bluuebunny/crossref_metadata_2025 huggingface dataset:
Applying quality improvement methods to address gaps in medicines reconciliation at transfers of care from an acute UK hospital
Authors: Marvin Vanessa , Kuo Shirley , Poots Alan J , Woodcock Tom , Vaughan Louella , Bell Derek
Published: June 2016

Objectives

Reliable reconciliation of medicines at admission and discharge from hospital is key to reducing unintentional prescribing discrepancies at transitions of healthcare. We introduced a team approach to the reconciliation process at an acute hospital with the aim of improving the provision of information and documentation of reliable medication lists to enable clear, timely communications on discharge.

Setting

An acute 400-bedded teaching hospital in London, UK.

Participants

The effects of change were measured in a simple random sample of 10 adult patients a week on the acute admissions unit over 18 months.

Interventions

Quality improvement methods were used throughout. Interventions included education and training of staff involved at ward level and in the pharmacy department, introduction of medication documentation templates for electronic prescribing and for communicating information on medicines in discharge summaries co-designed with patient representatives.

Results

Statistical process control analysis showed reliable documentation (complete, verified and intentional changes clarified) of current medication on 49.2% of patients' discharge summaries. This appears to have improved (to 85.2%) according to a poststudy audit the year after the project end. Pharmacist involvement in discharge reconciliation increased significantly, and improvements in the numbers of medicines prescribed in error, or omitted from the discharge prescription, are demonstrated. Variation in weekly measures is seen throughout but particularly at periods of changeover of new doctors and introduction of new systems.

Conclusions

New processes led to a sustained increase in reconciled medications and, thereby, an improvement in the number of patients discharged from hospital with unintentional discrepancies (errors or omissions) on their discharge prescription. The initiatives were pharmacist-led but involved close working and shared understanding about roles and responsibilities between doctors, nurses, therapists, patients and their carers.
Use of hospital services by age and comorbidity after an index heart failure admission in England: an observational study
Authors: Bottle Alex , Goudie Rosalind , Bell Derek , Aylin Paul , Cowie Martin R
Published: June 2016

Objectives

To describe hospital inpatient, emergency department (ED) and outpatient department (OPD) activity for patients in the year following their first emergency admission for heart failure (HF). To assess the proportion receiving specialist assessment within 2 weeks of hospital discharge, as now recommended by guidelines.

Design

Observational study of national administrative data.

Setting

All acute NHS hospitals in England.

Participants

82 241 patients with an index emergency admission between April 2009 and March 2011 with a primary diagnosis of HF.

Main outcome measures

Cardiology OPD appointment within 2 weeks and within a year of discharge from the index admission; emergency department (ED) and inpatient use within a year.

Results

15.1% died during the admission. Of the 69 848 survivors, 19.7% were readmitted within 30 days and half within a year, the majority for non-HF diagnoses. 6.7% returned to the ED within a week of discharge, of whom the majority (77.6%) were admitted. The two most common OPD specialties during the year were cardiology (24.7% of the total appointments) and anticoagulant services (12.5%). Although half of all patients had a cardiology appointment within a year, the proportion within the recommended 2 weeks of discharge was just 6.8% overall and varied by age, from 2.4% in those aged 90+ to 19.6% in those aged 18–45 (p<0.0001); appointments in other specialties made up only some of the shortfall. More comorbidity at any age was associated with higher rates of cardiology OPD follow-up.

Conclusions

Patients with HF are high users of hospital services. Postdischarge cardiology OPD follow-up rates fell well below current National Institute for Health and Care Excellence guidelines, particularly for the elderly and those with less comorbidity.
Healthcare use among preschool children attending GP-led urgent care centres: a descriptive, observational study
Authors: Gnani S , Morton S , Ramzan F , Davison M , Ladbrooke T , Majeed A , Saxena S
Published: June 2016

Objective

Urgent care centres’ (UCCs) hours were developed with the aim of reducing inappropriate emergency department (ED) attendances in England. We aimed to examine the presenting complaint and outcomes of care in 2 general practitioner (GP)-led UCCs with extended opening times.

Design

Retrospective observational epidemiological study using routinely collected data.

Setting

2 GP-led UCCs in London, colocated with a hospital ED.

Participants

All children aged under 5 years, attending 2 GP-led UCCs over a 3-year period.

Outcomes

Outcomes of care for the children including: primary diagnosis; registration status with a GP; destination following review within the UCC; and any medication prescribed. Comparison between GP-led UCC visit rates and routine general practices was also made.

Results

3% (n=7747/282 947) of all attenders at the GP-led UCCs were children aged under 5 years. The most common reason for attendance was a respiratory illness (27%), followed by infectious illness (17%). 18% (n=1428) were either upper respiratory tract infections or viral infections. The majority (91%) of children attending were registered with a GP, and over two-thirds of attendances were ‘out of hours’. Overall 79% were seen and discharged home. Preschool children were more likely to attend their GP (47.0 per 100) than a GP-led UCC (9.4 per 100; 95% CI 8.9 to 10.0).

