Cost of hospitalisation for hip fracture-findings from the Irish hip fracture database.

The authors utilised the Irish Hip Fracture Database (IHFD) to quantify the impact of hip fracture on the health service in terms of incidence, bed days and financial costs. The absolute number of hip fracture cases recorded by the IHFD has increased, as has the associated costs of hospitalisation. INTRODUCTION: Hip fracture places a considerable clinical and financial burden on the healthcare system, with acute hospitalisation accounting for a substantial proportion of the costs incurred. This paper aimed to quantify the cost of hospitalisation for hip fracture in Ireland in terms of bed days and direct hospital costs. METHODS: The authors analysed 23,494 cases in the Irish Hip Fracture Database (IHFD) from 2014 to 2020. Case numbers and length of stay were analysed annually. Hospital costs for hip fracture were described using the 2020 Activity-Based Funding Price List, which outlines the fees paid to public hospitals for inpatient activity. RESULTS: For the time period 2014-2020, the total cost of hospitalisation for hip fracture was approximately €296 million, equating to approximately €11,700 per episode of care. The annual cost of hospitalisation increased from approximately €34 million in 2014 to €44 million in 2020. In 2020, the mean length of stay for hip fracture was 17 days accounting for > 62,600 acute hospital bed days. CONCLUSION: The absolute number of hip fracture cases recorded by the IHFD has increased, as has the cost of hospitalisation. Given the current capacity issues and economic constraints, there is a growing need to prioritise time spent in the most expensive acute hospital setting to the immediate perioperative period and maximise the use of community services and early supportive discharge for the rehabilitation phase.

Discharge destination after hip fracture: findings from the Irish hip fracture database.

PURPOSE: Although home continues to be the place from which the majority of patients are admitted, less than one third of patients are Discharged Directly Home (DDH) following hip fracture. Once ready for discharge, DDH as opposed to Discharge to an Alternative Location (DAL), i.e., community care, rehabilitation facility or long-term care, is a high priority for patients and clinicians alike. Not only is DDH integral to the quality of life of patients, it is also an essential driver of the socioeconomic cost of hip fracture care. METHODS: We analysed 21,819 cases in the Irish Hip Fracture Database from 2013 to 2019. Descriptive and analytical statistics were conducted. RESULTS: 29% (n = 6476) of patients were DDH during the study period. On multivariate analysis, the odds of DDH decreased as age increased (OR 0.28, p < 0.01, 95% CI 0.24-0.34). Patients who were independently mobile prior to fracture were 47% more likely to be DDH (OR 1.47, p < 0.01, 95% CI 1.29-1.68). Those mobilised early post operatively were 24% more likely to be DDH (OR 1.24, p < 0.01, 95% CI 1.06-1.45). Patients who waited > 72 h prior to surgery were 30% less likely to be DDH (OR 0.70, p < 0.01, 95% CI 0.56-0.88). CONCLUSION: The authors identified patient characteristics that increased the likelihood of DDH, i.e., younger patients independently mobile prior to fracture, who received timely surgery and early post-operative mobilisation. The Irish Hip Fracture Standards (IHFS) incorporate 2 out the 3 modifiable factors identified, which reinforces the importance of the IHFS in improving patient outcomes.

Characteristics of Centenarians in the Irish Hip Fracture Database.

Aim Hip fractures are common amongst older people and result in significant morbidity and mortality. The Irish Hip Fracture Database (IHFD) collects data, from the 16 trauma orthopaedic units in Ireland, on patients aged 60 years and older who sustain hip fractures. This study aims to describe the characteristics of those patients aged 100 years and older in this database. Methods A retrospective analysis of the IHFD from 2012 to 2017. Characteristics of those patients aged 100 years and over were collected and analysed. Results 57 patients were identified for inclusion, 52 (91%) of which were women. Mean age was 101, while mean length of stay was 22.6 days. 51 (89%) fractures were due to low velocity trauma, consistent with likely high rates of osteoporosis in this group. The great majority underwent operative intervention. 50 (88%) were discharged alive. Fracture type varied widely. Only 24 (42%) patients were documented to have been seen by a geriatrician during admission. There were low reported rates of co-morbid medical conditions, likely due to lack of recorded data, rather than true low rates of co-morbidities in this group. Discussion This study provides insight into this distinct group of people, with important implications for future healthcare planning and budgeting.

