bluuebunny/crossref_metadata_2025 huggingface dataset:
Budidaya Strowberi Secara Hidroponik Di Rooftop Gedung Merah Dengan Pengendalian Lingkungan Sistem Mobile Phone
Authors: Daryono  , Hidayat Nur , Rusmini  , Yuanita  , Junirianto Eko , Hamka  , Nurmarini Eva , Rudito
Published: June 2021

Sistem hidroponik dapat menjadi salah satu solusi bagi pengembangan tanaman buah dan sayur dengan berbagai kelebihan dibandingkan sistem pertanian konvensional, dimana kebutuhan nutrisi dan lingkungan tumbuh (iklim mikro) dapat dimanipulasi dengan menggunakan teknologi tepat guna sehingga tanaman dapat tumbuh secara optimal. Tujuan Mengukur keberhasilan hidroponik dengan sistem pengendalian control jarak jauh untuk pengaturan intensitas cahaya, kelembaban dan suhu skala iklim mikro pada tanaman hidroponik dan Membandingkan tanaman strowberi yang diberi perlakuan pengaturan iklim mikro dengan tanpa perlakuan, dengan pembuatan naungan penutup dan humidifier dengan sistem otomasi dan sensor suhu. Penelitian ini dilaksanakan di Rooftop Gedung Merah Politani Samarinda selama 1 tahun terhitung sejak bulan Januari 2020 sampai dengan bulan Desember 2020 . Penelitian ini  menggunakan Rancangan Acak Lengkap  Non Faktorial satu faktor 2 taraf perlakuan yaitu P1= budidaya stroberi dengan perlakuan naungan dan humidifier P2   = budidaya stroberi tanpa perlakuan iklim mikro (naungan dan humidifier). Setiap taraf perlakuan diulang diulang sebanyak 20 tanaman sehingga total tanaman yang digunakan dalam penelitian ini 40 tanaman. Hasil dari penelitian ini adalah Pertambahan jumlah daun tanaman strowberi umur 8 minggu setelah tanam rerata tertinggi pada perlakuan P1 yaitu 8,55 cm dan rerata tanaman strowberi terendah pada perlakuan P2 yaitu 6,50, dan pertambahan jumlah daun tanaman strowberi umur 12 minggu setelah tanam rerata tertinggi pada P1 yaitu 13,7 cm dan rerata tanaman strowberi terendah pada perlakuan P2 yaitu 9,50. Sedangkan jumlah anakan stolon tanaman stowberi umur 8 dan 12 minggu setelah tanam (mst) P1 dan P2 berpengaruh tidak nyata artinya pemberian taraf perlakuan tidak berpengaruh terhadap jumlah anakan stolon tanaman strowberi.
Mary Daly’s Philosophy: Some Bergsonian Themes
Authors: Kapusta Stephanie
Published: June 2021

The primary goal of this article is point out certain close parallels between some ideas of the radical feminist theorist Mary Daly and those of the French philosopher Henri Bergson. These similarities are particularly striking regarding distinctions made by both authors between two fundamentally contrasting types of cognitive faculty, of time and temporal experience, and of self and emotion. Daly departs from Bergson inasmuch as she employs these distinctions in her own way. She does not—like Bergson—employ them to depict the result of a natural process of consciousness or life, and the dangers for human freedom and thought of not properly respecting these differences. Rather, she locates these differences within a more liberatory, ethical perspective to ground a sharp, inimical contrast between feminist creative movement on the one hand, and static, fixing, and “fixating” patriarchy, with its “technocratic” pretensions, on the other. My hope is that highlighting the similarities between Daly and Bergson will open new paths of appreciation and critique of Daly’s work.
Augmentation Index Predicts the Sweat Volume in Young Runners
Authors: Liu Yen-Yu , Hung Chung-Lieh , Sun Fang-Ju , Huang Po-Han , Cheng Yu-Fan , Yeh Hung-I
Published: June 2021

Sweating during exercise is regulated by objective parameters, body weight, and endothelial function, among other factors. However, the relationship between vascular arterial stiffness and sweat volume in young adults remains unclear. This study aimed to identify hemodynamic parameters before exercise that can predict sweat volume during exercise, and post-exercise parameters that can be predicted by the sweat volume. Eighty-nine young healthy subjects (aged 21.9 ± 1.7 years, 51 males) were recruited to each perform a 3-km run on a treadmill. Demographic and anthropometric data were collected and hemodynamic data were obtained, including heart rate, blood pressure and pulse wave analysis using non-invasive tonometry. Sweat volume was defined as pre-exercise body weight minus post-exercise body weight. Post-exercise hemodynamic parameters were also collected. Sweat volume was significantly associated with gender, body surface area (BSA) (b = 0.288, p = 0.010), peripheral systolic blood pressure (SBP), peripheral and central pulse pressure (PP), and was inversely associated with augmentation index at an HR of 75 beats/min (AIx@HR75) (b = -0.005, p = 0.019) and ejection duration. While BSA appeared to predict central PP (B = 19.271, p ≤ 0.001), central PP plus AIx@HR75 further predicted sweat volume (B = 0.008, p = 0.025; B = -0.009, p = 0.003 respectively). Sweat volume was associated with peripheral SBP change (B = -17.560, p = 0.031). Sweat volume during a 3-km run appears to be influenced by hemodynamic parameters, including vascular arterial stiffness and central pulse pressure. Results of the present study suggest that vascular arterial stiffness likely regulates sweat volume during exercise.
Imágenes de la Covid. Reflexiones sobre la emocionalidad resultante
Authors: Coll Espinosa Francisco Jesús
Published: June 2021

