTS AND METHODS: As proof of concept, a data collection study was developed for patients with tinnitus and dizziness (presenting with or without associated migraine) through a collaborative effort of the CHEER principal investigator (PI) and co-PIs. The 9-page questionnaire included validated instruments and additional patient- and physician-reported information. Information was captured electronically via REDCap by each site's CHEER research coordinator. Site initiation, data entry rates, and research coordinator feedback were also collected. RESULTS: Of the 21 CHEER sites, 15 participated in the study. Nine sites entered a patient within the first 31 days of study initiation, and all 15 sites were entering patients and corresponding clinical data within 72 days. During the 6-month study, 1044 patients were entered into the REDCap database. Research coordinator engagement was a major driver for success, whereas time and resources were deterrents. Incentives included altruism, professional development, and future financial opportunities. CONCLUSION: The CHEER research network has significant capability and infrastructure to collect prospective data in a practice-based environment. Research coordinator engagement undergirds network success; however, future efforts will cultivate stronger collaboration of the coordinator and site PI. Central coordination of practice-based research through a hub and spoke concept can be successful.

Zoledronic acid and clinical fractures and mortality after hip fracture.

BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients (mean age, 74.5 years) received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS: The rates of any new clinical fracture were 8.6% in the zoledronic acid group and 13.9% in the placebo group, a 35% risk reduction with zoledronic acid (P=0.001); the respective rates of a new clinical vertebral fracture were 1.7% and 3.8% (P=0.02), and the respective rates of new nonvertebral fractures were 7.6% and 10.7% (P=0.03). In the safety analysis, 101 of 1054 patients in the zoledronic acid group (9.6%) and 141 of 1057 patients in the placebo group (13.3%) died, a reduction of 28% in deaths from any cause in the zoledronic acid group (P=0.01). The most frequent adverse events in patients receiving zoledronic acid were pyrexia, myalgia, and bone and musculoskeletal pain. No cases of osteonecrosis of the jaw were reported, and no adverse effects on the healing of fractures were noted. The rates of renal and cardiovascular adverse events, including atrial fibrillation and stroke, were similar in the two groups. CONCLUSIONS: An annual infusion of zoledronic acid within 90 days after repair of a low-trauma hip fracture was associated with a reduction in the rate of new clinical fractures and with improved survival. (ClinicalTrials.gov number, NCT00046254 [ClinicalTrials.gov].).

Effects of scrubber by-product-stabilized dairy lagoon sludge on growth and physiological responses of sunflower (Helianthus annuus L.).

Brick manufacturing industries are challenged to comply with clean air mandates. Dry air scrubbers have been used to remove acid gases from the exhaust air from brick manufacturing plants. The use of dry air scrubbers results in the production of large quantities of an alkaline powder by-product. A greenhouse experiment was conducted to evaluate the potential of using dairy lagoon sludge stabilized with the scrubber by-product as a soil amendment. Lagoon sludge was stabilized with scrubber by-product at an application rate of 20 gl(-1). The sludge-scrubber by-product mixture was applied to a sandy loam soil to provide amendments ranging between 28 and 168 kg of plant available nitrogen (PAN)/ha for the growth of Helianthus annuus (sunflower). Use of the sludge-scrubber by-product mixture as a nitrogen fertilizer did not adversely affect sunflower seedling emergence; however, significantly higher (p<0.05) plant volume indices, leaf area, dry shoot and root masses, and seed yields were obtained for mature plants grown in sludge-treated soil relative to the control or fertilizer treatment. The sludge amendment did not severely impact gas exchange or chlorophyll a fluorescence of the plants and nutrient content of the sunflower tissues was generally within a sufficient range. The increased growth and yield of sunflower plants indicated the potential of the sludge-scrubber by-product mixture as a soil amendment in agricultural crop production.

Falling asleep.

We describe a 74-year-old woman who presented with a history of falling from bed in association with vivid dreams and physical violence towards her spouse. A clinical diagnosis of rapid eye movement sleep behaviour disorder was made and complete resolution of her symptoms was achieved with first line treatment.

A rural road: exploring opportunities, networks, services, and supports that affect rural families.

The Great Plains Rural Collaborative project explored rural poverty through the experiences of people living at or below 185% of poverty. Researchers collected information through qualitative and quantitative research methods. They designed focus group questions to identify obstacles rural families face when trying to access economic opportunities, social networks, and services and supports. The article highlights the salient findings.