Trends in hip fracture care in the Republic of Ireland from 2013 to 2018: results from the Irish Hip Fracture Database.

Hip fractures continue to be one of the most serious and costly injuries suffered by older people globally. This paper describes the development of a national hip fracture audit and summarises the first 6 years of data from the Republic of Ireland. This can help inform care, standards and outcomes of hip fracture patients. INTRODUCTION: Ireland has one of the highest standardised rates of hip fracture in the world behind northern European countries. The Irish Hip Fracture Database (IHFD) was established in 2012 to drive clinical and organisational improvements in quality and effectiveness of hip fracture care. This paper describes the progression of the IHFD between 2013 and 2018 and identifies trends and areas for improvement. METHODS: The IHFD is a clinically led, web-based audit, with data collected through the national Hospital Inpatient Enquiry (HIPE) electronic system, the principal source of information from publicly funded acute hospitals in Ireland. Eligible cases are aged ≥ 60 years with hip fracture as defined by IHFD or with other specified hip fracture excluding periprosthetic fractures. As of 2015, all 16 trauma-receiving hospitals within Ireland submitted data. Demographics and adherence to six national quality standards are described. RESULTS: A total of 17,983 cases were included in the analysis. National coverage has increased from 63% in 2013 to 99% in 2018. Demographic characteristics are unchanged, but higher levels of comorbidity are seen. Internal fixation and hemiarthroplasty are the most common modes of surgical repair with two-thirds of cases receiving spinal rather than general anaesthesia. Increasingly patients are being assessed by a geriatrician (11% in 2013 to 69% in 2018) and receive a bone health assessment (65% in 2013 to 84% in 2018). CONCLUSION: While some hip fracture standards have improved, further improvements are required to compare favourably internationally. Reduction of surgical delay and ensuring early mobilisation post-operatively are immediate priorities for the IHFD.

Scombrotoxic Fish Poisoning Secondary to Tuna Ingestion

Scombrotoxic poisoning results from the improper handling and refrigeration of fish containing naturally occurring histidine. Scombroid fish species such as tuna, mackerel and swordfish contain histidine, which is converted to histamine when inadequately chilled. European legislation states that scombroid fish species should be tested for the presence of histamine and mean values should be <100mg/kg1. The authors report an outbreak of scombrotoxic fish poisoning in 12 individuals following ingestion of tuna. Symptoms occurred rapidly and included flushing, headache, palpitations and diarrhoea. Fortunately, symptoms were short lived and self-limiting except in one individual, who required anti-histamine medication. Adequate refrigeration practices are crucial in preventing scombrotoxic food poisoning.

A Cluster of Hepatitis A Viral Infection in HSE South.

Hepatitis A is an acute viral infection of the liver that produces clinical features ranging from asymptomatic infection to fulminant hepatitis1. The authors report a cluster of 5 serologically-confirmed cases of acute Hepatitis A Virus (HAV), all serum IgM positive for HAV Genotype 1A. This is on a background of only 2 other cases notified to HSE-South in 2016 to date, both travel related. There was a considerable delay in notification in two out of 5 cases. This case report highlights the importance of prompt notification of Hepatitis A, as timely notification would have facilitated prompt contact vaccination and might well have prevented illness in two subsequent household contacts.

Soil Temperature Effects on the Interaction of Grape Rootstocks and Plant-parasitic Nematodes.

