bluuebunny/crossref_metadata_2025 huggingface dataset:
American options in an imperfect complete market with default
Authors: Dumitrescu Roxana , Quenez Marie-Claire , Sulem Agnès
Published: November 2018

We study pricing and hedging for American options in an imperfect market model with default, where the imperfections are taken into account via the nonlinearity of the wealth dynamics. The payoff is given by an RCLL adapted process (ξt). We define the seller's price of the American option as the minimum of the initial capitals which allow the seller to build up a superhedging portfolio. We prove that this price coincides with the value function of an optimal stopping problem with a nonlinear expectation 𝓔g (induced by a BSDE), which corresponds to the solution of a nonlinear reflected BSDE with obstacle (ξt). Moreover, we show the existence of a superhedging portfolio strategy. We then consider the buyer's price of the American option, which is defined as the supremum of the initial prices which allow the buyer to select an exercise time τ and a portfolio strategy φ so that he/she is superhedged. We show that the buyer's price is equal to the value function of an optimal stopping problem with a nonlinear expectation, and that it can be characterized via the solution of a reflected BSDE with obstacle (ξt). Under the additional assumption of left upper semicontinuity along stopping times of (ξt), we show the existence of a super-hedge (τ, φ) for the buyer.
Evaluation of long-term effect of pedestrian signage with time travel indication in Grenoble city (France)
Authors: Borowik Anna , Tessier Damien , Guinot Michel , Flore Patrice
Published: November 2018

Background:French population does not achieve recommended physical activity (PA) level. Promoting walking as an active transport mode through urban environment is a recommended strategy to maintain health. This study assessed long-term effect (1 year) of pedestrian signage in the city of Grenoble (France). The first part of our study focused on the attendance of general population living in Grenoble on two important crossroads in a neighborhood equipped with pedestrian signage. The second one studied the receptiveness to this signage of low to moderate socioeconomic status Grenoble citizens living in this neighborhood. In addition, we tried to evidence the potential impact of this signage in the latter population in term of walking activity, cardiometabolic health and motivation toward PA.Methods:For the first part of the study, we compared the attendance (number of passages manual counting) in Grenoble general population on 2 crossroads in a neighborhood equipped with signage (PSN) with 2 crossroads of a similar neighborhood not equipped (CN). For the second part of the study, we planned to specifically recruit 140 subjects (electoral lists, brochures, phone calls and mailing) in these two neighborhoods (pedestrian signage group: PSG; control group: CG). These subjects were proposed to participate in a follow-up of their health during one year. We asked if they have seen the pedestrian signage and compared these groups on daily steps number (pedometer), cardiometabolic risk (SCORE) and motivation toward PA (Self-Regulation Questionnaire for exercise) over one year period.Results:For the first part of the study, the attendance slightly increased between June and December (effect size: 0.5;p < 0.05) in PSN suggesting a transitory effect of the signage in general population. For the second part, only forty-two subjects (22 in PSG and 20 in CG) accepted to participate in this study. We failed to include low to moderate socio-economic citizens. Seventy percent of the recruited subjects did not see the pedestrian signage. This sample did not change its walking activity level, cardiometabolic risk as well as PA motivation.Conclusion:On the basis of attendance study, such a pedestrian signage might be incentive to increase PA in general population but this needs confirmation. The effects of a larger specific communication associated with this urban environment targeting particular population groups deserve to be studied.
Atemwegsmanagement in der Kinderanästhesie: Anwendung von Materialien und Methoden
Authors: Krebs Martin , Müller-Lobeck Lutz , Francis Roland
Published: November 2018

Das Atemwegsmanagement stellt eine Kernkompetenz des klinisch tätigen Anästhesisten dar. Insbesondere bei der Versorgung von pädiatrischen Patienten ist die sichere Anwendung entsprechender Materialien, Methoden und Abläufe für die Atemwegssicherung essenziell. Der wissenschaftliche Arbeitskreis Kinderanästhesie der DGAI (WAKKA) hat 2011 eine Handlungsempfehlung für das Management des unerwartet schwierigen Atemweges herausgegeben. Die Handlungsempfehlung für den erwartet schwierigen Atemweg ist aktuell als Entwurf auf der Seite des WAKKA abrufbar. Für die richtige Anwendung von Materialien und Methoden des Atemwegsmanagements benötigt man Kenntnisse über verfügbare Hilfsmittel und deren korrekte Verwendung, sowie Übung in ihrer Anwendung. Diese Übersichtsarbeit stellt eine Auswahl von Materialien und Methoden vor, die in den Handlungsempfehlungen zum Atemwegsmanagement empfohlen werden.
Mit klinischer Elektrophysiologie hinter die Netzhaut
Authors: Hoffmann Michael , Heinrich Sven , Thieme Hagen , Al-Nosairy Khaldoon
Published: November 2018