La pandemia Covid-19 no solo está siendo devastadora en los niveles de desarrollo económico, sino, fundamentalmente, en la vivencia de nuestra vivencia de la realidad íntima y social, afectiva y familiar. Lo que se quiere llamar la nueva realidad, implica una descontextualización psíquica y emocional que nos obliga a una reconstrucción y resignificación de nuestra presencia viva en los otros. Tenemos la acuciante necesidad de la creación de nuevos modos de elaboración de los vínculos, de modo que sigamos teniendo la alteridad como elemento nodal que sostiene las relaciones humanas. Para ello, el aporte del arte, la creatividad y las terapias creativas son mecanismos vivos e indispensables en esto de la nueva realidad
Investigation of the influence of hot asymmetric long products on the formation of the microstructure, mechanical properties and service characteristics of finished products
Authors: Razdobreev V.G. , Palamar D.G.
Published: June 2021

The aim of the work is to study the influence of the process of hot asymmetric rolling on the structural state, mechanical properties and operational characteristics of long products of simple form from ordinary carbon steel. To simulate the process of asymmetric high-quality rolling, the mathematical model previously developed in the ISI added the possibility of taking into account cases of rolling in a pair of rolls of different diameters, rolling in a pair of rolls of different materials, rolling with one drive and one non-drive rolls, rolling at different speeds in a pair of rolls and other. The calculations showed a reduction in rolling force to 10 % with an asymmetric rolling process compared to the traditional rolling process. The study of the features of the process of hot asymmetric rolling (shear rolling) compared with the traditional rolling process was carried out under industrial conditions in the production of a 12x12 mm square profile from ordinary low-carbon steel St3sp. It was found that the average values of HRB, σВ, and σТ in the studied samples practically do not differ, and the average values of δ5 are higher by 8 % (abs.) or ~ 27 % (rel.) In samples that were rolled using the asymmetric rolling technology than in samples that were rolled using traditional rolling technology. The estimation of dislocation density by the X-ray diffraction method showed that during hot asymmetric rolling, the dislocation density is reduced by ~ 46% due to the active flow of in-situ polygonization and recrystallization processes during deformation. In this case, the average values of the microfractures of the crystalline lattice of ferrite are 21% lower in the samples obtained by the method of asymmetric rolling than in the samples obtained by traditional rolling. For the first time, a decrease in the total atmospheric corrosion rate was found in samples that were rolled using asymmetric rolling technology (0.39 g/m2xh) compared to samples that were rolled using traditional rolling technology (0.445 g/m2xh).
Development and implementation of the new approaches to diagnostics and management of the blast furnace smelting
Authors: Semenov Yu.S. , Shumelchik Е.І. , Horupakha V.V
Published: June 2021

The article presents a brief description of the results of blast furnace production research carried out at the Yenakiieve Iron & Steel Works and the Dneprovsky Iron & Steel Integrated Works in 2011–2019. For the conditions of transition modes of blast furnace to ensure its stability in changing the qualitative and quantitative composition of the components of the charge materials, as well as in the change of fuel additives in the blast, the complex use of information of modern means of automated control is proved: stationary thermosets and thermocouples to the lining. New approaches to the choice of rational charging programs using the principle of variable maximum ore loading along the radius of the furnace within the charging cycle for working conditions on a charge of low quality have been developed. The implementation of such a charging program over the next three years has allowed to ensure a stable and economical course of melting, and its adaptation to the technology of using pulverized coal has allowed to reduce the gas flow temperature of the peripheral zone throughout the height of the blast furnace, as well as to preserve the cooling system during the development of lining-free. Expert module of adjustment of the program of charging using the established rational ranges of change of temperature indices of gas flow distribution along the radius of the furnace under different technological conditions of blast furnace has been developed and implemented on three blast furnaces. The method of reasonable choice of location of closed air tuyeres or air tuyeres of different diameter was developed and tested using information on change of lining temperatures on height and circumference of blast furnace. The method of equalizing the raceway adiabatic flame temperature around the blast furnace circumference by creating a non-uniform flow rate of pulverized coal in the air tuyeres has been improved and implemented. The basic technological requirements for blast furnace blasting after its long stop without release of "gantry" cast iron and scraping of materials from the furnace, the use of which before and in the blast furnace blasting of the Yenakiieve Iron & Steel Works and the Dneprovsky Iron & Steel Integrated Works after a long-lasting set-up were developed economic indicators, while ensuring the preservation of refractory lining, structures and equipment.
Valores de referencia para las pruebas de Cooper y de 20m de ida y vuelta en población residente en altitud elevada. [Reference values for Cooper and Shuttle Run Tests in population living at high altitude].
Authors:   Grupo de Investigación Ciencias Aplicadas al Ejercicio, Deporte y Salud - GICAEDS, Universidad Santo Tomás, 205070 Bogotá, Sánchez-Rojas Isabel Adriana ,   Colombia, Mendoza Romero Darío , Paola Argüello-Gutiérrez Yenni , Castro-Jiménez Laura Elizabeth , Triana-Reina Héctor Reynaldo , Perez-Cebreros Esteban Abdel , Petro Jorge Luis , Bonilla Diego A.
Published: June 2021

