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Only patients with a hip fracture undergoing surgery were included in the study. Our study findings therefore only reflect the delivered quality of care and the outcome among these patients and cannot be used to draw conclusions for the total population of hip fracture patients (e.g. patients with a hip fracture that for some reason did not present to the hospital, who were not eligible for a surgical procedure or who died before their surgery). This study was dependent on the validity of the registries used. The Danish registries are, in general, well documented and extensive effort is made to ensure the validity [ 25 , 26 ]. Furthermore, any misclassification of data would most likely be independent of time of admission.

To our knowledge, no prior studies examined the association between time of admission and process performance measures for hip fracture care.

Our primary analyses showed that patients admitted during off-hours had a lower risk of surgical delay than patients admitted on-hours. However, additional analyses clarified that this effect was driven by results for patients admitted on weekday evening and night shifts. In contrast, the patients admitted during weekends had a higher risk of surgical delay than those admitted during weekdays. Our results conflicted with findings from some previous studies on surgical delay. Two studies reported a higher risk of delay for patients admitted Thursdays to Sundays [ 17 , 18 ]; and one study reported a lower risk of delay for patients admitted Saturdays and Sundays [ 23 ]. The general organization of Danish orthopaedic hospital units may explain our finding that patients admitted on weekday evenings and nights had a lower risk of delay, because outpatient functions and elective surgery are limited to daytime shifts on weekdays. Thus, some organizational resources could be released during evenings and nights to facilitate the care pathway that leads to surgery. This possible explanation would not apply to our findings that patients admitted during weekends had a higher risk of delay (primarily driven by the year 2013). Further examination is required to clarify this particular finding. Scientific evidence on the effect of delay on prognosis after hip fracture surgery has not been fully clarified; however, there appears to be a broad consensus among clinicians about the benefits of early surgery, specifically regarding patients without complications or severe comorbidities [ 34–38 ].

Overall, we found that the risk of dying within 30 days after admission was equivalent for all patients with hip fractures, regardless of the time of admission. However, in the additional analyses, we found higher 30-day mortality among patients admitted during weekends; this finding remained unexplained after adjusting for patient, hospital and surgical delay covariates. The effect was primarily driven by observations during the two earliest years in the study period, and thus the effect may tend to diminish over time. Nevertheless, follow-up on the found weekend-effect on mortality is highly relevant. First of all, it should be examined whether the effect is still present, or if we do in fact see the effect mitigate. Secondly and importantly, the underlying causes for the weekend-effect should be examined. In our study, the effect remained unaffected by adjustment for patient and hospital characteristics and surgical delay, and was not explained by differences in the provided early care as reflected by the assessed performance measures. Still, other patient level prognostic factors, as well as possible organizational differences (e.g. altered staffing levels and availability of senior physicians), between weekdays and weekends could be causing the variation in mortality found in this study and further clarification is required. Our primary result was consistent with the majority of findings in studies of off-hours admissions and short-term mortality among patients with hip fractures [ 4 , 19 , 20 , 22 ]. Similarly, a previous Danish study by Daugaard et al . [ 21 ] found no excess mortality risk for patients admitted during off-hours. In contrast, another Danish study by Foss and Kehlet [ 15 ] found increased risks of 5- and 30-day mortality among patients admitted during long holiday periods. The discrepancy between those studies may be explained by differences in study populations. Our study and the study by Daugaard et al . were based on all Danish patients undergoing hip fracture surgery during the respective study periods, whereas the study of Foss and Kehlet was based on data from a single Danish hospital unit.

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Time for primary review 27 days.

This review concentrates on the function, molecular determinants and pharmacology of ion channels that reside in the sarcolemma and that contribute to the distinct phases of the altered transmembrane action potentials of myocytes surviving in the infarcted heart. The discussion will be divided into two general categories. First, substrate findings will be discussed and linked to the time course of arrhythmias as they are known to occur in experimental myocardial infarction models. This section will be followed by a discussion of the ion channel changes in myocytes remote from the infarct area, that is, in areas of regional hypertrophy. Finally, what is known about the molecular determinants of ion channels of myocytes from these diseased hearts is presented.

