General practitioner attitudes to the care of people with epilepsy: an examination of clustering within practices and prediction of patient-rated quality of care

BACKGROUND: There is wide variation in the quality of care provided by primary care practices to individuals with chronic illnesses. Individual doctor attitudes and interest have been demonstrated to influence patient outcomes in some instances. Given the trend towards larger practices and part-time working, continuity of care is likely to fall and thus practice-based rather than individual general practitioner attributes and attitudes are likely to become increasingly important. The aim in this paper was to examine the extent to which individual general practitioner (G.P.) attitudes to the care of people with epilepsy cluster within practices and predict patient-rated quality of care. METHODS: The sample consisted of 1255 people with active epilepsy (a recent seizure or on anti-convulsant medication for epilepsy) and 199 GPs from 82 general practices. Measures of GP attitudes (a 17-item GP attitudes questionnaire) and patient-rated quality of epilepsy care were obtained. 1210 individuals completed initial questionnaires and 975 patients filled in final questionnaires one year later. Responses were achieved from 64 practices (83% of total) and 115 GPs (60% of total). RESULTS: 2 main factors were found to underlie GP attitudes to the care of people with epilepsy and these demonstrated clustering within practices "epilepsy viewed as a primary care responsibility" (Eigenvalue 3.98, intra-class correlation coefficient (ICC) 0.40), and "medication skills"(Eigenvalue 2.74, ICC 0.35). GP-rated scores on "epilepsy care being a primary care responsibility" were a significant predictor of patient-rated quality of GP care (p = 0.031). Other contributory factors were seizure frequency (p = 0.044), and patient-rated "shared decision making" (p = 0.022). CONCLUSION: Specific general practitioner attitudes to the care of people with epilepsy cluster within practices and are significantly associated with patient-rated quality of epilepsy care. It is important to take these findings into consideration when planning primary care interventions to ensure people with epilepsy receive the benefits of available medical and surgical expertise

Corporate governance practices’ influence on customer loyalty in Nigerian retail banks

Orientation: Customer loyalty is crucial in the retail banking sector, given the increasing competition within the industry and from emerging non-traditional players. Research purpose: This study sought to establish the influence of corporate governance practices on customer loyalty in Nigerian retail banks. Motivation for the study: Conducting a study of this nature highlights how corporate governance practices contribute to customer loyalty in the retail banking sector of Nigeria as a developing country in Africa. Research design, approach and method: Premised on relationship marketing and stakeholder theoretical orientations, the study used a sample of 424 bank customers scientifically selected from eight commercial banks identified within Ibadan Metropolis, Nigeria. A six-construct survey instrument was used to collect relevant data. Partial least square structural equation modelling (PLS-SEM) version 3 was utilised to ascertain the interaction between customer loyalty and corporate governance practices domains. Main findings: The result of the PLS-SEM model established that all corporate governance practices had a positive effect on customer loyalty at a very significant level (p < 0.01), except transparency and disclosure, which had an inverse relationship and effect on customer loyalty, though at a non-significant level (β = -0.005, p = 0.93). Presence of competent bank management had the highest positive influence on customer loyalty. Practical/managerial implications: The findings of this study will be useful for bank management and role players in the financial and other service sectors on the importance of good corporate governance and specific attributes of the identified corporate governance that are critical for business success. Contribution/value-add: This study was able to identify corporate governance practices from customers’ perspective, which is a departure from the traditional shareholder perspective in business studies. It has advanced the relatively known terrain in corporate governance and business literature by opening up new debates on the relevance of corporate leadership beyond the confines of the boardroom

Ultra-Slow Vacancy-Mediated Tracer Diffusion in Two Dimensions: The Einstein Relation Verified