Resistance to Meloidogyne spp. in commonly used resistant grape rootstocks is slightly compromised at soil temperatures above 27°C. Newly released UCD-GRN series rootstocks, which have broad nematode resistance, exhibit trace infections by Meloidogyne spp. at elevated temperature. Pathotypes of M. incognita and M. arenaria that are virulent on 'Harmony' rootstock, as well as M. incognita Race 3, which is avirulent on 'Harmony', failed to produce egg masses on the UCD-GRN series rootstocks and other resistant selections at 24°C. At 27°C and above, there was increased nematode galling and egg mass production; at 30°C, egg mass production levels of M. incognita Race 3 on 'Harmony' were up to 12% of that on susceptible 'Colombard' while reproduction of the virulent pathotypes on the UCD-GRN series was less than 5% of that on 'Colombard'. Resistance of several of the parental genotypes of the UCD-GRN rootstock series was slightly compromised at soil temperatures of 30°C and above; however, others maintained their resistance to even the virulent M. arenaria pathotype A at high temperatures. Effects of high temperature on resistance to Xiphinema index could not be assessed because of temperature sensitivity of the nematodes while resistance to Mesocriconema xenoplax was not compromised at high soil temperature. Resistance to Meloidogyne spp. in the UCD-GRN series rootstocks was not compromised when plants and nematodes were subjected to cyclical high and low temperature conditions, indicating that once initiated, the resistance mechanism is not reversed.

Pancreatico pleural fistula: an unusual complication of chronic pancreatitis.

Pancreatico-pleural fistula secondary to chronic pancreatitis is a rare cause of pleural effusion. This case report presents a case of a middle aged female, a known case of chronic pancreatitis who presented with severe epigastric pain and progressive shortness of breath. CT and MRCP were useful in visualising the fistulous communication between the pancreas and pleural cavity. Treatment consisted of ERCP placement of a pancreatic stent, which facilitated internal drainage of pancreatic fluid thus resolving the pleural effusion and promoting healing of the fistula.

Resistance of Grape Rootstocks to Plant-parasitic Nematodes.

Candidate grape rootstocks were selected through a rigorous screening program initiated with important sources of resistance to Meloidogyne pathotypes and to Xiphinema index in Muscadinia rotundifolia and Vitis species native to North America. Based on their rooting capability and horticultural characteristics, 200 candidates were selected from 5,000 progeny of multiple crosses between commercial grape rootstocks and wild grape species that exhibited resistance to nematodes. After a 15-year screening process, 13 selections emerged with either almost complete or complete combined resistance to M. incognita Race 3, M. incognita pathotype Harmony C, M. arenaria pathotype Harmony A, and X. index, important nematode pests of grapevines. Durability of this broad resistance was tested by challenging the selections with the target nematodes in combination and with the target nematodes in combinations with species not included in the screening process. Durability of resistance of the candidate rootstocks was also tested by exposure to the nematode communities of infested field soils from different locations. Breadth of resistance was determined on the basis of their host status to non-target nematodes, including Mesocriconema xenoplax, Pratylenchus vulnus, Tylenchulus semipenetrans and Paratylenchus hamatus. After a total of 204 separate trials, the rootstocks were released to the grape industry as UCD GRN1, UCD GRN2, UCD GRN3, UCD GRN4, and UCD GRN5. We provide a compilation of current knowledge of the host status of these five newly released rootstocks and of 27 other rootstock cultivars to plant-parasitic nematodes.

Population Characteristics and Dosage Trajectory Analysis for Mesocriconema xenoplax in California Prunus Orchards.

The Mesocriconema xenoplax population increased exponentially in a newly planted peach orchard. The rate of increase was greater on Nemaguard than on Lovell rootstock and was reduced by postplant nematicides. Population levels were more stable in an established almond orchard on Nemaguard rootstock. All life stages of the nematode were present year round; lower ratios of juveniles to adults in summer suggested adverse effects of temperature and dry soil. Also in summer, there was a smaller proportion of the population in the upper 30 cm of soil than at greater depths. Nematode dosage, average nematode density multiplied by accumulated degree-days (physiological time) of the sampling interval, was useful in quantifying nematode stress on trees and as an indicator of the nematode management effectiveness. The annual trajectory of the nematode dosage could be determined by two samplings, one in spring and one in fall. A nematode predator, the parasitic fungus Hirsutella rhossiliensis, did not regulate ring nematode populations in the newly planted orchard; a recovery period was necessary for increase in the prevalence of parasitism.

Sensitivity of Meloidogyne javanica and Tylenchulus semipenetrans to Isothiocyanates in Laboratory Assays.