Conclusions

Two-thirds of preschool children attending GP-led UCCs do so out of hours, despite the majority being registered with a GP. The case mix is comparable with those presenting to an ED setting, with the majority managed exclusively by the GPs in the UCC before discharge home. Further work is required to understand the benefits of a GP-led urgent system in influencing future use of services especially emergency care.
Changes in Saturday outpatient volume and billings after introducing the Saturday incentive programme to clinics in South Korea: a longitudinal cohort study using claims data from 2012 to 2014
Authors: Ha Hyun Ji , Han Kyu-Tae , Kim Sun Jung , Sohn Tae Yong , Jeon Byungyool , Park Eun-Cheol
Published: June 2016

Objective

In October 2013, the South Korean government introduced an incentive programme to increase the availability of Saturday treatment at clinics, hoping to increase the role of primary care providers as gatekeepers to medical care. To the best of our knowledge, no one has yet investigated this programme's effect on overall outpatient care. Our study aims to analyse the change in Saturday outpatient volume and billings in clinics that adopted the Saturday incentive programme.

Setting

Our study used 3 types of data from the period October 2012 to March 2014: National Health Insurance Service (NHIS) claims data, hospital evaluation data and medical institution data.

Participants

These data consisted of 66 825 881 outpatient cases from 2837 clinics.

Interventions

Introducing the Saturday incentive programme.

Outcome measure

We performed a multilevel analysis that adjusted for clinic-level and outpatient-level variables to examine the difference in the percentage of Saturday outpatient volume and billings after introducing the Saturday incentive programme.

Results

The percentages of Saturday outpatient volume and billings were higher after introducing the programme (outpatient volume: β=2.065, p<0.001; outpatient billings: β=3.518, p<0.001). In addition, outpatient volume and billings on Friday and Saturday increased after introducing the programme, while those on weekdays, excluding Friday, decreased.

Conclusions

Our findings suggest that the Saturday incentive programme has affected clinic outpatient care and is a worthwhile health policy in terms of promoting primary care. Thus, it may improve healthcare accessibility and quality of care, and prevent inappropriate usage such as emergency room visits by providing patients with weekend clinic hours.
Early intervention of patients at risk for acute respiratory failure and prolonged mechanical ventilation with a checklist aimed at the prevention of organ failure: protocol for a pragmatic stepped-wedged cluster trial of PROOFCheck
Authors: Gong M N , Schenk L , Gajic O , Mirhaji P , Sloan J , Dong Y , Festic E , Herasevich V
Published: June 2016

Introduction

Acute respiratory failure (ARF) often presents and progresses outside of the intensive care unit. However, recognition and treatment of acute critical illness is often delayed with inconsistent adherence to evidence-based care known to decrease the duration of mechanical ventilation (MV) and complications of critical illness. The goal of this trial is to determine whether the implementation of an electronic medical record-based early alert for progressive respiratory failure coupled with a checklist to promote early compliance to best practice in respiratory failure can improve the outcomes of patients at risk for prolonged respiratory failure and death.

Methods and analysis

A pragmatic stepped-wedged cluster clinical trial involving 6 hospitals is planned. The study will include adult hospitalised patients identified as high risk for MV >48 hours or death because they were mechanically ventilated outside of the operating room or they were identified as high risk for ARF on the Accurate Prediction of PROlonged VEntilation (APPROVE) score. Patients with advanced directives limiting intubation will be excluded. The intervention will consist of (1) automated identification and notification of clinician of high-risk patients by APPROVE or by invasive MV and (2) checklist of evidence-based practices in ARF (Prevention of Organ Failure Checklist—PROOFCheck). APPROVE and PROOFCheck will be developed in the pretrial period. Primary outcome is hospital mortality. Secondary outcomes include length of stay, ventilator and organ failure-free days and 6-month and 12-month mortality. Predefined subgroup analysis of patients with limitation of aggressive care after study entry is planned. Generalised estimating equations will be used to compare patients in the intervention phase with the control phase, adjusting for clustering within hospitals and time.

Ethics and dissemination

The study was approved by the institutional review boards. Results will be published in peer-reviewed journals and presented at international meetings.

Trial registration number

NCT02488174.
Effect of different financial competing interest statements on readers' perceptions of clinical educational articles: study protocol for a randomised controlled trial
Authors: Schroter Sara , Pakpoor Julia , Morris Julie , Chew Mabel , Godlee Fiona
Published: June 2016

Introduction

Financial ties with industry are varied and common among academics, doctors and institutions. Clinical educational articles are intended to guide patient care and convey authors' own interpretation of selected data. Author biases in educational articles tend to be less visible to readers compared to those in research papers. Little is known about which types of competing interest statements affect readers' interpretation of the credibility of these articles. This study aims to investigate how different competing interest statements in educational articles affect clinical readers' perceptions of the articles.

Methods and analysis

2040 doctors who are members of the British Medical Association (BMA) and receive a copy of theBritish Medical Journal (The BMJ)each week will be randomly selected and invited by an email to participate in the study. They will be randomised to receive 1 of 2 Clinical Reviews, each with 1 of 4 possible competing interest statements. Versions of each review will be identical except for permutations of the competing interest statement. Study participants will be asked to read their article and complete an online questionnaire. The questionnaire will ask participants to rate their confidence in the conclusions drawn in the article, the importance of the article, their level of interest in the article and their likeliness to change their practice from the article. Factorial analyses of variance and analyses of covariance will be carried out to assess the impact of the type of competing interest statement and Clinical Review on level of confidence, importance, interest and likeliness to change practice.