Elektrophysiologische Ableitungen von Netzhaut und Kortex sind zielführend, um auch postretinale Schädigungen im Rahmen ophthalmologischer und neuroophthalmologischer Diagnostik aufzudecken. Dabei dienen Musterelektroretinogramme (PERG) der Überprüfung der retinalen Ganglienzellen und visuell evozierte Potenziale (VEP) der Überprüfung der Sehbahn in ihrer Gesamtheit. Sie unterstützen damit die objektive Funktionsüberprüfung der Sehbahn sowie die Differenzialdiagnostik. Während konventionelle elektrophysiologische Verfahren nur bedingt geeignet sind, lokale gesichtsfeldspezifische Defekte aufzudecken, ist dies die Domäne der multifokalen Elektrophysiologie. Diese ermöglicht eine ortsaufgelöste Beurteilung mit dem multifokalen PERG (mfPERG) und dem multifokalen VEP (mfVEP) bis hin zur objektiven Gesichtsfeldtestung mit dem mfVEP. Entscheidend für den erfolgreichen Einsatz dieses Methodenspektrums ist allerdings die Berücksichtigung möglicher Störfaktoren bei der Durchführung der Messungen und bei der Interpretation der Ergebnisse. Dies wird im vorliegenden Artikel anhand einer Reihe typischer Anwendungsbeispiele verdeutlicht.
Gastroesophageal Reflux in Asymptomatic Patients with Diabetes: An Impedance Study Diabetes, Obesity and Gastroesophageal Reflux
Authors: Gokturk Suut , Akyuz Filiz , Arici Serpil , Alpaslan Busra , Ormeci Asli , Soyer Ozlem Mutluay , Evirgen Sami , Cavus Bilger , Uzum Ayse Kubat , Gul Nurdan , Akyuz Umit , Karaca Cetin , Demir Kadir , Kaymakoglu Sabahattin , Satman Ilhan , Besisik Fatih
Published: November 2018

Introduction Gastroesophageal reflux disease (GERD) is more frequent in patients with diabetes mellitus (DM).The aim of the present study was to evaluate gastroesophageal reflux (GER) in asymptomatic patients with DM using 24-h pH impedance.

Materials and Methods 19 healthy controls and 35 patients with DM without typical GERD symptoms were enrolled in the study. A 24-h pH-impedance study, esophageal manometry and gastroscopy were performed on all patients with DM. In the control group, an impedance study was performed on all subjects, and gastroscopy and esophageal manometry were performed on those who consented to the procedures. Patients with diabetes were categorized as obese [body mass index (BMI)>30 kg/m2] or non-obese (BMI<30 kg/m2) and both groups were compared with healthy controls.

Results The mean BMI was similar in the control group (27.3±2.6 kg/m2) and the diabetic group (28.7±5 kg/m2) (p>0.05).Erosive esophagitis was found in 7.5% of the DM group. Esophageal dysmotility was higher in diabetics compared to the control group (45.5 vs. 11%, p=0.04). Neuropathy was found to be an independent risk factor for dysmotility. The mean DeMeester score (DMS) (25.6±32.5 vs. 11.2±17, p=0.01) and bolus exposure time (2.1±1.3 vs.1.3±1.3 min, p=0.009) were higher in the DM group compared with the control group.The difference was mainly observed between obese diabetics and the control group (p<0.05). The mean DMS, pathologic acid reflux, and esophageal dysmotility rate were higher in patients without complications of DM (p<0.05). BMI was higher in these patients than in patients with complications.

Conclusion Acid reflux is common in patients with diabetes.GER is associated with the existence of obesity rather than hyperglycemia.
Palladium-Catalyzed Coupling Reactions on Functionalized 2-Trifluoromethyl-4-chromenone Scaffolds: Synthesis of Highly Functionalized Trifluoromethyl Heterocycles
Authors: Izquierdo Javier , Jain Atul , Abdulkadir Sarki , Schiltz Gary
Published: November 2018

The chromenone core is an ubiquitous group in biologically active natural products and has been extensively used in organic synthesis. Fluorine-derived compounds, including those with a trifluoromethyl group (CF3), have shown enhanced biological activities in numerous pharmaceuticals compared with their non-fluorinated analogues. 2-Trifluoromethylchromenones can be readily functionalized at the 8- and 7-positions, providing chromenones cores of high structural complexity, which are excellent precursors for numerous trifluoromethyl heterocycles.
Immune and Antioxidant Enzyme Response of Longfin Yellowtail (Seriola rivoliana) Juveniles to Ultra-diluted Substances Derived from Phosphorus, Silica and Pathogenic Vibrio
Authors: Mazón-Suástegui José , Salas-Leiva Joan , Teles Andressa , Tovar-Ramírez Dariel
Published: November 2018

Background This research aimed to observe the effect of homeopathic treatments prepared from Vibrio parahaemolyticus and V. alginolyticus (H1) and commercial homeopathic medication Phosphoricum acidum and Silicea terra (H2) on the immune and antioxidant response in Seriola rivoliana juveniles under usual culture conditions and challenged with V. parahaemolyticus.

Materials and Methods Quantitative polymerase chain reaction analysis was used to study changes in the expression of key genes related to immune response, cytokines (interleukin-1β [IL-1β]), adapter protein for cytokine release (MyD88) and piscidin and spectrophotometric techniques to analyze the activity of antioxidant superoxide dismutase (SOD) and catalase (CAT) enzymes in Seriola rivoliana juveniles at 30 (weaning stage [WS]) and 60 (early juveniles [EJ]) days post-hatching.