El objetivo del estudio fue reportar los valores de referencia para el VO2máx indirecto obtenido en las pruebas de Cooper Run Test (CRT) y Shuttle Run Test (SRT-20m) en población adulta entrenada que reside a una altitud entre los 2600 y 3700 msnm. Un total de 614 sujetos físicamente activos (118 mujeres, 496 hombres; 20.2±2.3 años; 65.3±10.3 kg; 169.1 ± 7.8 cm; 22.7±2.8 kg·m-2) residentes en la ciudad de Bogotá, o municipios del área metropolitana, participaron en este estudio de tipo descriptivo transversal. Se establecieron los percentiles de VO2máx para las pruebas CRT y SRT-20m en la población de estudio, resaltando que los registros obtenidos en el SRT-20m fueron mayores que CRT. Los valores de VO2máx en los sujetos que habitan a <3000 msnm fueron menores en comparación con los residentes a 3001 – 4000 msnm (p=0.01); asimismo, las mujeres reportaron un menor nivel de aptitud física cardiorrespiratoria (AFC) que los hombres (p<0.01). En conclusión, estos valores reportados pueden ser empleados para la evaluación de la AFC de poblaciones con características similares. Por otra parte, las variaciones encontradas en los valores de VO2máx podrían estar asociadas a variantes genéticas (e.g. polimorfismos) o a las adaptaciones propias del entrenamiento (e.g., especificidad del entrenamiento, técnica de carrera); no obstante, se requiere más investigación sobre estos aspectos en este tipo de población.
A case study of role of Pancha tikta ghruta kshira basti in Avascular Necrosis of head of femur
Authors: Jagdhane Chandrakant , Yadav Prachi V.
Published: June 2021

Aim: To evaluate the role of panchatikta ghrita kshira basti in Avascular Necrosis of the head of femur Objectives:1. To evaluate the role and mechanism of action of Pancha tikta ghrita kshira basti in AVN.Observation: Follow up was taken after every week in Karma basti karma given to the patient for seven days.Observations were noted in the form of improvement in clinical parameters. Conclusion: Conclusion was drawn from above data.
Screening of Penicillium Species and Optimisation of Culture Conditions for the Production of Ergot Alkaloids Using Surface Culture Fermentation Process
Authors: Shahid Memuna Ghafoor , Nadeem Muhammad
Published: June 2021

The present study deals with the screening of fungal species and suitable fermentation medium for the production of ergot alkaloids. Various species of genus Penicillium were grown on differentfermentation media by employing surface culture fermentation technique to achieve the most suitable medium and the best Penicillium sp. The results showed that medium M5 gave maximum yield withPenicillium commune. Different culture conditions such as effect of different carbon and nitrogen sources, their concentration levels, different pH values and sizes of inoculum on the production of ergot alkaloids were also studied to improve the yield. Maximum production of ergot alkaloids (4.32 mg/L) was achieved with 15 mL spore suspension at pH 5 in fermentation medium containing 35% (w/v) sucrose. All these  results indicate that culture conditions are very much crucial to improve the yield of ergot alkaloids produced by Penicillium commune through surface culture process.
Concentration of Heavy Metals in Available Fish Species (Bain, Mastacembelus armatus; Taki, Channa punctatus and Bele, Glossogobius giuris) in the Turag River, Bangladesh
Authors: Afrin Rezuana , Mia Md. Younus , Ahsan Md. Aminul , Akbor Ahedul
Published: June 2021

This study was conducted to assess the concentration level of heavy metals in three available fish species (Bain, Mastacembelus armatus; Taki, Channa punctatus and Bele, Glossogobius giuris) of the Turag river, Bangladesh during the months from January to March, 2014. In case of bio-concentration of heavy metals in fish, the levels of Pb, Cd, Cr, Cu and Fe ranged from 0.01-0.13 mg/kg, 0.001-0.02 mg/kg, 0.17-0.48 mg/kg, 0.30-0.74 mg/kg and 4.05-46.86 mg/kg, respectively while Hg was below detection level. These values indicate that the heavy metals were concentrated in fish flesh at a higher level than water. The highest values of Pb, Cd and Cr were found in Bain fish, Fe was found in Taki fish and Cu was found in Bele fish. Most of the heavy metals have crossed the permissible limits in fish, especially for the values of Cr, Cu and Fe. From the results of the present investigation, it can be concluded that the available fish species are harmful for their consumers.
Enhancing Shelf Life of Vegetable Oils Blend by Using Moringa oleifera Leaf Extract as Antioxidant
Authors: Nadeem Muhammad , Ullah Ansar , Idnan Muhammad , Ali Muhammad
Published: June 2021

The antioxidant activity of ethanolic Moringa oleifera leaf extract for oxidative stabilisation of canola, sunflower and soybean oils was investigated at ambient temperature. The blend was prepared by mixing canola, sunflower and soybean oils in equal proportions. Ethanolic M. oleifera leaf extract was incorporated into vegetable oils blend at three different concentrations; 300, 600 and 900 ppm (T1, T2 and T3), compared with a control and the sample added with 100 ppm tertiary butylated hydroxyl quinine (TBHQ) was used as a positive control. Filled in one litre transparent PET bottles, kept at room tempera- ture (35-40 °C) for 3 months and sampled at 0 and 90 days for the assessment of oxidative stability. Peroxide value of three months stored blank, T3 and TBHQ supplemented samples were 2.25, 0.84 and 0.78 (meqO2/kg). Induction period of blank, T3 and TBHQ supplemented vegetable oils blend was 3.46, 7.95 and 8.57 h. Peroxide value of blank, T3 and TBHQ supplemented vegetable oils blend, after 5 days at 63 °C, was 7.55, 2.81 and 2.59 (meqO2/kg).
Antibacterial Activities of Aqueous Extracts of Terminalia catappa, Momordica charantia and Acalypha wilkesiana on Escherichia coli Isolated from Pediatrics
Authors: Adeyemi Ajenifuja Oluwafemi , Adeyinka Ajibade Victor , Olawande Fajilade Temilade
Published: June 2021

