Current challenges in palliative care provision for heart failure in the UK: a survey on the perspectives of palliative care professionals

Objective Palliative care (PC) in heart failure (HF) is beneficial and recommended in international HF guidelines. However, there is a perception that PC is underutilised in HF in the UK. This exploratory study aims to investigate, from a PC perspective, this perceived underutilisation and identify problems with current practice that may impact on the provision of PC in HF throughout the UK. Methods A prospective survey was electronically sent to PC doctors and nurses via the UK Association for Palliative Medicine and adult PC teams listed in the UK Hospice directory. Results We received 499 responses (42%—PC consultants). Although PC provision for patients with HF was widespread, burden on PC services was low (47% received less than 10 referrals annually). While PC was acknowledged to have a role in end-stage HF, there were differing views about the optimal model of care. Levels of interdisciplinary collaboration (58%) and mutual education (36%) were low. There were frequent reports that end-of-life matters were not addressed by cardiology prior to PC referral. Moreover, 24% of respondents experienced difficulties with implantable cardioverter defibrillator deactivation. Conclusions Low HF referrals despite widespread availability of PC services and insufficient efforts by cardiology to address PC issues may contribute to the perception that PC is underutilised in HF. The challenges facing PC and HF identified here need to be further investigated and addressed. These findings will hopefully promote awareness of PC issues in HF and encourage debate on how to improve PC support for this population

Population-specific material properties of the implantation site for transcatheter aortic valve replacement finite element simulations

Patient-specific computational models are an established tool to support device development and test under clinically relevant boundary conditions. Potentially, such models could be used to aid the clinical decision-making process for percutaneous valve selection; however, their adoption in clinical practice is still limited to individual cases. To be fully informative, they should include patient-specific data on both anatomy and mechanics of the implantation site. In this work, fourteen patient-specific computational models for transcatheter aortic valve replacement (TAVR) with balloon-expandable Sapien XT devices were retrospectively developed to tune the material parameters of the implantation site mechanical model for the average TAVR population. Pre-procedural computed tomography (CT) images were post-processed to create the 3D patient-specific anatomy of the implantation site. Balloon valvuloplasty and device deployment were simulated with finite element (FE) analysis. Valve leaflets and aortic root were modelled as linear elastic materials, while calcification as elastoplastic. Material properties were initially selected from literature; then, a statistical analysis was designed to investigate the effect of each implantation site material parameter on the implanted stent diameter and thus identify the combination of material parameters for TAVR patients. These numerical models were validated against clinical data. The comparison between stent diameters measured from post-procedural fluoroscopy images and final computational results showed a mean difference of 2.5 ± 3.9%. Moreover, the numerical model detected the presence of paravalvular leakage (PVL) in 79% of cases, as assessed by post-TAVR echocardiographic examination. The final aim was to increase accuracy and reliability of such computational tools for prospective clinical applications

Tunable Nanometer Electrode Gaps by MeV Ion Irradiation

We report the use of MeV ion-irradiation-induced plastic deformation of amorphous materials to fabricate electrodes with nanometer-sized gaps. Plastic deformation of the amorphous metal $\text{Pd}_{80}\text{Si}_{20}$ is induced by $4.64 \text{MeV O}^{2+}$ ion irradiation, allowing the complete closing of a sub-micrometer gap. We measure the evolving gap size in situ by monitoring the field emission current-voltage (I-V) characteristics between electrodes. The I-V behavior is consistent with Fowler-Nordheim tunneling. We show that using feedback control on this signal permits gap size fabrication with atomic-scale precision. We expect this approach to nanogap fabrication will enable the practical realization of single molecule controlled devices and sensors.Engineering and Applied SciencesPhysic

Harnessing bacterial power in microscale actuation

This paper presents a systematic analysis of the motion of microscale structures actuated by flagellated bacteria. We perform the study both experimentally and theoretically. We use a blotting procedure to attach flagellated bacteria to a buoyancy-neutral plate called a microbarge. The motion of the plate depends on the distribution of the cells on the plate and the stimuli from the environment. We construct a stochastic mathematical model for the system, based on the assumption that the behavior of each bacterium is random and independent of that of its neighbors. The main finding of the paper is that the motion of the barge plus bacteria system is a function of a very small set of parameters. This reduced-dimensional model can be easily estimated using experimental data. We show that the simulation results obtained from the model show an excellent match with the experimentally-observed motion of the barge

The Integrative Effects of Board Diversity, Firm Reputation, and Innovation vis-a-vis Firm Performance

A plethora of worldwide study on board diversity and its relationship with firm performance had produced mixed results. Our study investigated not only from the board diversity perspective, but also examined the integrative web of firm reputation and innovation as well as the shareholder activism. We employed Smart PLS and SPSS to run the 105-sampled data and the statistical findings suggested that firm reputation does boost firm performance but not innovation, and also there is a positive correlation between board diversity and firm reputation. The findings further posit that shareholder activism does indeed affect diverse representation of the board. However, it does not agree that shareholder activism itself has a positive correlation with firm performance. This could be attributed to the views of top-level management, directors, and company secretaries, who are more familiar with the nuances of the board modus operandi and functions