Results The H1 treatment led to over-expression of the IL-1β and MyD88 genes in fish at WS and EJ with respect to control, contrary to the H2 treatment that led to under-expression of the IL-1β, MyD88 and piscidin genes at the EJ stage. In fish challenged with V. parahaemolyticus, both H1 and H2 led to over-expression of IL-1β and MyD88; H2 caused an over-expression of piscidin. The SOD activity was higher in H1 with respect to H2 and the control group. CAT remained relatively stable with both H1 and H2 treatments.

Conclusions The results suggest that the overall effect of H1 was due to the presence of unknown antigens in low concentrations, while the response to H2—specifically during challenge—may have been due to a stimulating effect of nano-structures, prevailing from mother tincture after sequential dilution/succussion, in a pathway similar to that attributed to nano-vaccines.
Peritoneal Tuberculosis in Infants: Diagnostic Challenges
Authors: Ndoye Ndeye , Mbaye Papa , Tendeng Jacques , Cissé Lissoune , Diao Mamadou , Dieng Mactar , Gueye Doudou , Niang Dibor , Ndour Oumar , Ngom Gabriel
Published: November 2018

Abdominal tuberculosis is rare in immunocompetent infants. We report on two infants with peritoneal tuberculosis (6 and 8 months) who underwent laparotomy for suspected intussusception. In the first patient, characteristic lesions of peritoneal tuberculosis were observed intraoperatively with presence of multiple granulations. Tuberculin intradermal reaction (IDRt) was positive and tuberculous contagium could be cultured. In the second patient, the IDRt and GeneXpert tests were negative. In both patients, the histopathological examination of the biopsy specimens confirmed the diagnosis of peritoneal tuberculosis. The clinical courses under tuberculostatic therapy were favorable in both cases.
Simulating vibronic spectra via Matsubara-like dynamics: Coping with the sign problem
Authors: Karsten Sven , Ivanov Sergei D. , Bokarev Sergey I. , Kühn Oliver
Published: November 2018

Measuring vibronic spectra probes dynamical processes in molecular systems. When interpreted via suitable theoretical tools, the experimental data provides comprehensive information about the system in question. For complex many-body problems, such an approach usually requires the formulation of proper classical-like approximations, which is particularly challenging if multiple electronic states are involved. In this work, we express the imaginary-time shifted time correlation function and, thus, the vibronic spectrum in terms of the so-called Matsubara dynamics, which combines quantum statistics and classical-like dynamics. By applying the Matsubara approximation in the adiabatic limit, we derive a formal generalization of the existing Matsubara dynamics formalism to multiple potential energy surfaces (PESs), which, however, does not feature all the defining properties of its single-PES counterpart though suffering equally from the sign problem. The mathematical analysis for two shifted harmonic oscillators suggests a new modified method to practically simulate the standard correlation function via Matsubara-like dynamics. Importantly, this modified method samples the thermal Wigner function without suffering from the sign problem and yields an accurate approximation to the vibronic absorption spectrum, not only for the harmonic system but also for the anharmonic one.
Multi-channel averaging detection for fast imaging of weakly absorbing defects in surface thermal lensing
Authors: Dong Jingtao , Lu Rongsheng , Zhang Tengda , Yang Lei , Zhang Yuzhong , Wu Zhouling , Chen Jian
Published: November 2018

Surface thermal lensing (STL) is a high sensitive pump-probe technique for photothermal characterization of weakly absorbing defects in optical materials. Commonly, the frequency modulation is applied in the pump beam, and the STL signal that appears as small modulation on top of an intense background is then detected on the probe beam by lock-in amplification. However, the lock-in detection by filtering the signal in the frequency domain results in low efficiency in the STL, preventing investigations of the large area surfaces. Here it is shown that the multi-channel averaging, which corresponds to temporal integration, is better suited for detection of the STL signal. It is demonstrated that by converting the conventional single-point scanning STL to the line scanning STL and employing suitable width of the time bins and the number of records, the imaging speed of the multi-channel averaging detection can be improved by a factor of 3.7 relative to the lock-in detection at the same signal-to-noise ratio of 6 dB and imaging resolution of 20 μm. Therefore, high-quality photothermal images of weakly absorbing defects can be recorded with higher efficiency and lower laser irradiance, making it possible to investigate large samples.
Space qualified microwave source for cold atom clock operating in orbit
Authors: Li Tang , Huang Junchao , Qu Qiuzhi , Wang Bin , Li Lin , Ren Wei , Shi Wei , Zhao Jian-Bo , Zhao Xin , Ji Jing-Wei , Ye Mei-Feng , Yao Yuan-Yuan , Lü Desheng , Wang Yu-Zhu , Chen Wei-Biao , Liu Liang
Published: November 2018

The space cold atom clock (CAC) suffers more degradation of frequency stability from the local oscillator noise compared with fountain clocks operating on the ground because of the larger dead time of the clock cycle. Therefore, low phase noise is required for the microwave source of the space CAC in addition to robustness, compactness, and adaptability to the space environment. This paper presents the design and measurements of a low-phase-noise space qualified microwave source for the cold atom clock experiment in space CAC operating in the Tiangong-2 Chinese space laboratory. At frequencies near the carrier, a phase noise level of 10−6.7 × f−1.5 rad2/Hz (f is the Fourier frequency) is achieved. This guarantees a frequency stability of 1.4 × 10−13 τ−1/2 (τ is the average time in seconds) for the typical space CAC operation cycle.
A Luneburg lens for spin waves
Authors: Whitehead N. J. , Horsley S. A. R. , Philbin T. G. , Kruglyak V. V.
Published: November 2018