We study the dynamics of a charged tracer particle (TP) on a two-dimensional lattice all sites of which except one (a vacancy) are filled with identical neutral, hard-core particles. The particles move randomly by exchanging their positions with the vacancy, subject to the hard-core exclusion. In case when the charged TP experiences a bias due to external electric field ${\bf E}$, (which favors its jumps in the preferential direction), we determine exactly the limiting probability distribution of the TP position in terms of appropriate scaling variables and the leading large-N ($n$ being the discrete time) behavior of the TP mean displacement $\bar{{\bf X}}_n$; the latter is shown to obey an anomalous, logarithmic law $|\bar{{\bf X}}_n| = \alpha_0(|{\bf E}|) \ln(n)$. On comparing our results with earlier predictions by Brummelhuis and Hilhorst (J. Stat. Phys. {\bf 53}, 249 (1988)) for the TP diffusivity $D_n$ in the unbiased case, we infer that the Einstein relation $\mu_n = \beta D_n$ between the TP diffusivity and the mobility $\mu_n = \lim_{|{\bf E}| \to 0}(|\bar{{\bf X}}_n|/| {\bf E} |n)$ holds in the leading in $n$ order, despite the fact that both $D_n$ and $\mu_n$ are not constant but vanish as $n \to \infty$. We also generalize our approach to the situation with very small but finite vacancy concentration $\rho$, in which case we find a ballistic-type law $|\bar{{\bf X}}_n| = \pi \alpha_0(|{\bf E}|) \rho n$. We demonstrate that here, again, both $D_n$ and $\mu_n$, calculated in the linear in $\rho$ approximation, do obey the Einstein relation.Comment: 25 pages, one figure, TeX, submitted to J. Stat. Phy

The health burden and economic costs averted by ambient PM 2.5 pollution reductions in Nagpur, India

National estimates of the health and economic burdens of exposure to ambient fine particulate matter (PM2.5) in India reveal substantial impacts. This information, often lacking at the local level, can justify and drive mitigation interventions. Here, we assess the health and economic gains resulting from attainment of WHO guidelines for PM2.5 concentrations – including interim target 2 (IT-2), interim target 3 (IT-3), and theWHO air quality guideline (AQG) – in Nagpur district to inform policy decision making for mitigation. We conducted a detailed assessment of concentrations of PM2.5 in 9 areas, covering urban, peri-urban and rural environments, from February 2013 to June 2014. We used a combination of hazard and survival analyses based on the life table method to calculate attributed annual number of premature deaths and disability-adjusted life years (DALYs) for five health outcomes linked to PM2.5 exposure: acute lower respiratory infection for children b5 years, ischemic heart disease, chronic obstructive pulmonary disease, stroke and lung cancer in adults !25 years. We used GBD 2013 data on deaths and DALYs for these diseases. We calculated averted deaths, DALYs and economic loss resulting from planned reductions in average PM2.5 concentration from current level to IT-2, IT-3 and AQG by the years 2023, 2033 and 2043, respectively. The economic cost for premature mortality was estimated as the product of attributed deaths and value of statistical life for India, while morbidity was assumed to be 10% of the mortality cost. The annual average PM2.5 concentration in Nagpur district is 34± 17 μg m−3 and results in 3.3 (95% confidence interval [CI]: 2.6, 4.2) thousand premature deaths and 91 (95% CI: 68, 116) thousand DALYs in 2013 with economic loss of USD 2.2 (95% CI: 1.7, 2.8) billion in that year. It is estimated that interventions that achieve IT-2, IT-3 and AQG by 2023, 2033 and 2043,would avert, respectively, 15, 30 and 36%, of the attributed health and economic loss in those years, translating into an impressively large health and economic gain. To achieve this, we recommend an exposure-integrated source reduction approach

The Cranberry Flavonoids PAC DP-9 and Quercetin Aglycone Induce Cytotoxicity and Cell Cycle Arrest and Increase Cisplatin Sensitivity in Ovarian Cancer Cells