ABSTRACT Isothiocyanates are released through enzymatic degradation of glucosinolates produced by plants in the family Brassicaceae. Glucosinolate profiles differ among plant species and the isothiocyanate derivatives differ in their toxicity to nematodes. Control of plant-parasitic nematodes in soil by isothiocyanates released from incorporated brassicaceous plant material has been inconsistent. Success might be improved with knowledge of the relative toxicities of various isothiocyanates against nematodes. Laboratory assays were conducted to determine lethal concentration (LC) values in sand of seven commercially available isothiocyanates against Tylenchulus semipenetrans and Meloidogyne javanica. The LC(90) values were 0.01 and 0.03 mumol/ml for 2-phenylethyl isothiocyanate and 0.48 and 0.35 mumol/ml for phenyl isothiocyanate for T. semipenetrans and M. javanica, respectively. Brassicaceous sources of benzyl or 2-phenylethyl isothiocyanate and, to a lesser extent allyl isothiocyanate, are the most promising candidates for plant-parasitic nematode management. The broader context of this research is the development of approaches for consistent and reliable use of plant-derived chemicals for nematode management. The strategy is to select plants in the family Brassicaceae based on their glucosinolate profiles and the sensitivity of the target nematode species to the associated isothiocyanates.

Relationship between crop losses and initial population densities of Meloidogyne arenaria in winter-grown oriental melon in Korea.

To determine the economic threshold level, oriental melon (Cucumis melo L. cv. Geumssaragi-euncheon) grafted on Shintozoa (Cucurbita maxima x Cu. moschata) was planted in plots (2 x 3 m) under a plastic film in February with a range of initial population densities (Pi) of Meloidogyne arenaria. The relationships of early, late, and total yield to Pi measured in September and January were adequately described by both linear regression and the Seinhorst damage model. Initial nematode densities in September in excess of 14 second-stage juveniles (J2)/100 cm(3) soil caused losses in total yields that exceeded the economic threshold and indicate the need for fosthiazate nematicide treatment at current costs. Differences in yield-loss relationships to Pi between early- and late-season harvests enhance the resolution of the management decision and suggest approaches for optimizing returns. Determination of population levels for advisory purposes can be based on assay samples taken several months before planting, which allows time for implementation of management procedures. We introduce (i) an amendment of the economic threshold definition to reflect efficacy of the nematode management procedure under consideration, and (ii) the concept of profit limit as the nematode population at which net returns from the system will become negative.

Plant sources of chinese herbal remedies: laboratory efficacy, suppression of Meloidogyne javanica in soil, and phytotoxicity assays.

Extracts of Chinese herbal medicines from plants representing 13 families were tested for their ability to suppress plant-parasitic nematodes. Effective concentration (EC50 and EC90) levels for 18 of the extracts were determined in laboratory assays with Meloidogyne javanica juveniles and all stages of Pratylenchus vulnus. Efficacy of 17 extracts was tested against M. javanica in soil. Generally, EC50 and EC90 values determined in the laboratory were useful indicators for application rates in the soil. Extracts tested from plants in the Liliaceae reduced galling of tomato by M. javanica and were not phytotoxic. Similarly, isothiocyanate-yielding plants in the Brassicaceae suppressed root galling without phytotoxicity. Other plant extracts, including those from Azadirachta indica, Nerium oleander, and Hedera helix, suppressed root galling but were phytotoxic at the higher concentrations tested. Many of these plant sources have been tested elsewhere. Inconsistency in results across studies points to the need for identification of active components and for determination of concentration levels of these components when plant residues or extracts are applied to soil.

Fatty acid composition and dynamics of selected fungal-feeding nematodes and fungi.