Antibacterial activity of aqueous extract of Terminalia catappa, Momordica charantia and  Acalypha wilkesiana was investigated against Escherichia coli isolated from pediatrics with the minimum inhibitory concentration (MIC) of 0.5mg/mL by agar dilution technique. The antibacterial potency of the extracts as evaluated by broth dilution technique, showed diameter of inhibition zone of 22.80 mm, 14.20 mm and 21.00 mm at a concentration of 0.5 mg/mL for T. catappa, M. charantia and A. wilkesiana, respectively. The antibacterial effect of T. catappa was found to be more pronounced with its plausible use for the treatment of infections caused by E. coli.
Characterisation and Identification of Taraxerol and Taraxer-14-en-3-one from Jatropha tanjorensis (Ellis and Saroja) Leaves
Authors: Oladoye Sunday Olusegun , Ayodele Ezekiel Temidayo , Hammed Misbaudeen Abdul- , Idowu Olajumoke Tolulope
Published: June 2021

Jatropha tanjorensis leaves were collected, air dried and pulverised. The pulverised sample was extracted with solvents (n-hexane, ethylacetate and ethanol) of varying polarity to obtain the crude extracts.Repeated column and thin layer chromatographic separation of the crude extracts afforded two compounds which were characterised by their IR, MS, 1H and 13C-NMR spectral data. Comparison of the data withliterature confirmed the compounds to be taraxerol and taraxer-14-en-3-one.
Automated Method for Delineating Watershed, Drainage Pattern and Calculation of Flow Accumulation in Punjab Province using Digital Elevation Model
Authors: Zamir Umair bin , Kazmi Jamil Hassan
Published: June 2021

Delineation of the watershed and drainage is among the prior requirement of any organised hydrological study. Delineating watershed is important for elucidating the geo-hydrological conditions of any geographical space. This study aims to explore the vitality of Digital Elevation Model (DEM) data in calculating the flow accumulation, flow length, drainage pattern and watershed basin delineation of Punjab as well as elevational profiling district wise and delineating the catchment density. The potential hydrological system developed is based on 1 arc second Aster GDEM data. Depression less DEM is developed by filling process. Furthermore flow accumulation, drainage pattern and watershed is demarcated on the basis of derived stream channels. This study presents the effectiveness of DEM data for hydrological studies and introduces a better method of water management in Punjab province of Pakistan.
Design and Implementation on Patchouli Growth Environment Monitoring System Based on IoT
Authors: Li Guodong , Zhang Ping
Published: June 2021

With the development of the times, the concept of "interconnection of all things" has been deeply rooted in the hearts of people. As an early and developing Internet technology, the Internet of things(IoT) has shown its infinite potential in many fields of social life. In agriculture, the agricultural IoT is coverring a growing number of fields: greenhouse planting, climate factor collection, climate prediction and so on. Based on this idea, the design idea of "patchouli growth environment monitoring system" is put forward. In this paper, the medicinal plant "patchouli" is studied, and its medicinal value and growth factors are discussed. Meanwhile, based on zigbee technology, we design a set of feasible monitoring scheme including hardware and software. The hardware part used ZigBee wireless network design, mainly relies on the cc2530 chip and the esp8266 wifi chip to carry on the wireless distance transmission to the sensor data. It interacts between OneNET cloud server and mysql database through MQTT protocol, TCP/IP protocol and HTTP protocol.
Mobile dating applications and sexual and violent offending
Authors: Pooley Kamarah , Boxall Hayley
Published: June 2021

In the last few years, a number of high-profile cases of sexual and violent offending have been committed after the offender and victim met through a mobile dating application (dating app). Subsequent media and popular rhetoric have positioned dating app sexual and violent offending as a major safety concern. A literature review was conducted to determine the prevalence of dating app violence, the design features of dating apps that create and prevent opportunities for violence to occur, and the prevention strategies used by individual users and app designers. Results suggest that dating app users are at greater risk of sexual and violent victimisation than non-users. Dating app features designed to promote safety and connectedness paradoxically place users at risk of victimisation. Although some dating apps feature innovative safety mechanisms, most place the onus on users to protect themselves against victimisation. More research is needed to inform prevention and intervention efforts.
Factors Contributing to Industrial Conflicts within Higher Education Institutions in Lesotho: A Case of the National University of Lesotho
Authors: Mojalefa Mamoeletsi Limakatso
Published: June 2021