Cranberry flavonoids (flavonols and flavan-3-ols), in addition to their antioxidant properties, have been shown to possess potential in vitro activity against several cancers. However, the difficulty of isolating cranberry compounds has largely limited anticancer research to crude fractions without well-defined compound composition. In this study, individual cranberry flavonoids were isolated to the highest purity achieved so far using gravity and high performance column chromatography and LC-MS characterization. MTS assay indicated differential cell viability reduction of SKOV-3 and OVCAR-8 ovarian cancer cells treated with individual cranberry flavonoids. Treatment with quercetin aglycone and PAC DP-9, which exhibited the strongest activity, induced apoptosis, led to caspase-3 activation and PARP deactivation, and increased sensitivity to cisplatin. Furthermore, immunofluorescence microscopy and western blot study revealed reduced expression and activation of epidermal growth factor receptor (EGFR) in PAC DP-9 treated SKOV-3 cells. In addition, quercetin aglycone and PAC DP-9 deactivated MAPK-ERK pathway, induced downregulation of cyclin D1, DNA-PK, phospho-histone H3 and upregulation of p21, and arrested cell cycle progression. Overall, this study demonstrates promising in vitro cytotoxic and anti-proliferative properties of two newly characterized cranberry flavonoids, quercetin aglycone and PAC DP-9, against ovarian cancer cells

Corrosion inhibitive properties of Epimedium grandiflorum on mild steel in HCl acidic media

Corrosion inhibitors in controlling metal failure had been the practice for handling the menace of corrosion. Most of synthetic inhibitors is expensive and not environmental friendly, hence, the need for cheap, renewable, non-hazardous and green inhibitors to handle environmental issues. In this particular study, the inhibitory properties of Epimedium grandiflorum plant extract on the corrosion of mild steel in HCl acidic media was investigated. The gasometric, weight loss and the linear polarization methods were used in the study with adsorption isotherms (Langmuir, Freundlich, Frumkin and Temkin) validating the state of the reaction. The concentration of the extract was prepared in serial dilution of 10 - 50% using a stock solution of 1.75 M HCl. Mild steel coupons of known elemental compositions were immersed in test solutions of both stock solution and extract solutions. In the gasometric method, a decrease in volume of hydrogen gas evolved was observed as concentration of extract increases. Result from the weight loss shows similar trend of inhibitory behaviour for the weight loss method as the weight loss experienced by the coupons reduces as extract concentration increases. The Taffel plot for the extract indicates good inhibitive properties with inhibition efficiency increasing with extract concentration. In all the three methods studied, the maximum inhibition efficiency was observed in the 50% extract concentration. The extract fits best into the Freundlich isotherm indicating physisorption. This study showed that this particular plant extract is an effective inhibitor in suppressing the corrosion on the surface of the metal

Effect of connectivity on the carrier transport and recombination dynamics of perovskite quantum dot networks

Quantum dot (QD) solids are being widely exploited as a solution-processable technology to develop photovoltaic, light-emission, and photo-detection devices. Charge transport in these materials is the result of a compromise between confinement at the individual QD level and electronic coupling among the different nanocrystals in the ensemble. While this is commonly achieved by ligand engineering in colloidal-based systems, ligand-free QD assemblies have recently emerged as an exciting alternative where nanostructures can be directly grown into porous matrices with optical quality as well as control over their connectivity and hence charge transport properties. In this context, we present a complete photophysical study comprising fluence and temperature-dependent time-resolved spectroscopy to study carrier dynamics in ligand-free QD networks with gradually varying degrees of interconnectivity, which we achieve by changing the average distance between the QDs. Analysis of the photoluminescence and absorption properties of the QD assemblies, involving both static and time-resolved measurements, allows us to identify the weight of the different recombination mechanisms, both radiative and non-radiative, as a function of QD connectivity. We propose a picture where carrier diffusion, which is needed for any optoelectronic application and implies inter-particle transport, gives rise to the exposure of carriers to a larger defect landscape than in the case of isolated QDs. The use of a broad range of fluences permits extracting valuable information for applications demanding either low or high carrier injection levels and highlighting the relevance of a judicious design to balance recombination and diffusion.Comment: 16 pages, 5 figures in main manuscript; 11 pages, 11 figures in Supporting Informatio

