A qualitative study of the contribution of pharmacists to heart failure management in Scotland

Study objectives: (1) To identify the medication management needs of chronic heart failure (CHF) patients and their caregivers; (2) To examine the perceived support for medication management available to these people from health professionals; (3) To identify the actual and potential perceived contribution of pharmacists to medication management. Setting: A mixed urban/ rural region in the west of Scotland. Design: Semi-structured qualitative research interviews. Participants: A total of 50 people with CHF (NYHA Class II and III) due to left ventricular systolic dysfunction (33 males; mean age 67 years, 17 females; mean age 68 years) and 30 nominated caregivers recruited from the outpatient departments of two hospitals in the West of Scotland. Sampling was purposive to include patients from a range of CHF severity, ages and sexes. Main results: Managing medications was a responsibility shared by both the patients with CHF and caregivers. Treatment regimens were reported to be difficult to comply with. Health professionals were seen to provide little support for medication management. Pharmacists were viewed as being a good and accessible source of practical assistance who were also knowledgeable about the individual’s heart health history. Participants reported valuing advice from pharmacists about the side effects of medications and for their assistance in reducing the complex logistics of medication management and in having medications delivered. Conclusions: Patients with CHF and caregivers voiced a willingness to try to manage their medication regimen accurately but had a limited capacity to do so. Pharmacists were viewed as providing valuable support to patients with CHF and their caregivers, in terms of medication management. The extended role of pharmacists in medication management of CHF should be encouraged

Novel electrocardiographic criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy

Aims: In order to improve the electrocardiographic (ECG) diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC), we evaluated novel quantitative parameters of the QRS complex and the value of bipolar chest leads (CF leads) computed from the standard 12 leads. Methods and results: We analysed digital 12-lead ECGs in 44 patients with ARVC, 276 healthy subjects including 44 age and sex-matched with the patients and 36 genotyped members of ARVC families. The length and area of the terminal S wave in V1 to V3 were measured automatically using a common for all 12 leads QRS end. T wave negativity was assessed in V1 to V6 and in the bipolar CF leads computed from the standard 12 leads. The length and area of the terminal S wave were significantly shorter, whereas the S wave duration was significantly longer in ARVC patients compared with matched controls. Among members of ARVC families, those with mutations (n = 15) had shorter QRS length in V2 and V3 and smaller QRS area in lead V2 compared with those without mutations (n = 20). In ARVC patients, the CF leads were diagnostically superior to the standard unipolar precordial leads. Terminal S wave duration in V1 >48 ms or major T wave negativity in CF leads separated ARVC patients from matched controls with 90% sensitivity and 86% specificity. Conclusion: The terminal S wave length and area in the right precordial leads are diagnostically useful and suitable for automatic analysis in ARVC. The CF leads are diagnostically superior to the unipolar precordial leads

Asymptotic normalization coefficients for 8B->7Be+p from a study of 8Li->7Li+n

Asymptotic normalization coefficients (ANCs) for 8Li->7Li+n have been extracted from the neutron transfer reaction 13C(7Li,8Li)12C at 63 MeV. These are related to the ANCs in 8B->7Be+p using charge symmetry. We extract ANCs for 8B that are in very good agreement with those inferred from proton transfer and breakup experiments. We have also separated the contributions from the p_1/2 and p_3/2 components in the transfer. We find the astrophysical factor for the 7Be(p,gamma)8B reaction to be S_17(0)=17.6+/-1.7 eVb. This is the first time that the rate of a direct capture reaction of astrophysical interest has been determined through a measurement of the ANCs in the mirror system.Comment: 5 pages, 3 figures, 2 table

Andreev Reflections in Micrometer-Scale Normal-Insulator-Superconductor Tunnel Junctions

Understanding the subgap behavior of Normal-Insulator-Superconductor (NIS) tunnel junctions is important in order to be able to accurately model the thermal properties of the junctions. Hekking and Nazarov developed a theory in which NIS subgap current in thin-film structures can be modeled by multiple Andreev reflections. In their theory, the current due to Andreev reflections depends on the junction area and the junction resistance area product. We have measured the current due to Andreev reflections in NIS tunnel junctions for various junction sizes and junction resistance area products and found that the multiple reflection theory is in agreement with our data

Influence of temperature gradients on tunnel junction thermometry below 1 K: cooling and electron-phonon coupling

We have studied thermal gradients in thin Cu and AlMn wires, both experimentally and theoretically. In the experiments, the wires were Joule heated non-uniformly at sub-Kelvin temperatures, and the resulting temperature gradients were measured using normal metal-insulator-superconducting tunnel junctions. The data clearly shows that even in reasonably well conducting thin wires with a short ($\sim 10 \mu$m) non-heated portion, significant temperature differences can form. In most cases, the measurements agree well with a model which includes electron-phonon interaction and electronic thermal conductivity by the Wiedemann-Franz law.Comment: J. Low Temp. Phys. in pres

The Effective Action For Brane Localized Gauge Fields

The low energy effective action including gauge field degrees of freedom on a non-BPS p=2 brane embedded in a N=1, D=4 target superspace is obtained through the method of nonlinear realizations of the associated super-Poincare symmetries. The invariant interactions of the gauge fields and the brane excitation modes corresponding to the Nambu-Goldstone degrees of freedom resulting from the broken space translational symmetry and the target space supersymmetries are determined. Brane localized matter field interactions with the gauge fields are obtained through the construction of the combined gauge and super-Poincare covariant derivatives for the matter fields.Comment: 12 pages, no figure

The role of nucleon structure in finite nuclei

The quark-meson coupling model, based on a mean field description of non-overlapping nucleon bags bound by the self-consistent exchange of $\sigma$, $\omega$ and $\rho$ mesons, is extended to investigate the properties of finite nuclei. Using the Born-Oppenheimer approximation to describe the interacting quark-meson system, we derive the effective equation of motion for the nucleon, as well as the self-consistent equations for the meson mean fields. The model is first applied to nuclear matter, after which we show some initial results for finite nuclei.Comment: The revised version. This is tar, compressed and uuencoded (including 3 tables and 8 figures). 45 page