Incidences of industrial actions, which have frequently paralyzed learning at most of the educational institutions, are frequent in Lesotho. Despite the safeguards for collective bargaining in Lesotho, the incidences of industrial actions at higher institutions of learning in Lesotho are still common. The study was conducted to investigate the factors which contribute to industrial conflict at the National University of Lesotho. In order to gain a deeper understanding of the participants’ unionism experiences, semi-structured interviews were used to collect data. This study reveals that lack of transparency, inconsistent application of policies, lack of communication, lack of motivation, poor salaries, bias as well as poor working conditions are some of the factors that cause strikes at the institutions of higher learning in Lesotho.
A Day in the Life of the AMU– The Society for Acute Medicine’s Benchmarking Audit 2012 (SAMBA ‘12)
Authors:   Bangor University & Ysbyty Gwynedd Hospital Bangor, Wales, Subbe Christian P , Ward David ,   Queen Elizabeth Hospital, Woolwich, South London Healthcare NHS Trust, UK, Latip Lenny ,   Betsi Cadwaladr University Health Board, Bangor, UK, Le Jeune Ivan ,   Nottingham University Hospitals NUH Trust, Nottingham, UK, Bell Derek ,   Imperial College, London, UK
Published: June 2021

Background: The absence of published data for benchmarking serves as a disincentive for Acute Medical Units to improve care. Aim: To test feasibility of a national audit in Acute Medicine for compliance with common standards Methods: On line questionnaire with summary data for patients admitted to participating Acute Medicine Units over a 24-hour-period. Results: 30 units submitted summary data. The mean number of admission was 36 (SD 14). Compliance with standards around timing of junior and senior review was highly variable. In almost all other standards only a small number of units achieved high reliability with compliance of more than 90%. Conclusion: SAMBA provides a data set that can be used for local and national benchmarking and quality improvement work. Annual audit might be beneficial to track improvements.
The Ability of Frailty to Predict Outcomes in Older People Attending an Acute Medical Unit
Authors:   Leicester Royal Infirmary, Leicester, Conroy Simon , Dowsing Teresa ,   UK Association of Physician Associates
Published: June 2021

Background: This study assessed the role of frailty assessment in the AMU. Methods: Patients were assessed for frailty and their outcomes ascertained at 90 days. Results: The Canadian Study on Health and Aging Clinical Frailty Scale categorised 29% of patients as moderately-severely frail. Frailty did not differentially identify those likely to be discharged within one day, nor with long stays. Mortality at 90 days was 32%; frailty was associated with the risk of dying, odds ratio 1.4. 21% of patients were readmitted at 30 days, and 33% at 90 days, but frailty was not predictive. Discussion: Moderate-severe frailty in people aged 70+ was common and was predictive of higher mortality, but did not appear to predict admission, length of stay or readmission.
Performance of TOTAL, in medical patients attending a resource-poor hospital in sub-Saharan Africa and a small Irish rural hospital
Authors:   St. Joseph’s Kitovu Health Care Complex, Masaka, Uganda, Opio Martin Otyek , Nansubuga Gertrude ,   St. Joseph’s Kitovu Health Care Complex, Masaka, Uganda, Kellett John ,   Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark, Cliffor M , Murray Alan ,   Dundalk Institute of Technology, Dundalk, Ireland
Published: June 2021

Background: Recently a very simple, easy to remember early warning score (EWS) dubbed TOTAL has been reported. The score was derived from 309 acutely ill medical patients admitted to a Malawian hospital and awards one point for Tachypnea >30 breaths per minute, one point for Oxygen saturation <90%, two points for a Temperature <35°C, one point for Altered mental status, and one point for Loss of independence as indicated by the inability to stand or walk without help. TOTAL has an area under the receiver operator characteristic curve (AUROC) for death within 72 hours of 78%. Methods: We compared the performance of the TOTAL score in 849 medical patients attending a resource poor hospital in Uganda and 2935 patients admitted to a small rural hospital in Ireland. Results: TOTAL’s AUROC for death within 24 hours was the same in both hospital populations: 85.1% (95% CI 78.6 – 91.6%) for Kitovu Hospital patients and 84.7% (95% CI 77.1 – 92.2%) for Nenagh Hospital patients. Conclusion: The discrimination of TOTAL is exactly the same in elderly Irish patients as it is in young African patients. The score is easy to remember, easy to calculate, and works over a broad range of patients.
‘State of the Nation’ – The Society for Acute Medicine’s Benchmarking Audit 2013 (SAMBA ’13)
Authors:   Nottingham University Hospitals NUH Trust, Nottingham, UK, Le Jeune Ivan , Masterton-Smith Charlotte ,   St Thomas’ Hospital, London, Subbe Christian P ,   Bangor University & Ysbyty Gwynedd Hospital Bangor, Wales, Ward David ,   Queen Elizabeth Hospital, Woolwich
Published: June 2021

Background: Benchmarking is important to improve quality of care. Aim: To audit the performance of Acute Medical Units (AMUs) against the clinical quality indicators published by the Society for Acute Medicine (SAM). Methods: 24-hour data collection on the 20th of June 2013 with follow-up data at 72 hours. Results: 43 units submitted data on 1425 patients. 76% of patients had early warning scores recorded within 30 minutes of admission, 95% of patients had been seen by a competent decision maker within four hours. 79% of patients were seen by a consultant physicians within the appropriate period of time. Conclusion: The difference in compliance with quality standards between UK units opens opportunities for learning. The reasons why some units perform better than others require further investigation.
ST elevation in ECG lead aVR signals severe acute left main coronary artery disease
Authors:   Department of Cardiology, Northern General Hospital, Sheffield, Dastidar A Ghosh , Garg P ,   Department of Cardiology, Northern General Hospital, Sheffield, West JN ,   Department of Cardiology, Northern General Hospital, Sheffield, Muthusamy R ,   Department of Cardiology, Rotherham District General Hospital, Rotherham, Gunn JP ,   Department of Cardiovascular Science, University of Sheffield
Published: June 2021