Ethics and dissemination

The study protocol, questionnaire and letter of invitation to participants have been reviewed by members ofThe BMJ'sEthics Committee for ethical concerns. The trial results will be disseminated to participants and published in a peer-reviewed journal.

Trial registration number

NCT02548312; Pre-results.
A grieving process illustrated?
Authors: Hutchinson Rory
Published: June 2016

The sudden death of Pablo Picasso's closest friend Carlos Casagemas in 1901 came as a great shock to the young Picasso. From a young age, Picasso had ruminated on life and death; however, this was his first experience of bereavement. Following the death of Casagemas, Picasso's paintings can be seen as a diary of his grieving process and clearly illustrate the five stages of the grieving process as outlined by Kubler-Ross in ‘On Death and Dying’ (1969).
Comprehensive analysis of intra-arterial treatment for acute ischemic stroke due to cervical artery dissection
Authors: Jensen Judd , Salottolo Kristin , Frei Donald , Loy David , McCarthy Kathryn , Wagner Jeffrey , Whaley Michelle , Bellon Richard , Bar-Or David
Published: June 2016

Objective

The safety and efficacy of intra-arterial treatment (IAT) in patients with acute ischemic stroke (AIS) due to cervical artery dissection (CeAD) has not been formally studied. The purpose of this study was twofold: first, describe a large series with CeAD treated with IAT; second, analyze outcomes with CeAD receiving IAT versus (a) CeAD not treated with IAT, (b) CeAD receiving intravenous thrombolysis (IVT) alone, and (c) non-CeAD mechanism of AIS receiving IAT.

Design

Demographics, clinical characteristics, treatment, and outcomes were summarized for all CeAD patients treated with IAT from January 2010 to May 2015. Outcomes included favorable 90 day modified Rankin Scale (mRS) score of 0–2, symptomatic intracerebral hemorrhage (sICH), recanalization (Thrombolysis in Cerebral Infarction 2b-3), procedural complications, and mortality. Outcomes were analyzed with χ2tests and multivariate logistic regression.

Results

There were 161 patients with CeAD: 24 were treated with IAT and comprised our target population. Dissections were more common in the internal carotid (n=18) than in the vertebral arteries (n=6). All but one patient had intracranial embolus. IAT techniques included thrombectomy (n=19), IA thrombolysis (n=17), stent (n=14), and angioplasty (n=7). Outcomes included favorable 90 day mRS score of 0–2 in 63%, 4 deaths, 1 sICH, and 3 procedural complications. After adjustment, favorable mRS in our target population was similar to comparison populations: (a) in CeAD, IAT versus no IAT (OR 0.62, p=0.56); (b) In CeAD, IAT versus IVT alone (OR 1.32, p=0.79); and (c) IAT in CeAD versus non-CeAD mechanism of AIS (OR 0.58, p=0.34).

Conclusions

IAT is a valid alternative therapeutic option for AIS caused by CeAD due to the low complication rate and excellent outcomes observed in this study.
Two-year single-center experience with the ‘Baby Trevo’ stent retriever for mechanical thrombectomy in acute ischemic stroke
Authors: Kühn Anna Luisa , Wakhloo Ajay K , Lozano J Diego , Massari Francesco , De Macedo Rodrigues Katyucia , Marosfoi Miklos G , Perras Mary , Brooks Christopher , Howk Mary , Rex David E , Gounis Matthew J , Puri Ajit S
Published: June 2016

Objective

To evaluate the safety and efficacy of the ‘Baby Trevo’ (Trevo XP ProVue 3×20 mm Retriever) stent retriever for large vessel occlusions (LVOs) in acute ischemic stroke (AIS).

Materials and methods

We retrospectively analyzed our stroke database and included all patients treated with the Baby Trevo for distal LVOs in AIS. Patient gender, mean age, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score at presentation, and modified Rankin Scale (mRS) score at baseline and 90-day follow-up were documented. Reperfusion rates for the vessels treated were recorded using the Thrombolysis in Cerebral Infarction (TICI) classification. Occurrence of vasospasm and new or evolving infarcts in the treated vascular territory was documented.

Results

Thirty-five subjects with a mean NIHSS score of 18 were included. The Baby Trevo device was used in 38 branches of the anterior and posterior circulations. TICI 2b/3 blood flow was restored after one single pass in 20/38 (52.6%) and after two or three passes in 11 vessels. The remaining vessels required either more than three passes, showed less than a TICI 2b/3 reperfusion (n=3), or demonstrated failure to retrieve the clot (n=4). TICI 2b/3 reperfusion was achieved in 30 patients (85.7%). No vessel injuries, rupture, or significant vasospasm were seen. Overall, a mRS score of ≤2 was seen in 56.5% of the subjects successfully treated with the Baby Trevo at 90 days and in 81.3% of surviving patients; seven patients died (20%).