We report on the theory of a Luneburg lens for forward-volume magnetostatic spin waves and verify its operation via micromagnetic modelling. The lens converts a plane wave to a point source, and vice versa, by a designed graded refractive index, realized by modulating either the thickness or the saturation magnetization in a circular region. We find that the lens enhances the wave amplitude by about 5 times at the lens focus, and 47% of the incident energy arrives in the focal region. A lens with small deviations from the optimal profile can still result in good focusing if the index is graded smoothly.
Phase-field method for epitaxial kinetics on surfaces
Authors: Posthuma de Boer Joel , Ford Ian J. , Kantorovich Lev , Vvedensky Dimitri D.
Published: November 2018

We present a procedure for simulating epitaxial growth based on the phase-field method. We consider a basic model in which growth is initiated by a flux of atoms onto a heated surface. The deposited atoms diffuse in the presence of this flux and eventually collide to form islands which grow and decay by the attachment and detachment of migrating atoms at their edges. Our implementation of the phase-field method for this model includes uniform deposition, isotropic surface diffusion, and stochastic nucleation (in both space and time), which creates islands whose boundaries evolve as the surface atoms “condense” into and “evaporate” from the islands. Computations using this model in the submonolayer regime, prior to any appreciable coalescence of islands, agree with the results of kinetic Monte Carlo (KMC) simulations for the coverage-dependence of adatom and island densities and island-size distributions, for both reversible and irreversible growth. The scaling of the island density, as obtained from homogeneous rate equations, agrees with KMC simulations for irreversible growth and for reversible growth for varying deposition flux at constant temperature. For reversible growth with varying temperature but constant flux, agreement relies on an estimate of the formation energy of the critical cluster. Taken together, our results provide a comprehensive analysis of the phase-field method in the submonolayer regime of epitaxial growth, including the verification of the main scaling laws for adatoms and island densities and the scaling functions for island-size distributions, and point to the areas where the method can be extended and improved.
Mode Grüneisen parameters of an efficient thermoelectric half-Heusler
Authors: Pang Hong-Jie , Chen Liu-Cheng , Cao Zi-Yu , Yu Hao , Fu Chen-Guang , Zhu Tie-Jun , Goncharov Alexander F. , Chen Xiao-Jia
Published: November 2018

Half-Heusler compounds have recently been identified as promising thermoelectric materials, but their relatively high thermal conductivities impede the further improvement of thermoelectric performance. The knowledge of phonon vibrational properties provides a fundamental understanding of the thermal transport behavior of solids and thus could serve as a guidance on further suppressing the thermal conductivity. Herein, a highly efficient p-type half-Heusler thermoelectric alloy FeNb0.8Ti0.2Sb is taken as an example to explore its phonon vibrational properties. Phonon spectrum with the frequencies down to 10 cm−1 and its evolution with pressure for the studied material are provided by Raman scattering. It is found that two vibrational modes with the frequency >200 cm−1 display a common mode frequency increase with increasing pressure. Based on the bulk modulus from synchrotron X-ray powder diffraction and phonon frequency shifts, the mode Grüneisen parameters are obtained. Our results establish characteristic phonon vibrational properties of this high-performance half-Heusler thermoelectric alloy.
Letter: Convergence rate of individual and global quantities in direct numerical simulations
Authors: Flageul Cédric , Tiselj Iztok
Published: November 2018

Typical individual quantities in direct numerical simulations of statistically steady flows are converging at a rate of 1/T, where T is the averaging time of the simulation. However, global quantities that represent the integral momentum balance in the computational domain can exhibit a faster convergence rate of 1/T. This faster convergence rate is analysed and explained. Theoretical predictions are supported with a direct numerical simulation.
Driving chemical interactions at graphene-germanium van der Waals interfaces via thermal annealing
Authors: Kiraly Brian , Mannix Andrew J. , Jacobberger Robert M. , Fisher Brandon L. , Arnold Michael S. , Hersam Mark C. , Guisinger Nathan P.
Published: November 2018

Despite its extraordinary charge carrier mobility, the lack of an electronic bandgap in graphene limits its utilization in electronic devices. To overcome this issue, researchers have attempted to chemically modify the pristine graphene lattice in order to engineer its electronic bandstructure. While significant progress has been achieved, aggressive chemistries are often employed which are difficult to pattern and control. In an effort to overcome this issue, here we utilize the well-defined van der Waals interface between crystalline Ge(110) and epitaxial graphene to template covalent chemistry. In particular, by annealing atomically pristine graphene-germanium interfaces synthesized by chemical vapor deposition under ultra-high vacuum conditions, chemical bonding is driven between the germanium surface and the graphene lattice. The resulting bonds act as charge scattering centers that are identified by scanning tunneling microscopy. The generation of atomic-scale defects is independently confirmed by Raman spectroscopy, revealing significant densities within the graphene lattice. The resulting chemically modified graphene has the potential to impact next-generation nanoelectronic applications.
Wave diffraction by a circular crack in an ice sheet floating on water of finite depth
Authors: Li Z. F. , Wu G. X. , Shi Y. Y.
Published: November 2018

