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Objectives: Despite established standards and guidelines, substantial variation remains in the delivery of hip fracture care across the United Kingdom. We aimed to determine which hospital-level organisational factors predict adverse patient outcomes in the months following hip fracture., Methods: We examined a national record-linkage cohort of 178,757 patients aged ≥60 years who sustained a hip fracture in England and Wales in 2016-19. Patient-level hospital admissions datasets, National Hip Fracture Database and mortality data were linked to metrics from 18 hospital-level organisational-level audits and reports. Multilevel models identified organisational factors, independent of patient case-mix, associated with three patient outcomes: length of hospital stay (LOS), 30-day all-cause mortality and emergency 30-day readmission., Results: Across hospitals mean LOS ranged from 12 to 41.9 days, mean 30-day mortality from 3.7 to 10.4% and mean readmission rates from 3.7 to 30.3%, overall means were 21.4 days, 7.3% and 15.3%, respectively. In all, 22 organisational factors were independently associated with LOS; e.g. a hospital's ability to mobilise >90% of patients promptly after surgery predicted a 2-day shorter LOS (95% confidence interval [CI]: 1.2-2.6). Ten organisational factors were independently associated with 30-day mortality; e.g. discussion of patient experience feedback at clinical governance meetings and provision of prompt surgery to >80% of patients were each associated with 10% lower mortality (95%CI: 5-15%). Nine organisational factors were independently associated with readmissions; e.g. readmissions were 17% lower if hospitals reported how soon community therapy would start after discharge (95%CI: 9-24%)., Conclusions: Receipt of hip fracture care should be reliable and equitable across the country. We have identified multiple, potentially modifiable, organisational factors associated with important patient outcomes following hip fracture., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose of the Study: Research has linked several aspects of religion--including service attendance, prayer, meditation, religious coping strategies, congregational support systems, and relations with God, among others--with positive mental health outcomes among older U.S. adults. This study examines a neglected dimension of religious life: listening to religious music., Design and Methods: Two waves of nationally representative data on older U.S. adults were analyzed (n = 1,024)., Results: Findings suggest that the frequency of listening to religious music is associated with a decrease in death anxiety and increases in life satisfaction, self-esteem, and a sense of control across the 2 waves of data. In addition, the frequency of listening to gospel music (a specific type of religious music) is associated with a decrease in death anxiety and an increase in a sense of control. These associations are similar for blacks and whites, women and men, and low- and high-socioeconomic status individuals., Implications: Religion is an important socioemotional resource that has been linked with desirable mental health outcomes among older U.S. adults. This study shows that listening to religious music may promote psychological well-being in later life. Given that religious music is available to most individuals--even those with health problems or physical limitations that might preclude participation in more formal aspects of religious life--it might be a valuable resource for promoting mental health later in the life course., (© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Research and practice partnerships have the potential to enhance the translation of research findings into practice., Purpose: This paper describes such a partnership in the development of Walk Kansas (WK) and highlights individual and organizational level outcomes., Method: Phase 1 examined: (a) the reach of WK, (b) physical activity changes, and (c) maintenance of physical activity changes 6 months after the program was completed. Phase 2 explored WK adoption and sustainability over 5 years., Results: WK attracted a large number of participants who were more likely to be female, more active, and older than the adult population within the counties where they resided. Inactive or insufficiently active participants at baseline experienced significant increases in both moderate (p < 0.001) and vigorous (p < 0.001) physical activity. A random selection of participants who were assessed 6 months post-program did not demonstrate a significant decrease in moderate or vigorous activity between program completion and 6-month follow-up. The number of counties adopting the program increased across years, peaking at 97 in 2006 and demonstrated the sustainability of the WK over 5 years., Conclusions: WK is effective, has a broad reach, and enables participants to maintain increased activity. It also shows promise for broad adoption and sustainability.

The rate of cognitive decline in AD has been noted to vary significantly among patients. The ability to predict the probable rate of decline early in the disease process would be of great practical importance. Attempts to analyze early cognitive deficits to find patterns associated with rapid decline have met with limited success. This paper utilized a large sample of patients with a diagnosis of probable AD evaluated longitudinally in ongoing research at the ADRC at Baylor College of Medicine and a statistical procedure of profile analysis to assess the initial data for a pattern associated with rapid decline. The findings indicated that despite initial equality of MMSE scores, patients showing rapid MMSE decline at one year displayed significantly more impaired performance on neuropsychological measures at diagnosis. Discussion includes discussion on the use of the MMSE for tracking general cognitive function and the difficulties of ascertaining stable profiles for prediction.