Fatty acid profiles of fungal-feeding nematodes, Aphelenchus avenae and Aphelenchoides composticola, and selected fungi were determined in microcosm cultures of agar, broth, or sand amended with organic matter. Fatty acids of A. avenae and A. composticola included 16:0 18:0, 18:1omega7, 18:1omega9, 18:2, 20:0, 20:1, 20:2, 20:3 and 20:4 phospholipid fatty acids (PLFAs) and neutral lipid fatty acids (NLFAs). The nematodes differed in relative amounts of saturated and C(18) fatty acids. Similar C(16) and C(18) PLFAs and whole-cell fatty acids were found in Rhizoctonia solani, Fusarium oxysporum and Trichoderma sp. with 18:2omega6 as the major component. The C(20) fatty acids were not found in these fungi. Although only present in the nematodes, C(20) PLFAs were only detected when nematode population levels were > or =22 per gram of sand, suggesting that there is a detection threshold that might limit their use as biomarkers in the soil community. After removal of nematodes from a food source, the relative amount of C(20) PLFAs (structural components of nematode cell membranes) decreased more slowly than the C(16) and C(18) PLFAs, which may have reflected ingested fungal cytoplasm in the nematode intestine. In the early stage of organic matter decomposition, total and fungal PLFAs were lower in the presence of A. composticola then in its absence at C:N ratios > or =30:1.

Comparative demography of isogenic populations of Caenorhabditis elegans.

Demographic characteristics of the bacterial-feeding nematode Caenorhabditis elegans were determined in two long-lived mutant strains, TJ1052 (age-1), CB4876 (clk-1), and a wild-type strain, N2. Within each strain, there was little correlation between longevity and reproduction for individuals that lived longer than 10days. Long-lived mutant strains produced fewer eggs than the wild type. Mean total life spans were 13.2days for the wild type, 21.9days for age-1, and 15.8days for clk-1; maximum life spans were 24days for the wild type, 47days for age-1, and 32days for clk-1. Differences in total life span resulted primarily from longer post-reproductive survival. The mean post-reproductive life spans were longer than the wild type by 183% in age-1 and 60% in clk-1. We conclude that (i) post-reproductive survival is not correlated with egg production within isogenic populations of C. elegans, and (ii) the relationship between reproduction and longevity differs among isogenic populations with specific longevity genes.

Cholecystokinin activates PYK2/CAKbeta by a phospholipase C-dependent mechanism and its association with the mitogen-activated protein kinase signaling pathway in pancreatic acinar cells.

PYK2/CAKbeta is a recently described cytoplasmic tyrosine kinase related to p125 focal adhesion kinase (p125(FAK)) that can be activated by a number of stimuli including growth factors, lipids, and some G protein-coupled receptors. Studies suggest PYK2/CAKbeta may be important for coupling various G protein-coupled receptors to the mitogen-activated protein kinase (MAPK) cascade. The hormone neurotransmitter cholecystokinin (CCK) is known to activate both phospholipase C-dependent cascades and MAPK signaling pathways; however, the relationship between these remain unclear. In rat pancreatic acini, CCK-8 (10 nM) rapidly stimulated tyrosine phosphorylation and activation of PYK2/CAKbeta by both activation of high affinity and low affinity CCK(A) receptor states. Blockage of CCK-stimulated increases in protein kinase C activity or CCK-stimulated increases in [Ca(2+)](i), inhibited by 40-50% PYK2/CAKbeta but not p125(FAK) tyrosine phosphorylation. Simultaneous blockage of both phospholipase C cascades inhibited PYK2/CAKbeta tyrosine phosphorylation completely and p125(FAK) tyrosine phosphorylation by 50%. CCK-8 stimulated a rapid increase in PYK2/CAKbeta kinase activity assessed by both an in vitro kinase assay and autophosphorylation. Total PYK2/CAKbeta under basal conditions was largely localized (77 +/- 7%) in the membrane fraction, whereas total p125(FAK) was largely localized (86 +/- 3%) in the cytosolic fraction. With CCK stimulation, both p125(FAK) and PYK2/CAKbeta translocated to the plasma membrane. Moreover CCK stimulation causes a rapid formation of both PYK2/CAKbeta-Grb2 and PYK2/CAKbeta-Crk complexes. These results demonstrate that PYK2/CAKbeta and p125(FAK) are regulated differently by CCK(A) receptor stimulation and that PYK2/CAKbeta is probably an important mediator of downstream signals by CCK-8, especially in its ability to activate the MAPK signaling pathway, which possibly mediates CCK growth effects in normal and neoplastic tissues.

Nematode community structure as a bioindicator in environmental monitoring.