The problem of wave diffraction by a circular crack in an ice sheet floating on water of finite depth is considered. The fluid flow is described by the linear velocity potential theory, while the infinitely extended ice sheet is modeled as a thin elastic plate with uniform properties. At the crack, zero bending moment and shear force conditions are enforced. The solution starts from the Green function for ice sheet without the crack. This is then used to obtain an integral equation, in which the jumps of the displacement and slope across the crack are the unknowns. For a circular crack, the unknowns are expanded into the Fourier series in the circumferential direction. Through imposing the boundary conditions at the crack, a matrix equation is obtained for the unknowns, which is then truncated and solved. Convergence study is undertaken with respect to the truncation, and it has been found that the series converges fast. A far field identity is used to verify the solution procedure and is found to be satisfied very accurately. Extensive results are provided, and their physical implications are discussed. These include the jumps of the displacement and slope across the crack, resonant motion, far field diffracted wave amplitude, and the deflection of the ice sheet.
Damage detection of offshore platforms using acoustic emission analysis
Authors: Liu Guijie , Wang Shirui , Xie Yingchun , Tian Xiaojie , Leng Dingxin , Malekain Reza , Li Zhixiong
Published: November 2018

This paper aims to detect the structure damage in KT type jacket offshore platforms using acoustic emission analysis. Experimental investigation has been implemented to analyze the transmission characteristics, attenuation law, and source localization of the acoustic emission signals. The range of energy attenuation coefficient α and the signal amplitude attenuation law were obtained from experimental data. Hence, the layout of acoustic emission sensors was optimized based on the energy attenuation to achieve online damage monitoring for KT-jacket platforms. In order to validate the performance of the optimized sensor layout, another experimental test was conducted on the designed KT-jacket offshore platform to locate the acoustic emission sources. The test results demonstrate that a positioning error of 8 mm or below can be obtained using the optimized sensor layout, and the number of sensors can be reduced by 80% compared with that of the theoretical layout. As a result, the optimized sensor layout enables efficient and effective damage detection for KT-jacket offshore platforms.
Femtosecond-laser-induced plasma spectroscopy for high-pressure gas sensing: Enhanced stability of spectroscopic signal
Authors: Hsu Paul S. , Patnaik Anil K. , Stolt Adam J. , Estevadeordal Jordi , Roy Sukesh , Gord James. R.
Published: November 2018

Gas composition detection and analysis in high-pressure environments, such as those encountered in combustors, power plants, and planetary bodies, are important for scientific and engineering research. Conventional laser-based sensing using nanosecond (ns)-laser-induced breakdown spectroscopy (ns-LIBS) remains unreliable at elevated pressures because of the relatively high measurement uncertainty. To circumvent this problem, we propose to employ femtosecond-laser-induced plasma spectroscopy (FLIPS) to achieve a stable and reliable gas sensing at elevated pressures. A comprehensive study on the differences in the measurement quality of FLIPS and ns-LIBS for high-pressure nitrogen gas is conducted. The results show that the signal level and stability of ns-LIBS significantly decrease with the increase in pressure. In contrast, the signal level of FLIPS increases with the increase in pressure while maintaining the stability in the pressure range of 1–40 bar. In addition to the superior measurement stability, the FLIPS measurement provides a longer probe length (∼3 times compared to ns-LIBS) with a higher data acquisition speed (100 times compared to 10-Hz ns-LIBS).
Reverse Micro-Emulsion Synthesis of Oxygen-Enriched Low-Friction Boron Nitride/Calcium Borate Microspheres
Authors: Yuan Songdong , Yang Canxing , Zhu Xing , Jiang Guodong , Huang Renzhong , Xiong Jian , Ai Qing
Published: November 2018

Oxygen enriched boron nitride microspheres (BNOs) coated with nano-sized calcium borate (CB) were synthesised by a reverse micro-emulsion method, in which calcium chloride and sodium borate were selected as the calcium and boron source, respectively. The phase identification and chemical bonding of the composite were confirmed by X-ray driffraction (XRD) and FT-IR spectroscopy. The chemical composition and valence state were determined by X-ray photoelectron spectroscopy (XPS). The morphology and microstructure of the samples were characterised by transmission electron microscopy (TEM) along with surface area analysis. The tribological property of the microspheres as a wear resistance additive in base oil was evaluated by a four-ball tester. The results show that the strawberry-like BNO/CB nanocomposites were fabricated successfully and possess a relatively high friction-reducing and antiwear performance. After the addition of BNO/CB nanocomposites, the friction coefficients of the base oil decreased by 13.3% while the diameter of the grinding spot decreased by 16.4%.
The provision of mental health care by primary health organisations in the northern region: Barriers and enablers
Authors: O'Brien Anthony , Moir Fiona , Thom Katey
Published: November 2018