Conclusions

Our preliminary data suggest that the ‘Baby Trevo’ achieves a high recanalization rate without any significant risk. Larger cohort studies are needed to validate the clinical benefit.
Comparison between National Institute for Health and Care Excellence (NICE) and European Society of Cardiology (ESC) guidelines for the diagnosis and management of stable angina: implications for clinical practice
Authors: Archbold R Andrew
Published: June 2016

Cardiologists in the UK use clinical practice guidelines from the National Institute for Health and Care Excellence (NICE) and from the European Society of Cardiology (ESC) to aid clinical decision-making. This review compares their recommendations regarding stable angina. NICE's diagnostic algorithm changed clinical practice in the UK, with most cardiologists moving from the exercise ECG towards newer, more accurate imaging modalities such as CT and MRI for diagnostic testing in patients with a low or medium probability of coronary artery disease (CAD), and directly to invasive coronary angiography in patients with a high probability of CAD. ESC guidelines are based around stress imaging for most patient groups. Both guidelines stress the importance of optimal medical therapy for patients with stable angina. NICE recommends coronary artery bypass graft surgery to improve prognosis for patients with left main stem and/or proximal 3-vessel disease, whereas the ESC also includes proximal left anterior descending artery disease among its indications for revascularisation to improve prognosis, particularly if there is evidence of myocardial ischaemia. The relation between disease complexity and 5-year clinical outcomes after revascularisation in patients with left main stem and/or 3-vessel CAD has been integrated into ESC guidance through the use of the SYNTAX score to aid treatment selection in this group of patients. Patients with stable angina who have disease involving the proximal left anterior descending artery are less likely to undergo myocardial revascularisation if they are managed according to NICE's guidance compared with the ESC's guidance.
Contributions to sequence stratigraphy from analogue and numerical experiments
Authors: Muto Tetsuji , Steel Ron J. , Burgess Peter M.
Published: June 2016

The sequence stratigraphic model, although no longer focused on eustasy and accommodation, has been until recently based largely on observation and interpretation of outcrop and subsurface data. This approach may be restrictive if the current model places limits on what is observed and how observations are interpreted. To make progress in our understanding of strata, the sequence stratigraphic model and method should be tested against and fully incorporate theoretical and experimental results that provide new knowledge of (1) autogenesis, (2) intrinsic stratigraphic responses, (3) alluvial grade, and (4) scales appropriate to single depositional systems evolving with relative sea-level changes. More extensive inclusion of analogue and numerical experimental results could lead to significant modification and refinement of existing sequence stratigraphic models.
A centennial reappraisal of the Vredefort pseudotachylytes: shaken, not stirred by meteorite impact
Authors: Garde A. A. , Klausen Martin B.
Published: June 2016

Major pseudotachylyte zones constitute a spectacular component of the renowned
c.
2.023 Ga Vredefort impact structure, South Africa, but it has always been difficult to explain how they were formed. In his original account, in 1916, Shand interpreted the pseudotachylyte as due to cataclasis and frictional heating but pointed out two enigmas that have remained since: there were no associated major faults, and the pseudotachylyte volumes he observed were far greater than in similar rocks located within faults elsewhere on Earth. New observations show that the Vredefort pseudotachylyte zones were indeed formed by cataclasis and frictional heating, not by faulting but owing to impact-induced seismic shaking initiated around temporarily loosened blocks in dendritic fracture systems. Progressive cataclasis of such loose blocks by intense, high-frequency oscillations of the country rock at the beginning of the cratering process led to size reduction, rounding and comminution, and frictional melting of feldspars and biotite in the comminuted parts. Most pseudotachylyte was thus not injected from anywhere but produced
in situ
. The process of seismic shaking is well known from impacts on the Moon and asteroids, terrestrial earthquakes and nuclear tests but has largely been overlooked in terrestrial cratering, except in the theoretical concept of acoustic fluidization.
Carvedilol-responsive microRNAs, miR-199a-3p and -214 protect cardiomyocytes from simulated ischemia-reperfusion injury
Authors: Park Kyoung-mi , Teoh Jian-peng , Wang Yongchao , Broskova Zuzana , Bayoumi Ahmed S. , Tang Yaoliang , Su Huabo , Weintraub Neal L. , Kim Il-man
Published: June 2016

The nonselective β-adrenergic receptor antagonist (β-blocker) carvedilol has been shown to protect against myocardial injury, but the detailed underlying mechanisms are unclear. We recently reported that carvedilol stimulates the processing of microRNA (miR)-199a-3p and miR-214 in the heart via β-arrestin1-biased β1-adrenergic receptor (β1AR) cardioprotective signaling. Here, we investigate whether these β-arrestin1/β1AR-responsive miRs mediate the beneficial effects of carvedilol against simulated ischemia/reperfusion (sI/R). Using cultured cardiomyocyte cell lines and primary cardiomyocytes, we demonstrate that carvedilol upregulates miR-199a-3p and miR-214 in both ventricular and atrial cardiomyocytes subjected to sI/R. Overexpression of the two miRs in cardiomyocytes mimics the effects of carvedilol to activate p-AKT survival signaling and the expression of a downstream pluripotency marker Sox2 in response to sI/R. Moreover, carvedilol-mediated p-AKT activation is abolished by knockdown of either miR-199a-3p or miR-214. Along with previous studies to directly link the cardioprotective actions of carvedilol to upregulation of p-AKT/stem cell markers, our findings suggest that the protective roles of carvedilol during ischemic injury are in part attributed to activation of these two protective miRs. Loss of function of miR-199a-3p and miR-214 also increases cardiomyocyte apoptosis after sI/R. Mechanistically, we demonstrate that miR-199a-3p and miR-214 repress the predictive or known apoptotic target genes ddit4 and ing4, respectively, in cardiomyocytes. These findings suggest pivotal roles for miR-199a-3p and miR-214 as regulators of cardiomyocyte survival and contributors to the functional benefits of carvedilol therapy.
AdipoR-increased intracellular ROS promotes cPLA2and COX-2 expressions via activation of PKC and p300 in adiponectin-stimulated human alveolar type II cells
Authors: Chen Hsiao-Mei , Yang Chuen-Mao , Chang Jia-Feng , Wu Chi-Sheng , Sia Kee-Chin , Lin Wei-Ning
Published: June 2016