The nucleotide sequences of the upstream regions of the botulinum neurotoxin type A1 (BoNT/A1) cluster of Clostridium botulinum strain NCTC 2916 and the BoNT/A2 cluster of strain Kyoto-F were determined. A novel gene, designated orfx3, was identified following the orfx2 gene in both clusters. ORF-X2 and ORF-X3 exhibit similarity to the BoNT cluster associated P-47 protein. The BoNT/A1 and BoNT/A2 clusters share a similar gene arrangement, but exhibit differences in the spacing between certain genes. Sequences with similarity to transposases were identified in these intergenic regions, suggesting that these differences arose from an ancestral insertion event. Transcriptional analysis of the BoNT/A2 cluster revealed that the genes of the cluster are primarily synthesized as three polycistronic transcripts. Two divergent polycistronic transcripts, one encoding the orfx1, orfx2, and orfx3 genes, the second encoding the p47, ntnh, and bont/a2 genes, are transcribed from conserved BoNT cluster promoters. The third polycistronic transcript, expressed at low levels, encodes the positive regulatory botR gene and the orfx genes. This is the first complete analysis of a botulinum toxin A2 cluster.

The functional analysis of genes frequently requires manipulation of large genomic regions embedded in yeast artificial chromosomes (YACs). We have designed a yeast-bacteria shuttle vector, pClasper, that can be used to clone specific regions of interest from YACs by homologous recombination. The important feature of pClasper is the presence of the mini-F factor replicon. This leads to a significant increase in the size of the plasmid inserts that can be maintained in bacteria after cloning by homologous recombination in yeast. The utility of this vector lies in its ability to maintain large fragments in bacteria and yeast, allowing for mutagenesis in yeast and simplified preparation of plasmid DNA in bacteria. Using PCR-generated recombinogenic fragments in pClasper we cloned a 27 kb region from a YAC containing the Hoxc cluster and a 130 kb region containing the entire Hoxb cluster. No rearrangements were seen when the recombinants in the shuttle vector were transferred to bacteria. We outline the potential uses of pClasper for functional studies of large genomic regions by transgenic and other analyses.

Isolation of Edwardsiella tarda in humans has been associated with an asymptomatic carrier state as well as mild, self-limited diarrheal illness. Extraintestinal manifestations have included soft-tissue infections, meningitis, osteomyelitis, cholangitis, and sepsis. Only three cases of patients who had documented hepatic abscess due to E. tarda have been reported in the English-language literature; two patients died, and the third required a laparotomy and drainage. We report what is, to our knowledge, the first autochthonous case of hepatic abscess due to E. tarda in the United States and the first case that was successfully managed with antibiotic therapy alone.

A computer-controlled system for the investigation of the response properties of the tibio-femoral chordotonal organ in the locust is described. The computer is used to generate small amplitude sinusoidal movements of the tibia via a small servo-controlled motor. The resulting response recorded via a suction electrode is simultaneously detected, processed and stored on disk. Full constructional details for all hardware required are given. The software, developed for a BBC microcomputer, in addition to controlling all the hardware, has graphics and analysis routines enabling the operator to display and manipulate the stored data.

During one year, out of 1829 faecal specimens examined at the Chelmsford Public Health Laboratory, campylobacters were isolated from 109 (6%), 21 of the positive cultures were from hospital in-patients and 3 were from hospital staff. The remaining 85 isolates were from specimens sent in by general practitioners. The authors' figures show a marked season variation with most of the infections occurring from June to September. The highest incidence (36%) was in the 20 to 30 age group, 99% of patients had diarrhoea, usually watery, occasionally explosive, and 9% had visible blood in their stools. Eighteen per cent. of patients had abdominal pain, 5 of the 21 hospital in-patients underwent abdominal surgery. Fifty-nine faecal specimens were examined microscopically and 30 of these had blood and pus cells or pus cells alone. Three patients had rectal biopsies showing a nonspecific colitis, 11 patients had recently been abroad.

Agranulocytosis developed in a patient with staphylococcal osteomyelitis after 35 days of treatment with orally administered cloxacillin. The patient had fever, prostration, pharyngitis, and profound leukopenia, which subsequently abated upon withdrawal of the drug. Cloxacillin should be included in the growing list of drugs capable of producing leukopenia and agranulocytosis.