Four of every five multicellular animals on the planet are nematodes. They occupy any niche that provides an available source of organic carbon in marine, freshwater and terrestrial environments. Nematodes vary in sensitivity to pollutants and environmental disturbance. Recent development of indices that integrate the responses of different taxa and trophic groups to perturbation provides a powerful basis for analysis of faunal assemblages in soil as in situ environmental assessment systems.

CCKA receptor activation stimulates p130(Cas) tyrosine phosphorylation, translocation, and association with Crk in rat pancreatic acinar cells.

p130(Cas) (Crk-associated substrate), because of its structure as an adapter protein, can interact when tyrosine-phosphorylated with a large number of cellular proteins and therefore be an important modulator of downstream signals. A number of growth factors, lipids, and a few G protein-coupled receptors can stimulate p130(Cas) tyrosine phosphorylation. Recent studies show that tyrosine phosohorylation of intracellular proteins by the hormone/neurotransmitter cholecystokinin (CCK) in rat pancreatic acinar cells may be an important signaling cascade. In this study, we show in rat dispersed pancreatic acini CCK-8 rapidly stimulates tyrosine phosphorylation of p130(Cas), reaching a maximum (6.6 +/- 1. 4)-fold increase with a half-maximal effect at 0.3 nM. Activation of protein kinase C by TPA or increases in [Ca2+]i by the calcium ionophore A23187 stimulated p130(Cas) phosphorylation. Blockade of CCK increases in [Ca2+]i or PKC activity did not alter CCK-8-stimulated p130(Cas) phosphorylation; however, simultaneous blockage of both cascades caused a 50% inhibition. Partial inactivation by C. botulinum toxin of the small GTP-binding protein Rho caused a 41 +/- 12% decrease in the CCK-stimulated p130(Cas) phosphorylation. Disruption of the actin cytoskeleton with cytochalasin D, but not the microtubule network with colchicine, completely inhibited CCK-8-stimulated p130(Cas) phosphorylation. Total p130(Cas) under basal conditions was largely localized (70 +/- 2%) in the membrane fraction, and stimulation with CCK-8 induced total p130(Cas) translocation from the cytosolic fraction. CCK stimulation also caused a (5 +/- 1)-fold increase in p130(Cas) tyrosine phosphorylated in the plasma membrane. Treatment with tyrphostin B44 inhibited CCK-8-stimulated p130(Cas) phosphorylation, but it had no effect on p130(Cas) translocation. CCK-8 caused rapid formation of a p130(Cas)-Crk complex. In conclusion, our results demonstrate CCKA receptor activation causes rapid tyrosine phosphorylation of p130(Cas) through PLC-dependent and -independent mechanisms that require the participation of the small GTP-binding protein Rho and the integrity of the actin cytoskeleton, but not the microtubule network. Moreover, CCKA receptor activation causes translocation of p130(Cas) to the membrane and an increase in membrane tyrosine-phosphorylated p130(Cas). The translocation to the membrane does not require antecedent tyrosine phosphorylation. CCKA activation promotes the rapid formation of a p130(Cas)-Crk complex. These results suggest that p130(Cas) is likely an important modulator of downstream signals activated by CCK-8, possibly involved in regulating numerous cellular effects, such as effects on cell growth or cell shape.

Plant Sources of Chinese Herbal Remedies: Effects on Pratylenchus vulnus and Meloidogyne javanica.

More than 500 plant species, used alone or in combination, are documented in Chinese traditional medicine to have activity against helminth and micro-invertebrate pests of humans. We subjected 153 candidate medicines or their plant sources to multilevel screening for effectiveness against plant-parasitic nematodes. For extracts effective in preliminary screens, we determined time-course and concentration-response relationships. Seventy-three of the aqueous extracts of medicines or their plant sources killed either Meloidogyne javanica juveniles or Pratylenchus vulnus (mixed stages), or both, within a 24-hour exposure period. Of 64 remedies reported as antihelminthics, 36 were effective; of 21 classi- fied as purgatives, 13 killed the nematodes; of 29 indicated as generally effective against pests, 13 killed the nematodes. Sources of extracts effective against one or both species of plant-parasitic nematodes are either the whole plant or vegetative, storage or reproductive components of the plants. Effective plants include both annuals and perennials, range from grasses and herbs to woody trees, and represent 46 plant families.