Adiponectin, an adipokine, accumulated in lung system via T-cadherin after allergens/ozone challenge. However, the roles of adiponectin on lung pathologies were controversial. Here we reported that adiponectin stimulated expression of inflammatory proteins, cytosolic phospholipase A2(cPLA2), cyclooxygenase-2 (COX-2), and production of reactive oxygen species (ROS) in human alveolar type II A549 cells. AdipoR1/2 involved in adiponectin-activated NADPH oxidase and mitochondria, which further promoted intracellular ROS accumulation. Protein kinase C (PKC) may involve an adiponectin-activated NADPH oxidase. Similarly, p300 phosphorylation and histone H4 acetylation occurred in adiponectin-challenged A549 cells. Moreover, adiponectin-upregulated cPLA2and COX-2 expression was significantly abrogated by ROS scavenger ( N-acetylcysteine) or the inhibitors of NADPH oxidase (apocynin), mitochondrial complex I (rotenone), PKC (Ro31-8220, Gö-6976, and rottlerin), and p300 (garcinol). Briefly, we reported that adiponectin stimulated cPLA2and COX-2 expression via AdipoR1/2-dependent activation of PKC/NADPH oxidase/mitochondria resulting in ROS accumulation, p300 phosphorylation, and histone H4 acetylation. These results suggested that adiponectin promoted lung inflammation, resulting in exacerbation of pulmonary diseases via upregulating cPLA2and COX-2 expression together with intracellular ROS production. Understanding the adiponectin signaling pathways on regulating cPLA2and COX-2 may help develop therapeutic strategies on pulmonary diseases.
Phase 1 Study of Tabalumab, a Human Anti-B-Cell Activating Factor Antibody, and Bortezomib in Patients with Relapsed/Refractory Multiple Myeloma
Authors: Raje Noopur S. , Faber Edward A. , Richardson Paul G. , Schiller Gary , Hohl Raymond J. , Cohen Adam D. , Forero Andres , Carpenter Susan , Nguyen Tuan S. , Conti Ilaria , Kaiser Christopher J. , Cronier Damien M. , Wooldridge James E. , Anderson Kenneth C.
Published: June 2016

Purpose: Tabalumab, a human mAb that neutralizes B-cell–activating factor (BAFF), demonstrated antitumor activity in xenograft models of multiple myeloma. Here we report on a phase I study of relapsed/refractory multiple myeloma patients in which the primary objective was to identify a tolerable and potentially efficacious dose of tabalumab when combined with bortezomib.

Experimental Design: Forty-eight patients were enrolled; 20 to the dose-escalation cohort, and 28 to cohort expansion in which a dose of 100 mg of tabalumab was evaluated. All patients had received either prior bortezomib or an immunomodulatory drug; the median number of prior therapies was 3. Bortezomib was administered intravenously on days 1, 4, 8, and 11 of a 21-day schedule. Tabalumab was given every 21 days for 3 cycles, then every 42 days thereafter.

Results: The most common grade 3/4 toxicities included thrombocytopenia, neutropenia, pneumonia, and peripheral sensory neuropathy. There were no dose-limiting toxicities, and the maximum tolerated dose was not reached. Pharmacokinetic data suggested serum exposure increased in a greater than dose-proportional manner up to a dose of 100 mg. Out of 46 evaluable patients, 20 had confirmed responses. The median time to progression (9 patients censored) was 4.8 months, and the median response duration (4 patients censored) was 7.2 months.

Conclusions: A dose of 100 mg tabalumab in combination with bortezomib was well tolerated and active and is currently under further investigation. Clin Cancer Res; 22(23); 5688–95. ©2016 AACR.
Value of Image Fusion in Coronary Angiography for the Detection of Coronary Artery Bypass Grafts
Authors: Plessis Julien , Warin Fresse Karine , Cahouch Zachary , Manigold Thibaut , Letocart Vincent , Le Gloan Laurianne , Guyomarch Béatrice , Guerin Patrice
Published: June 2016

Background

Coronary angiography is more complex in patients with coronary artery bypass grafts (
CABG
). Image fusion is a new technology that allows the overlay of a computed tomography (
CT
) three‐dimension (3D) model with fluoroscopic images in real time.