Patients with suspected acute coronary syndrome are commonly assessed by acute physicians on arrival in hospital. Although most will recognise the typical ECG features of ST elevation myocardial infarction, the significance of ST elevation in lead aVR may not always be appreciated. This case series describes 6 cases in which this ECG abnormality was the predominant feature in patients whose subsequent angiogram revealed severe acute left main coronary artery disease. The importance of early referral of such patients to a centre in which percutaneous coronary intervention can be performed, is discussed.
Problem based review: A patient with Parkinson’s disease
Authors:   The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR, Arora Anshu , Fletcher Peter ,   FRCP (London) Cheltenham General Hospital Cheltenham
Published: June 2021

Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disease characterized by bradykinesia, tremor and/ or rigidity, often with gait disturbance and postural instability. In addition to these typical features, patients with PD may experience further problems related to the disease itself or to the medications used to treat it. These comorbid problems include neuropsychiatric conditions (including psychosis, hallucinations, excessive daytime sleepiness, anxiety, depression, fatigue and dementia) as well as problems associated with autonomic nervous system function such as bowel and bladder function. PD can also present in emergency situations with a ‘neuroleptic malignant like picture’ and acute psychosis. It is not uncommon to see motor fluctuations due to drug interactions and ‘withdrawal’ symptoms following dose reduction of dopamine agonists. In patients with PD, disturbances of mental state constitute some of the most difficult treatment challenges of advanced disease, often limiting effective treatment of motor symptoms and leading to increased disability and poor quality of life. While some of these symptoms may be alleviated by antiparkinsonian medication, especially if they are ‘off-period’ related, treatment-related phenomena are usually exacerbated by increasing the number or dosage of antiparkinsonian drugs. Elimination of exacerbating factors and simplification of drug regimens are the first and most important steps in improvement of such symptoms.
Trainee Update December 2012
Authors:   R Johnson, Johnson R , Conway Nerys ,   Society for Acute Medicine
Published: June 2021

It was great to see so many of you at SAM Glasgow back in October and we hope you enjoyed the conference and found it worthwhile. There were so many excellent sessions together with the opportunity to mix with acute medicine colleagues it’s hard to imagine anyone leaving without feeling positive.
Editorial
Authors:   Acute Medicine University Hospital Southampton Foundation Trust Tremona Road Mail Point 520 Southampton SO16 6YD UK, Roseveare Chris
Published: June 2021

Over the course of our careers we will see many thousands of patients, but there are one or two who we remember vividly; it is often these patients who shape and change our practice most. The problem-based review written by Kevin Jones’ team in Bolton in this edition reminded me of one of the first patients I clerked as a medical Senior House Off icer, while working in a District General Hospital back in the early 1990s. I was revising for the written part of the MRCP Part 2 examination at the time, so when the general practitioner described the young man’s fatigue, low grade fever and rash as ‘probable viraema’, my thoughts immediately turned to far more esoteric diagnoses. For once my suspicions were confirmed. The ‘fatigue’ was clearly proximal myopathy with marked tenderness suggesting a myositis; his rash had the typical ‘heliotrope’ distribution accompanied by nail-fold oedema; the diagnosis of dermatomyositis was sealed long before the consultant ward round when the laboratory phoned through his Creatinine Kinase result of over 15,000. I remember the feeling of elation at having made the diagnosis, the metaphorical pat on the back from my consultant and the look of relief in the eyes of the patient and his mother when I told them that we had the answer. I had no doubt in my mind that the hydrocortisone I had prescribed would rapidly improve his symptoms allowing him to resume his usual activity within a few weeks – I had read all about it in Kumar and Clark or some other erudite medical text book. For a few hours medicine was wonderful – until my cardiac arrest bleep went off. CPR was already in progress when I arrived on the ward; I had attended resuscitation calls before, but never for an 18 year old. A nurse reported that he had complained of dyspnoea and became drowsy shortly before he stopped breathing. There was a cardiac output, but no respiratory effort – he was intubated, ventilated, transferred to intensive care and then to a regional specialist unit, but sadly never regained consciousness before he died 2 weeks later. This was a tragic story which affected many people, but which taught me a really important lesson: making a diagnosis is where our job starts – not where it ends. We will never know whether we could have made any difference to this poor young man by anticipating a different outcome, closer monitoring of his respiratory function or earlier involvement of our critical care team. The speed of his deterioration was such that even today’s focus on early warning scoring and prompt recognition of changes in physiology, which has developed over the past 2 decades, would probably not have changed his outcome. However the key is to expect the unexpected; there are formes frustes of many conditions which behave differently to those which appear in the text books. Making a diagnosis should never be a cause for celebration.
The patient with Acute Muscular Weakness
Authors:   Acute Medicine Royal Bolton Hospital Bolton, Constable H , Wood F ,   Furness General Hospital Barrow in Furness Cumbria, Jones Kevin ,   Acute Medicine, Royal Bolton Hospital, Bolton
Published: June 2021