AIM: To identify barriers and enablers to the provision of mental health care by Primary Health Organisations (PHOs) in the northern region. METHODS: Information was generated from structured interviews with 22 of the 25 PHOs and the four District Health Boards (DHBs) in the northern region. RESULTS: Of the 22 PHOs who participated in the study, 17 had at least one specific mental health initiative; others had up to five initiatives. PHOs that were funded to provide one of the 41 Ministry of Health mental health pilot projects had more mental health initiatives in place. Barriers and enablers to providing mental health care occurred in areas such as workforce capacity, funding, infrastructure, and limited interest in transfer of care from secondary to primary care. CONCLUSIONS: Barriers to providing mental health care within the primary sector include stigma, lack of training, communication between sectors, funding and perceptions of sector roles. Factors which enable provision of mental health care are availability of training, good communication between sectors, use of available and new funding mechanisms and community involvement. Further research at the practice and practitioner level is necessary to fully understand development of mental health care within the primary care sector. KEYWORDS: Mental health, primary care, Primary Health Organisations, health policy
Ethics: In search of true autonomy
Authors: Willis Derek
Published: November 2018

Patient autonomy is discussed in medical care now both because this is an appropriate ethical practice and also as a reaction against the emphasis that was placed in the past on the medical profession always knowing best. This article examines where our present understanding and practice of the ethical concept of autonomy may be flawed. It examines both doctors and patients responsibilities for this flaw and how they may be rectified.
Use of aspirin and statins for cardiovascular risk reduction in New Zealand: The residential care story
Authors: Bon Hoem Jae , Kerse Ngaire , Scahill Shane , Moyes Simon , Chen Charlotte , Peri Kathy , Hughes Carmel
Published: November 2018

INTRODUCTION : Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality for older New Zealanders. Medication prescribing for secondary prevention of cardiovascular events in residential care is unknown and prescribing patterns for aspirin and statins by general practitioners (GPs) in residential care facilities in Auckland, New Zealand are reported here. METHODS: A representative sample of residential care facilities, all residents over age 65 years and their GPs in one district health board region in Auckland were recruited. Prescribing and medical records were audited by a trained nurse and medications coded into classes according to a standardised process. Diagnoses from summary sheets and hospital letters were recorded. Descriptive statistics were used to show variability in proportion of residents prescribed aspirin and statins. RESULTS: Of a total of 24 facilities approached, 14 consented to participate (58%); 537 residents (88% of eligible) agreed to participate and 533 completed the study. Residents took on average 8.3 (standard deviation 2.4) medications. On average 2.64 (range 16) GPs serviced each facility with eight GPs working in more than one facility. On average 54% of residents with documented CVD were prescribed aspirin and 31% of those with CVD and/or dyslipidaemia were prescribed statins. Variability between prescribers and facilities was high. DISCUSSION: Prescribing in residential care does not appear to be guidelines-based. The reasons for this are unknown. Ongoing social debate about the role of prevention for older people and interventions for GPs and residential care facilities may impact prescribing rates. KEYWORDS: Cardiovascular diseases; residential care; aspirin; statins; prescribing patterns; general practitioners
The reality of subclinical hypothyroidism in general practice
Authors: Gibbons Veronique , Lillis Steven , Conaglen John , Lawrenson Ross
Published: November 2018

INTRODUCTION: Subclinical hypothyroidism (SCH) is common, reported to affect 410% of the adult population. Recommendations for treatment of SCH are contentious, with protagonists even disagreeing over the rationale for medical intervention. How general practitioners (GPs) manage patients with elevated thyroid stimulating hormone (TSH) and normal thyroid hormone results are unknown. This study aimed to explore how GPs think about diagnosing and managing SCH. METHODS: A qualitative study using focus groups conducted between December 2007 and March 2008 to understand how GPs perceive SCH and their diagnostic and management process. FINDINGS: Thirteen GPs in three focus groups in Waikato, New Zealand participated. There is wide variability in how GPs perceive SCH and their knowledge of the disease. A patient-centred approach to diagnosis and management was commonly reported. Consideration of overt pathology and medicolegal issues also influenced perceptions of SCH, but lack of evidence regarding outcomes of treatment made such issues complex. CONCLUSION: SCH remains a complex entity because of ambiguity regarding symptoms, uncertainty regarding prognosis and variation in advice regarding treatment. This complexity is reflected in the disparate responses by GPs to the diagnosis and management of SCH. KEYWORDS: Hypothyroidism; family practice; qualitative research
Why dont patients with diagnosed diabetes attend a free Get Checked annual review?
Authors: Porter Tesa , Le Lièvre Clem , Lawrenson Ross
Published: November 2018

Introduction : A key strategy for improving the management of patients with diabetes is the provision of a free annual review Get Checked. Although it is known that certain patients do not attend these free reviews, little is known about the barriers. METHODS: A group of patients with diabetes who had not attended an annual review in the previous two years were identified and sent questionnaires asking about the barriers to attending. Non-respondents where followed up with a telephone call. Barriers were thematically analysed. FINDINGS: 26/68 patients identified patients responded (38%). Key issues identified included difficulty with transport, conflict with work and lack of motivation. There were differences in responses between Maori and non-Maori. CONCLUSION: Recommendations include more emphasis in recognising Maori tikanga (culture), more flexible provision of services to allow working patients to attend and increased emphasis on reminders for patients. KEYW ORDS: Diabetes mellitus; Maori; family practice; barriers
Ethics: Making people be healthy
Authors: Wilkinson Timothy
Published: November 2018