Methods and Results

This single‐center prospective study included 66 previous
CABG
patients undergoing coronary and bypass graft angiography. Image fusion coronary angiographies (fusion group, 20 patients) were compared to conventional coronary angiographies (control group, 46 patients). The fusion group included patients for whom a previous chest
CT
scan with contrast was available. For patients in this group, aorta and
CABG
were reconstructed in 3D from
CT
acquisitions and merged in real time with fluoroscopic images. The following parameters were compared: time needed to localize the
CABG
; procedure duration; air kerma (
AK
); dose area product (
DAP
); and volume of contrast media injected. Results are expressed as median. There were no significant differences between the 2 groups in patient demographics and procedure characteristics (access site, number of bypass to be found, and interventional cardiologist's experience). The time to localize
CABG
was significantly shorter in the fusion group (7.3 versus 12.4 minutes;
P
=0.002), as well as the procedure duration (20.6 versus 25.6 minutes;
P=
0.002),
AK
(610 versus 814 mGy;
P=
0.02),
DAP
(4390 versus 5922.5 cGy·cm
2
;
P
=0.02), and volume of iodinated contrast media (85 versus 116 cc;
P
=0.002).

Conclusions

3D image fusion improves the
CABG
detection in coronary angiography and reduces the time necessary to localize
CABG
, total procedure time duration, radiation exposure, and volume of contrast media.
A Web of opportunity or the same old story? Women digital entrepreneurs and intersectionality theory
Authors: Dy Angela Martinez , Marlow Susan , Martin Lee
Published: June 2016

This article critically analyses the manner in which intersectionality and related social positionality shape digital enterprise activities. Despite popular claims of meritocratic opportunity enactment within traditional forms of entrepreneurship, ascribed social characteristics intersect to influence the realization of entrepreneurial potential. However, it is purported that the emerging field of digital entrepreneurship may act as a ‘great leveller’ owing to perceived lower barriers to entry, disembodiment of the entrepreneurial actor and the absence of visible markers of disadvantage online. Using an interpretivist approach, we analyse empirical evidence that reveals how the privileges and disadvantages arising from intersecting social positions of gender, race and class status are experienced by UK women digital entrepreneurs. This analysis challenges the notion that the internet is a neutral platform for entrepreneurship and supports our thesis that offline inequality, in the form of marked bodies, social positionality and associated resource constraints, is produced and reproduced in the online environment.
The Effect of Free Adult Preventive Care Services on Subsequent Utilization of Inpatient Services in Taiwan
Authors: Tian Wei-Hua
Published: June 2016

The objective of this article is to investigate the relationship between the utilization of free adult preventive care services and subsequent utilization of inpatient services among elderly people under the National Health Insurance program in Taiwan. The study used secondary data from the 2005 Taiwan National Health Interview Survey and claim data from the 2006 Taiwan National Health Insurance Research Database for the elderly aged 65 or over. A bivariate probit model was used to avoid the possible endogeneity in individuals’ utilization of free adult preventive care and inpatient services. This study finds that, when individuals had utilized the preventive care services in 2005, the probability that they utilized inpatient services in 2006 was significantly reduced by 13.89%. The findings of this study may provide a good reference for policy makers to guide the efficient allocation of medical resources through the continuous promotion of free adult preventive care services under the National Health Insurance program.
The relationship between childhood trauma and type D personality in university students
Authors: Demirci Kadir , Yıldız Mesut , Selvi Cansu , Akpınar Abdullah
Published: June 2016

Aim:

There has been increasing evidence that childhood traumas are related to reduced health-related quality of life, neurobiological changes and long-term adverse effects, such as an increase in the likelihood of psychiatric disorders in adulthoods. The aim of this study was to investigate the relationships between childhood traumas and type D personality.

Subjects and methods:

In total, 187 university students (64 males and 123 females; mean age = 21.69 ± 2.00) were included in the study. All participants were evaluated using the Type D Personality Scale (DS-14), Childhood Trauma Questionnaire (CTQ-28) and Beck Depression Inventory (BDI). The participants were divided into the two groups according to the presence of type D personality. Then, statistical analyses were performed.

Results:

The frequency of type D personality in participants was 43.3% ( n = 81). The emotional neglect, physical neglect, emotional abuse component of the CTQ-28, total CTQ-28 scores and BDI scores were higher in the group with type D personality than in the group without type D personality ( p < .001, p = .003, p = .001, p < .001 and p < .001, respectively). There were significantly positive correlations between the type D personality scores and BDI scores, emotional neglect, physical neglect, emotional abuse and childhood trauma total scores ( p < .05, for all). Linear regression analyses showed that the significant and independent predictors of the score of DS-14 were total score of CTQ-28 and BDI score.

Conclusion:

Childhood trauma may be associated with type D personality, and there is predictive value of the childhood trauma on the scores of type D personality.
Re-visioning social work education: A nonexclusive challenge for the United Kingdom
Authors: Muñoz-Guzmán Carolina
Published: June 2016

The analyses of the contesting moment social work faces in the United Kingdom bring to discussion many claims that appear familiar to the context and performance of social work in Chile. This note compares the UK assessment of social work education and professional practice with Chilean social work, concluding that rising demand, high vacancy rates and reliance on agency staff, quality of recruits and training, and low status of the profession are issues shared by both countries, raising the question of how to improve international standards of the profession.
Microscopical, physico-chemical, mineralogical, and mechanical characterization of Sansevieria zeylanica fibers as potential reinforcement of composite structures
Authors: Ponnu Krishnan P , Selwin Rajadurai J
Published: June 2016