Proximal muscle weakness can present acutely or subacutely to the Acute Medical Unit. Early diagnosis of the underlying pathology is essential due to life threatening complications such as respiratory failure and cardiac disturbances as well as causing significant levels of disability. The diagnosis requires thorough history-taking and examination to discern evidence of true weakness, assess its onset, distribution and severity followed by extensive investigations including a CK level, which if high should raise suspicion of rhabdomyolysis. Assessment of respiratory function should be done promptly to identify patients with associated respiratory muscle weakness and treatment should not be delayed waiting for definitive and confirmatory investigations. Poor response to treatment is unusual when diagnosis is correct; this raises the possibility of an alternative diagnosis.
Trainee Update May 2014
Authors:   Society for Acute Medicine, Johnson R , Conway Nerys ,   Society for Acute Medicine
Published: June 2021

You may have seen in the Springspring newsletter that there was a plan to do a “virtual marathon” from Edinburgh to Brighton for this year’s AMAW using a GPS tracker App. However, this has now been changed back to same format as in previous years but you can arrange any event you like from parachute jumping to a cake stall. In order to register your AMAW event contact SAM via communications@ acutemedicine.org.uk.
Improving recognition and management of acute kidney injury
Authors:   Department of Acute Medicine, Northwick Park Hospital, Tsui A , Rajani C ,   Department of Acute Medicine, Northwick Park Hospital, Doshi R ,   Department of Acute Medicine, Northwick Park Hospital, De Wolff JF ,   Department of Acute Medicine, Northwick Park Hospital, Tennant R ,   Department of Acute Medicine, Northwick Park Hospital, Penn H ,   Department of Acute Medicine, Northwick Park Hospital, Duncan N ,   Department of Acute Medicine, Northwick Park Hospital
Published: June 2021

Acute kidney injury (AKI) is currently suboptimally recognised and managed in the UK, despite its association with significant patient morbidity, mortality and consequent implications for healthcare economics. Our prospective study, performed in a large urban London hospital, demonstrated that the introduction of a specially designed care bundle can significantly improve documentation of baseline creatinine, assessment and optimisation of fluid status, performance of urine dip, withholding of nephrotoxic drugs, appropriate monitoring of urine output, prescription of renal drug doses, and appropriate consideration of a renal ultrasound and urinary protein-creatinine ratio. Improved compliance of appropriate investigations and initial treatments translated to decreased requirement for intensive care admission and a trend towards shorter length of stays.
Lumbar Punctures in the Acute Medicine Department: indications and evaluation of use
Authors:   Heart of England NHS Foundation Trust, Birmingham, D’Cruz Rebecca FM , Dev Vellore Arun ,   Heart of England NHS Foundation Trust, Birmingham
Published: June 2021

Aims: • Evaluate the use of lumbar puncture (LP) in the Acute Medical Department of a typical urban district general hospital. • Increase the proportion performed on appropriate patients. Methodology: An observational, single-centre, retrospective examination of patients undergoing LP at Solihull Hospital over four consecutive months. Discussion of findings and LP indications with the Acute Medicine Department. Re-audit over four months. Results: Total LPs performed fell by 65%. The proportion performed on patients presenting with red flags rose by 19% (p=0.0098). The proportion that yielded positive findings rose by 33% (p<0.0001). 72% of patients with red flags had negative LP. Conclusions: Awareness of indications and observation of practice reduces total LPs performed and increases the proportion performed on appropriate patients.
Problem based review: The Pregnant Woman Presenting to the AMU with Palpitations
Authors:   The Queen Elizabeth Hospital, King’s Lynn NHS Foundation Trust, UK, Middleton Danielle , Aljuboori Saba ,   Obstetrics and Gynaecology, Norfolk and Norwich University Hospitals NHS Foundation Trust, UK, Banerjee Anita ,   Diabetes and Endocrinology Department, Guys and St Thomas’ NHS Foundation Trust, Altemimi Harith ,   The Queen Elizabeth Hospital, King’s Lynn NHS Foundation Trust, UK, Nelson-Piercy Catherine ,   Guy’s and St. Thomas’ NHS Foundation Trust, UK
Published: June 2021

Pregnant patients commonly present to the acute medical team with symptoms requiring further investigation. Palpitations are a common reason for presentation on the acute medical take, and most acute physicians will be familiar with the process of investigation. The combination of pregnancy and palpitations raises a broad differential diagnosis and can complicate the management pathway. This problem based review is designed to summarise the key issues which may arise during the management of a typical patient presenting in this way.
Does admission via an Acute Medical Unit influence hospital mortality? 12 years’ experience in a large Dublin Hospital
Authors:   St James’s Hospital, Dublin 8, Ireland., Coary Roisin , Byrne Declan ,   St James’s Hospital, Dublin 8, Ireland., O’Riordan Deirdre ,   St James’s Hospital, Dublin 8, Ireland., Conway Richard ,   St James’s Hospital, Dublin 8, Ireland., Cournane Seán ,   St James’s Hospital, Dublin 8, Ireland., Silke Bernard ,   St James’s Hospital, Dublin 8, Ireland.
Published: June 2021