How are we supposed to decide the rights and wrongs of banning smoking in bars, restricting adverts for junk food, nagging people into being screened for cancers, or banning the sale of party pills? The aim of this paper is to think through the political ethics of trying to make people healthier through influencing or restricting their choices. This paper covers: (1) Paternalism. What it is, what it assumes. (2) The place of health in well-being, and how this makes paternalism problematic. (3) The mistakes people make in acting in their own interests, and the implications for pro-health paternalism. (4) Autonomy objections to paternalism. The paper (5) finishes on a note of hope, by commending the currently fashionable libertarian paternalism: trying to have ones carrot cake and eat it too. A persistent theme is that thinking sensibly about making people healthier needs subtlety, not broad, ringing declarations. KEYWORDS: Paternalism; nanny state; health; autonomy; rational choice
Barriers experienced by Asians in accessing injury-related services and compensations
Authors: Sobrun-Maharaj Amritha , Tse Samson , Hoque Ekramul
Published: November 2018

INTRODUCTION: The Accident Compensation Corporation (ACC) administers New Zealands (NZ) accident compensation scheme. Asians in NZ are apparently under-serviced by ACC and may be experiencing barriers to accessing services. This study identifies barriers that Asians in NZ face in accessing ACCs injury-related services and compensations. METHODS: By utilising a qualitative research design, 113 Chinese, Korean, Indian, and South East Asian participants residing in Auckland, NZ were recruited through maximum variation and purposive snowball sampling. Data were gathered during 2006 through 22 individual in-depth interviews and 14 focus group discussions based on semi-structured interview schedules. Interviewees included Asian general practitioners, traditional health providers, users and non-users of injury-related services, case managers and Asian community leaders. Data were analysed using a general inductive approach. FINDINGS: Results show that personal/cultural characteristics such as age, gender, English language competence, injury-related language competence, differing Asian worldviews, and consequent helpseeking behaviours act as barriers to accessing services and entitlements. This is exacerbated by logistical and environmental factors such as cost, transport, time, inadequate interpretation and translation services, as well as institutional barriers such as lack of information about services, culturally inappropriate services, discriminatory attitudes and employment risks. CONCLUSION: It is evident that Asians living in NZ are experiencing several cultural, environmental and institutional barriers to accessing ACC services. There is clearly a need for more culturally relevant information and injury-related services if Asian immigrants use of such services and entitlements is to be increased. KEYWORDS: Barriers; access; Asians; injury-related services
Introducing point-of-care testing into a rural hospital setting: thematic analysis of interviews with providers
Authors: Blattner Katharina , Nixon Garry , Jaye Chrystal , Dovey Susan
Published: November 2018

INTRODUCTION: Hauora Hokianga Enterprises Trust, an integrated Primary Health Organisation (PHO), which provides primary and intermediate/secondary care to a remote rural community, introduced point-of-care (POC) testing at Rawene Hospital in June 2008. Previously, all laboratory tests were undertaken in Whangarei, with a one to three day turn-around for results. This study aimed to identify the perceived impact of POC testing on clinicians and the community. METHOD: Face-to-face interviews were conducted with 13 health professionals working at Rawene Hospital. The qualitative data analysis computer programme Atlas.ti v5.2 was used to assist the thematic analysis. FINDINGS: Three overall themes captured the main issues with introducing POC testing: (1) POC testing increased clinicians confidence, certainty and assurance in their daily practice; (2) POC testing improved diagnostic certainty and this impacted on patients and their families/whanau; (3) the challenges associated with POC testing included increased workload, pressure to up-skill, over-testing, and continuing professional education gaps. CONCLUSION: POC testing is an invaluable technological adjunct for improving clinical decisions and culturally safe care provided to a remote rural community, but it brings challenges to care providers in managing higher workloads and pressures to up-skill. POC testing can improve the acute medical care (access and quality) provided to an economically-deprived, predominantly Maori, rural community. KEYWORDS: Hospitals, rural; point-of-care systems; rural health
How do newly diagnosed patients with type 2 diabetes in the Waikato get their diabetes education?
Authors: Lawrenson Ross , Joshy Grace , Eerens Yoska , Johnstone Wayne
Published: November 2018

INTRODUCTION: Education is accepted as the mainstay of management for people with diabetes. However, there are few population-based studies describing what education has been delivered from the patients perspective. AIM: To ascertain the sources of education for patients with newly diagnosed type 2 diabetes; what education was received and what were the patients views of group education. Delivery of education to Maori was compared with non-Maori. METHODS: A cross-sectional survey of patients identified from the Waikato Regional Diabetes Service database. Patients identified in one calendar year, having a diagnosis of type 2 diabetes and being aged between 20 and 89 years were included in the survey. Patients were sent a four-page questionnaire. Non-responders were followed up by telephone. RESULTS: 333/667 patients (50%) responded. The principal source of education for Waikato patients was general practice, from the general practitioner and/or the practice nurse. Ninety-three percent of patients reported that they had received some education about diabetes at the time of diagnosis. There was no difference between Maori and non-Maori in the reported levels of diabetes education received, but the patient perceived knowledge score was significantly lower for Maori in all aspects studied. DISCUSSION: The overall impression was that patients were receiving appropriate information about diabetes, but there does appear to be room for improvement in some areas, particularly the importance of blood pressure and lipid control. We believe that further research on the educational needs of Maori and ethnic minorities is needed. KEYWORDS: Diabetes; family practice; education; New Zealand
Influenza H1N1 2009 in Canterbury: a case study in pandemic response co-ordination
Authors: Williams Daniel , Begg Annabel , Burgess Kim , Hider Michele , Jennings Lance , Martin-Smith Mary , McCormack Paul , Mitchell Jon , Pithie Alan , Schroeder Phil , Wermo Anja
Published: November 2018