The aim of this article is to examine for the first time the morphological, physical, chemical, mechanical, and thermal properties of a new kind of fibers, extracted from the leaves of a plant of the Asparagaceae family, to make it possible to use them as potential reinforcement for composite structures. The fibers were extracted from the leaves of Sansevieria zeylanica by decortication process. The presence of mechanical fibers and ribbon fibers were identified through the anatomy of Sansevieria zeylanica leaves. The hierarchical cell structure of these fibers was analyzed through polarized optical microscopy and scanning electron microscopy. It consists of primary cell wall, secondary cell wall, fiber lumen, and middle lamellae. The chemical composition of the natural fibers, in terms of cellulose 76.12%, hemicelluloses 9.32%, lignin 4.28%, and ash content 1.36%, was analyzed by using standard test methods and compared with other natural fibers. The fiber density and fineness were found to be 0.945 ± 0.004 g/cm3 and 8.35 tex, respectively. The thermal behavior of the fiber was investigated through thermogravimetric analysis/differential thermogravimetric analysis. The initial degradation temperature of the cellulose component is 304℃. The results obtained through Fourier transform infrared spectroscopy and X-ray diffraction showed the presence of cellulose with the crystallinity index of 66.67%. Finally, single fiber tensile tests have been performed to assess the mechanical properties. Tensile test of Sansevieria zeylanica fibers showed the tensile strength of 359 MPa and Youngs modulus of 8 GPa.
Multi-sliding surface control for the speed regulation system of ship diesel engines
Authors: Yuan Yupeng , Zhang Meng , Chen Yongzhi , Mao Xiaobing
Published: June 2016

The steady and reliable operation of a ship’s diesel engine is important to the ship’s electrical power system and the engine’s performance, and stable control of rotational speed is crucial to a diesel engine’s emission, economy and power performance. A ship’s diesel engine is a nonlinear and time-varying system. A traditional proportional–integral–derivative (PID) controller cannot regulate the speed under different working conditions. In this paper, a nonlinear mathematical model for speed regulation of diesel engines is established according to experiments and a multi-sliding surface variable structure controller for speed regulation of diesel engine is established by sliding mode control. A bulk cargo ship 500-I was analysed as an example. The MATLAB/Simulink simulation took the navigation environment and the effect of the ship propeller on the diesel engine into consideration. A simulation model considering the whole ship–engine–propeller system is built and some conclusions can be drawn from the simulation. The multi-sliding surface control can restrain the overshoot and realize a quick track of the targeted value with high accuracy and strong robustness. In addition, the fuel consumption and CO2 emission of this sliding mode variable structure control is reduced by 4.6% compared with traditional PID control.
Active vibration control of carbon nanotube reinforced composite beams
Authors: Mirghaffari Ali , Rahmani Behrooz
Published: June 2016

In this paper, active vibration control of carbon nanotube reinforced composite beams subjected to a temperature rise is studied. For this purpose, piezoelectric patches are used as sensors to measure the displacement of the beam and as actuators to implement control forces. The governing equation of motion of this beam is derived from the Euler–Bernoulli theory and Hamilton’s principle. Galerkin’s method is utilized to obtain the temporal ordinary differential equations. An optimal observer-based output feedback controller is designed by the linear quadratic regulator ( LQR) methodology to ensure closed-loop stability. Simulation studies demonstrate the effectiveness of the proposed method.
Force tracking control of an electro-hydraulic control loading system on a flight simulator using inverse model control and a damping compensator
Authors: Zhao Jinsong , Shen Gang , Zhu Weidong , Yang Chifu , Agrawal Sunil K
Published: June 2016

The electro-hydraulic control loading system (EHCLS) of a flight simulator is mainly used to simulate the force feel of flying a real airplane. A double-loop model, including control and hydraulic mechanism of the EHCLS, is established and its force–displacement impedance is analysed to evaluate force tracking performances and its stability. An approximated feed-forward inverse model controller is designed using a zero phase error compensation method for expanding the frequency bandwidth of the inner loop because the identified force closed-loop model is a nonminimum phase system and its direct inverse model is unstable. Modelling error between the designed feed-forward inverse model and the actual plant is discussed and a damping compensator is presented to increase stability of the EHCLS. Theoretical analysis, simulation and experimental results show that the control methods presented are feasible and can effectively improve force feel fidelity and stability of the EHCLS.
Esophageal necrosis after endovascular repair for ruptured aortic dissection
Authors: Koizumi Shintaro , Yamaguchi Seiichi , Asano Soichi , Fujita Hisanori , Sueta Tomonori , Takeuchi Shigeyasu
Published: June 2016

A 78-year-old man presented with back pain and shock and was transferred to our hospital. Computed tomography showed a ruptured aortic dissection in which the false lumen was thrombosed with an ulcer-like projection, and the mid-esophagus was shifted to the right due to a mediastinal hematoma. He underwent emergency thoracic endovascular aortic repair of the descending thoracic aorta. One week later, esophageal necrosis occurred, and he died of mediastinitis and sepsis on postoperative day 16. Although esophageal necrosis is a rare and fatal complication after thoracic endovascular aortic repair, a management strategy has not yet been established.
Tricuspid valve repair for severe tricuspid regurgitation due to pacemaker leads
Authors: Uehara Kyokun , Minakata Kenji , Watanabe Kentaro , Sakaguchi Hisashi , Yamazaki Kazuhiro , Ikeda Tadashi , Sakata Ryuzo
Published: June 2016

Background

Tricuspid valve regurgitation due to pacemaker leads is a well-known complication. Although some reports have suggested that pacemaker leads should be surgically explanted, strongly adhered leads cannot always be removed. The aim of this study was to describe our tricuspid valve repair techniques with pacemaker leads left in situ.