Background: Following an emergency medical admission, patients may be admitted an acute medical assessment unit (AMAU) or directly into a ward. An AMAU provides a structured environment for their initial assessment and treatment. Methods: All emergency admissions (66,933 episodes in 36,271 patients) to an Irish hospital over an 12-year period (2002-2013) were studied with 30-day in-hospital mortality as the outcome measure. Univariate Odds Ratios, by initial patient allocation, and the fully adjusted Odds Ratios were calculated, using a validated logistic regression model. Results: Patients, by design, were intended to be admitted initially to the AMAU (<= 5 day stay). Capacity constraints dictated that only 39.8% of patients were so admitted; the remainder bypassed the AMAU to a ward (60.2%). All patients remained under the care of the admitting consultant/team. We computed the risk profile for each group, using a multiple variable validated model of 30-day in-hospital mortality; the model indicated the same risk profile between these groups. The univariate OR of an in-hospital death by day 30 for a patient initially allocated to the AMAU, compared with an initial ward allocation was 0.76 (95% CI: 0.71, 0.82- p<0.001). The fully adjusted risk for patients was 0.67 (95% CI: 0.62, 0.73- p<0.001). Conclusion: Patients, with equivalent mortality risk, allocated initially to AMAU or a more traditional ward, appeared to have substantially different outcomes.
The Perils Of Grandma’s Medication: Colchicine Toxicity causing Pneumomediastinum.
Authors:   Departments of Acute Medicine and Radiology, University Hospital of South Manchester, Manchester, Shuttleworth Elinor , Sawyer Richard ,   Departments of Acute Medicine and Radiology, University Hospital of South Manchester, Manchester, Holland Mark ,   Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, United Kingdom, Cooksley Timothy ,   Acute Medicine Department of Acute Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL
Published: June 2021

A 19 year old male presented with a deliberate overdose of colchicine (50mg). He had no other significant medical history. 36 hours following admission he developed widespread surgical emphysema. An urgent CT scan of his chest and abdomen demonstrated mediastinal gas of lung origin. He also developed bone marrow suppression and disseminated intravascular coagulopathy. He was treated supportively with intravenous fluids, high flow oxygen and intravenous antibiotics and made a full recovery. Colchicine toxicity is a rare, but important presentation with high levels of morbidity and mortality. Pneumomediastinum is a potentially important complication. It may be appropriate to monitor patients in the later stages of the condition through an ambulatory setting.
Weil’s disease presenting as atypical pneumonia
Authors:   Department of Internal Medicine, Singapore General Hospital, Balakrishnan Tharmmambal , Moore Alice ,   Chelsea and Westminster Hospital, Krishnamoorthy Sanjay ,   Chelsea and Westminster Hospital, Davies Gary ,   Chelsea & Westminster Hospital, Lee Philip Ka Ho ,   Chelsea and Westminster Hospital Honorary Senior Clinical Lecturer – Imperial College London
Published: June 2021

Leptospirosis is a disease caused by spp. Leptospira, also known as Weil’s disease if it manifests with jaundice. It can be associated with respiratory, renal, hepatic and haematological complications and most importantly carries a high mortality when untreated. We describe a case of a 53 year old man presenting with myalgia and fever in whom the diagnosis of leptospirosis was not initially considered. Following a deterioration in his condition a careful history revealed an apparent brief exposure to animal urine and subsequent grossly positive Leptospira serology. Treatment of his condition led to complete resolution after a brief stay on the intensive care unit. This case highlights the atypical nature of a presentation of Leptospirosis, its respiratory complications, and importance of serological testing in its diagnosis.
Correspondence
Authors:   Acute Medicine and Infectious Diseases Nottingham University Hospitals Nottingham NG5 1PB, Hart Elizabeth
Published: June 2021

Dear Editor I was disappointed to read, in the case scenario of a recent article regarding the investigation of a patient with polyarthritis 1 that a patient was not offered an HIV test despite there being clinical indication. The reason given was the absence of risk factors.
Trends in weighted vital signs and the clinical course of 44,531 acutely ill medical patients while in hospital
Authors:   Hospital of South West Jutland, Esbjerg, Denmark, Kellett John , Murray Alan ,   Dundalk Institute of Technology, Dundalk, Ireland, Woodworth Simon ,   Health Information Systems Research Center, University College Cork, Ireland, Huang Wendy ,   Department of Mathematical Sciences, Lakehead University, Thunder Bay, Ontario, Canada
Published: June 2021

Background: little is known about the changes and trends of individual vital signs during the course of acute illness in hospital. Methods: the weighted points of the VitalPAC Early Warning Score (ViEWS) were assigned to each vital sign value measured on 44,531 acutely ill medical patients while they were hospitalized in the Thunder Bay Regional Health Sciences Centre, Ontario, Canada. These ViEWS weighted vital signs were averaged for every 24 hour period for five days after admission and five days before death or discharge and then combined to obtain an approximation of the trajectory of each vital sign while in hospital. Results: compared with the other vital signs, the ViEWS weighted points for respiratory rate increase the most in patients who died in hospital and decrease the most in survivors. Combining respiratory rate with the weighted points for any of the other vital signs reduced rather than increased their monitoring performance. Conclusion: trends in respiratory rate, measured by observation at the bedside and given a ViEWS weighting is the best predictor of clinical outcome; minor changes predicted clinical outcome several days in advance.
Sepsis on the AMU – Time to Pick up the Baton
Authors:   Department of Acute Medicine, Royal Hampshire County Hospital, Hampshire Hospitals NHS Trust, Inada-Kim Matthew , Viswesvaraiah Guhavarma ,   Department of Acute Medicine, Royal Hampshire County Hospital, Hampshire Hospitals NHS Trust
Published: June 2021

Clinical diagnoses of sepsis that relate to bacterial infection were responsible for 650,000 admissions and 55,000 deaths in English hospitals last year. The vast majority of these patients are admitted to acute medicine units (AMUs) via Emergency Departments (EDs). AMUs and EDs are the areas where the biggest improvement in patient outcomes can be made, with better integrated, standardized and collaborative systems focused on early recognition, expedient intervention and senior review.