BACKGROUND AND CONTEXT: Reviews of overseas pandemic responses have suggested that stronger links between primary care and other parts of the health sector are required. The influenza A (H1N1) 2009 (H1N1 09) pandemic was the first real test of New Zealands pandemic preparedness. ASSESSMENT OF PROBLEM: In the six months from May to October 2009, there were 595 confirmed cases of H1N1 09 in Canterbury, with 187 hospitalisations and three deaths. This paper describes the way a range of Canterbury agencies worked together in a co-ordinated health-led response aimed at minimising the impact of H1N1 09 in the community and maintaining effective health care services for both influenza and non-influenza patients. STRATEGIES FOR IMPROVEMENT: Key strategies included sector-wide response co-ordination, intelligence and communications, a combined public health/primary care response during the containment phase, and universal red/green streaming supported by dedicated flu centres and an 0800 call centre during the manage it phase. LESSONS: Despite the considerable impact of the H1N1 09 virus in Canterbury, health care services were not overwhelmed. The key lesson learned from the Canterbury H1N1 09 response has been the importance of preparing and working together across the sector. KEYWORDS: Influenza, human; pandemic; primary health care; public health; mass media; civil defence
Charms & Harms: Feverfew
Authors: Goodyear-Smith Felicity
Published: November 2018

SUMMARY MESSAGE: There is insufficient evidence to support the use of feverfew for prevention of migraine headaches or for treatment of rheumatoid arthritis. Feverfew can cause mouth ulcers and gastrointestinal upsets and occasional allergic reactions. Health professionals should be aware of the possibility of (undisclosed) use of feverfew in patients on aspirin or warfarin. As with all herbal medicines, different feverfew products vary in their pharmaceutical quality, and the implications of this for efficacy and safety should be considered.
Long-term condition management: health professionals perspectives
Authors: Ashworth Natasha , Thompson Shona
Published: November 2018

INTRODUCTION: Long-term conditions (LTCs) are the leading cause of morbidity and mortality in New Zealand. The burden upon patients and health care services to manage these conditions has prompted calls for primary care to lead the way in early diagnosis and coordination of LTC care. The purpose of this study was to investigate the perspectives of health professionals in a geographically-isolated region of New Zealand regarding current levels of LTC management to provide direction for future service development. METHODS: Semi-structured, face-to-face interviews conducted in 2009 with 10 purposively sampled health professionals in the primary care field, including four general practitioners, four nurses and two management team personnel, all practising in a regional District Health Board. The resultant data were analysed using a general inductive thematic approach. FINDINGS: Three main themes were identified by the health professionals as being key issues pertaining to the management of LTCs. These are discussed as issues pertaining to management, information and communication and leadership. CONCLUSION: The results showed that LTC management is rated as highly important by health care professionals who are aware of the need to change current delivery methods to improve client outcomes. All those interviewed highlighted issues related to funding as being a significant barrier to implementing innovations in LTC management, including nurse-led services. Plans to develop integrated family health centres, information technology systems and increased collaboration between clinicians were hailed as potential solutions to improving LTC management. KEYWORDS: Chronic disease; family nursing; family practice; nurse led clinics; nurses practice patterns
Clinical outcomes and patients perceptions of nurse-led healthy lifestyle clinics
Authors: Marshall Bob , Floyd Sue , Forrest Rachel
Published: November 2018

BACKGROUND AND CONTEXT: The Nurse-Led Healthy Lifestyle Clinics focussed on lifestyle issues for patients with known health inequalities. Much of the nursing was educative and preventative care. This evaluation assessed patient experiences and opinions, as well as clinical outcomes. ASSESSMENT OF PROBLEM: Information came from clinical outcome data for 2850 individuals and 424 patient satisfaction surveys. Results: Patients were aged 095 years (45% between 40 and 59 years); 60% Pakeha/European, 31.4% Maori, 4.2% Pacific and 4.4% other ethnicities. Only 19% of claimants (approximately 40% were Maori or Pacific) came from quintile 5 addresses, suggesting the target population was not reached effectively. Ninety-four percent of patients had a better understanding of their diagnosis, medication and treatment plan, and were more motivated to self-manage their health needs. This increase in patient empowerment is a significant outcome of the project. Clinical outcome data showed no significant differences between first and last clinic visits for average weight, blood pressure, smoking, glycosylated haemoglobin levels, waist circumference or cardiovascular risk. Significant improvements were shown in the Dartmouth Primary Care Cooperative Information results for social activity, change in health, and overall health (n=89). STRATEGIES FOR IMPROVEMENT: More effective techniques to access the target population have been implemented, as has an extended period for review of clinical outcomes. LESSONS: More focussed evaluation of clinical outcomes is necessary to provide quantitative data on the clinics. The large percentage of patients who felt more empowered to self-manage their health needs suggests the clinics were effective in this area. KEYWORDS: Nurse-led clinics; life style; program evaluation; patient satisfaction; health status disparities