Clinical Study Outcome of Glansectomy and Skin Grafting in the Management of Penile Cancer

properly cited. Purpose. To report outcome data for patients with penile cancer treated surgically with glansectomy and skin grafting. Materials and Methods. We retrospectively reviewed data on all patients undergoing surgical management of penile cancer by a single surgeon between 1998 and 2008. Outcomes in patients who underwent glansectomy and skin grafting were analysed. Results. Between 1998 and 2008 a total of 25 patients with a mean age 60 (39-83) underwent glansectomy and skin grafting. Six patients had carcinoma in situ (CIS); the stage in the remaining patients ranged from T1G1 to T3G3. Mean followup for patients was 28 months (range 6-66). Disease specific survival was 92% with 2 patients who had positive nodes at lymph node dissection developing groin recurrence. One patient developed a local recurrence requiring a partial penectomy. Conclusions. Penile preserving surgery with glansectomy and skin grafting is a successful technique with minimal complications for local control of penile carcinoma arising on the glans. Careful followup to exclude local recurrence is required

A Composite Metric for Benchmarking Site Performance in TAVR: Results from the STS/ACC TVT Registry

Background: Transcatheter aortic valve replacement (TAVR) is a transformative therapy for aortic stenosis. Despite rapid improvements in technology and techniques, serious complications remain relatively common and are not well described by single outcome measures. The purpose of this study was to determine if there is site-level variation in TAVR outcomes in the United States using a novel 30-day composite measure. Methods: We performed a retrospective cohort study using data from the STS/ACC TVT Registry to develop a novel ranked composite performance measure that incorporates mortality and serious complications. The selection and rank order of the complications for the composite was determined by their adjusted association with 1-year outcomes. Sites whose risk-adjusted outcomes were significantly more or less frequent than the national average based on a 95% probability interval were classified as performing worse or better than expected. Results: The development cohort consisted of 52,561 patients who underwent TAVR between January 1, 2015 and December 31, 2017. Based on the associations with 1-year risk-adjusted mortality and health status, we identified four periprocedural complications to include in the composite risk model in addition to mortality. Ranked empirically according to severity, these included stroke, major, life-threatening or disabling bleeding, stage III acute kidney injury, and moderate or severe peri-valvular regurgitation. Based on these ranked outcomes, we found that there was significant site-level variation in quality of care in TAVR in the United States. Overall, better than expected site performance was observed in 25/301 (8%) of sites; performance as expected was observed in 242/301 sites (80%); and worse than expected performance was observed in 34/301 (11%) of sites. Thirty-day mortality, stroke, major, life-threatening or disabling bleeding, and moderate or severe peri-valvular leak were each substantially more common in sites with worse than expected performance as compared with other sites. There was good aggregate reliability of the model. Conclusions: There are substantial variations in the quality of TAVR care received in the United States, and 11% of sites were identified as providing care below the average level of performance. Further study is necessary to determine structural, process-related, and technical factors associated with high- and low-performing sites

Comments on Holographic Entanglement Entropy and RG Flows

Using holographic entanglement entropy for strip geometry, we construct a candidate for a c-function in arbitrary dimensions. For holographic theories dual to Einstein gravity, this c-function is shown to decrease monotonically along RG flows. A sufficient condition required for this monotonic flow is that the stress tensor of the matter fields driving the holographic RG flow must satisfy the null energy condition over the holographic surface used to calculate the entanglement entropy. In the case where the bulk theory is described by Gauss-Bonnet gravity, the latter condition alone is not sufficient to establish the monotonic flow of the c-function. We also observe that for certain holographic RG flows, the entanglement entropy undergoes a 'phase transition' as the size of the system grows and as a result, evolution of the c-function may exhibit a discontinuous drop.Comment: References adde