Various arrhythmic phases occur after the onset of experimentally produced myocardial ischemia and infarction in animal hearts. Current hypotheses maintain that the mechanisms of some of these cardiac arrhythmias can be understood in terms of the alterations in cellular electrical activity in specific regions of the heart post myocardial infarction (MI) (see [1] ). For example, in hearts of large animals, acute coronary artery occlusion results in rapid ventricular arrhythmias (ventricular tachycardias and fibrillation) (acute phase). It is unlikely that chronic or persistent changes in ion channel function underlie these acute arrhythmias. Over the following 24–48 h (subacute phase of infarction) post occlusion, delayed spontaneous arrhythmias of ventricular origin (subendocardial Purkinje) occur in experimental models and may have counterparts in humans [2–4] . During the healing (days, weeks) or healed (months) infarct phase, sustained ventricular tachycardias are inducible in both animal and human hearts suggesting that the reentrant substrate is present. The site of origin of the ventricular arrhythmias in these hearts depends on the location of the surviving cells overlying the infarcted region. In one canine model, these reentrant arrhythmias have been mapped to an area described as the epicardial border zone [1] .

Numerous studies have described the specific changes in action potential (AP) configuration that occur in the canine subendocardial Purkinje fiber and the subepicardial ventricular fiber postcoronary artery occlusion. Generally, by 24–48 h after total coronary artery occlusion the APs of the subendocardial Purkinje fibers show reduced resting potentials and maximal action potential upstroke velocity (V̇ max ), as well as an increase in total time of repolarization. On the other hand, the cells of the epicardial border zone of the canine infarction model show a reduction in V̇ max , and a shortening and triangularization of the action potential by 5 days after total artery occlusion. By 14 days post occlusion further shortening of the AP occurs. Then by the time of the healed infarct (2 months), AP voltage profiles have returned to nearly normal [5] suggesting the presence of a process that might be termed ‘reverse remodeling’ ( Fig. 1 ). In addition, changes in conduction of the impulse at various times after coronary artery occlusion as well as the altered refractoriness of the tissue in the infarcted myocardium have been documented. Electrical changes at the level of the myocyte and the role they play in providing the substrate for inducible reentrant arrhythmias have been reviewed [1] .

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Posted under: Education

This 11-Year-Old Co-Organized A Walkout At Her Elementary School Adding 1 Minute To Honor Courtlin Arrington And Other Black Women Victims

"I think...that specifically African-American women, when they are shot and killed, or when they are killed in general, their names aren’t remembered. So I thought it would be important to add an extra one minute."

Kimberley Richards
• 4 months ago
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Photo Credit: Lois Beckett/Twitter

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Students at schools across the country participated in a national 17-minute walkout to honor the 17 victims from the mass shooting at Marjory Stoneman Douglas High School in Parkland, Florida, on Wednesday morning. Naomi, an 11-year-old student in Alexandria, Virginia, co-organized a walkout adding one minute to also honorCourtlin Arrington, a black teen girl killed last week at her high school inBirmingham, Alabama.

According to reporting by Guardian senior reporter Lois Beckett on Twitter, Naomi and her classmate Carter organized a walkout for Wednesday morning at their elementary school, George Mason Elementary. They thought it would be important to add one minute to the nationally planned 17-minute walkout to include Arrington.

In a QA, Naomi told the Guardian that it's particularly important to change the walkout to 18 minutes since black women victim's names are often not remembered.

"I think, well specifically me, I don’t know what Carter thinks, that specifically African-American women, when they are shot and killed, or when they are killed in general, their names aren’t remembered," she said. So I thought it would be important to add an extra one minute."

Carter, 11, who helped organize the walkout with Naomi, told Beckett that, "everyone thought it would be a good idea,' to add one minute to the walkout. He also added, "[Arrington] was studying to be a nurse. She could have saved people's lives."

Arrington died in a fatal shooting last Wednesday atHuffman High School in Birmingham. Arrington was set to graduate in May and was already accepted into a college, AL.com reported. Friends and family say the teen victim had plans to become a nurse.

Birmingham City Schools Superintendent Lisa Herring said Arrington was one of the district's "brightest and best scholars," AL.comreported.

"We have lost one of our brightest and best scholars, Courtlin Arrington, to senseless gun violence," she said. "She was energetic, friendly and well-liked by peers and teachers alike. We have more than 23,000 students at Birmingham City Schools, and when one of them is harmed, all are impacted."

The elementary students at George Mason remained silent while they held posters outside during their walkout. At one point, they were lying down on the grass as parents nearby watched, Beckett tweeted.

Our future is looking bright!

Naomi is 11. She is organizing a school walkout next week at her elementary school in Alexandria, Virginia. She said her principal is not sure that the walkout is “safe” for the students, and that this attitude is “completely unacceptable.” pic.twitter.com/Cdi8Yhzpkf

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