Methods

Our retrospective study investigated 6 consecutive patients who required tricuspid valve surgery for severe regurgitation induced by pacemaker leads.

Results

From the operative findings, we identified 3 patterns of tricuspid valve and pacemaker lead involvement. In 3 patients, the leads were caught in the chordae, in 2 patients, tricuspid regurgitation was caused by lead impingement on the septal leaflet, and in 3 patients, tricuspid valve leaflets had been perforated by the pacemaker leads. During surgery, all leads were left in situ after being separated from the leaflet or valvular apparatus. In addition, suture annuloplasty was performed for annular dilatation in all cases. In one patient, the lead was reaffixed to the annulus after the posterior leaflet was cut back towards the annulus, and the leaflet was then closed. There was one hospital death due to sepsis. The degree of tricuspid regurgitation was trivial in all surviving patients at discharge. During a mean follow-up of 21 months, one patient died from pneumonia 20 months after tricuspid valve repair.

Conclusion

In patients undergoing tricuspid valve surgery due to severe tricuspid regurgitation caused by pacemaker leads, the leads can be left in situ after proper repair with annuloplasty.
Evaluating the Implementation of the Pyramid Model for Promoting Social-Emotional Competence in Early Childhood Classrooms
Authors: Hemmeter Mary Louise , Snyder Patricia A. , Fox Lise , Algina James
Published: June 2016

We conducted a potential efficacy trial examining the effects of classroom-wide implementation of the Pyramid Model for Promoting Young Children’s Social-Emotional Competence on teachers’ implementation of Pyramid Model practices and children’s social-emotional skills and challenging behavior. Participants were 40 preschool teachers and 494 children. Using a randomized controlled design, 20 teachers received a professional development (PD) intervention to support their implementation of the practices. The 20 teachers in the control condition received workshops after all study-related data were collected. Teachers who received PD significantly improved their implementation of Pyramid Model practices relative to control teachers. Children in intervention teachers’ classrooms were rated as having better social skills and fewer challenging behaviors relative to children in control teachers’ classrooms. Exploratory analyses showed that children at elevated risk for behavior disorders in intervention teachers’ classrooms had improvements in their observed social interaction skills relative to similar children in control teachers’ classrooms.
Associations of Perceived Sibling and Parent-Child Relationship Quality With Internalizing and Externalizing Problems: Comparing Indian and Dutch Early Adolescents
Authors: Buist Kirsten L. , Verhoeven Marjolein , Hoksbergen René , ter Laak Jan , Watve Sujala , Paranjpe Analpa
Published: June 2016

The aims of the present study were (a) to examine whether Dutch and Indian early adolescents differ concerning sibling and parent-child relationship quality and externalizing and internalizing problems, and (b) to compare the associations between sibling and parent-child relationship quality and externalizing and internalizing problems for Indian and Dutch early adolescents. Our sample consisted of 274 Dutch (mean age = 10.9 years) and 236 Indian early adolescents (mean age = 10.8 years). Questionnaires were administered in the final grades of 15 Dutch primary schools and six Indian English-language middle schools. Indian early adolescents reported more sibling warmth and parental negative interaction than Dutch early adolescents. However, associations between sibling and parent-child relationship quality and externalizing and internalizing problems were similar. Our study indicates that cross-cultural differences may exist in quality of sibling and parent-child relationships, but not in their impact on externalizing and internalizing problems. More cross-cultural research concerning family relationship quality and its impact on early adolescent psychosocial development is needed to confirm our findings.
Health-Related Research Projects in Fiji and Papua New Guinea
Authors: Sridharan Kannan , Gowri S.
Published: June 2016

Evidence-based medicine and evidence-based public health rely on the best available evidence generated in a specific area for it to be implemented in healthcare practice. This study assesses the range of research studies conducted in Fiji and Papua New Guinea (PNG) islands by reviewing the types of studies now registered with the respective health research registry portals. We assessed all studies registered on the Fiji Health Research Portal (FHRP) and Papua New Guinea Health Research Portal (PNGHRP) since 2014 for the following details: year of registration; study type and participants; field of research; basic statistical analyses; and multicentric or single center study. A total of 99 studies were registered in the FHRP and 6 in PNGHRP during the period under review. Nearly, one fourth of the studies from Fiji and one third from PNG islands are studies evaluating various health policies without involving or collecting data from human subjects. All the registered studies in both the islands were observational (rather than experimental). A total of 58.2% of the registered studies in FHRP and 66.7% in PNGHRP were performed as student projects. A geographic scope of 21.2% of the proposed studies in FHRP and 33.3% in PNGHRP was limited to the respective islands. We conclude from the present analysis that there is a clear need for conducting more high-quality research in both Fiji and PNG in order to meet the health needs of the respective nations. More research focusing on health needs and contributing factors to both communicable and noncommunicable diseases are the need of the hour in both of these south Pacific islands.