Pulmonary arterial hypertension in repaired congenital heart disease: a multicentre study

This doctoral thesis aims to investigate the demographics, treatment patterns and prognosis of paediatric pulmonary hypertension (PH) and the emerging group of children and adults with PH in the setting of repaired congenital heart disease (CHD). I have conducted three studies, each with a distinct focus. The first is a retrospective, longitudinal study of ten CHD centres across the UK that assesses the clinical characteristics and treatment patterns of adults with a Fontan-type circulation receiving pulmonary vasodilators. I have compared treated patients with a matched cohort of Fontan patients who are not receiving pulmonary vasodilator therapy, complemented by an expert survey to determine current practice and the goals of therapy. In the second study, I created a 20-year national UK registry of paediatric PH and derived estimates of incidence and prevalence for all groups of paediatric PH in different age categories. I determined the natural history of paediatric PH and performed survival analysis. I then focused on patients with CHD and described the changes in demographics, with a substantial increase in patients with previously repaired CHD, who now form the largest PAH-CHD subgroup. The third study focuses on this latter group of repaired PAH-CHD. I highlighted the heterogeneity in terms of severity and onset of PAH. I identified prognostic markers and variables associated with PH resolution and developed a novel risk score for predicting adverse clinical outcomes in this group. This score will form the basis for the risk stratification of this high-risk population, to inform prognostication and guide treatment.Open Acces

Analysis of enhanced pharmacy services in rural community pharmacies in Western Australia

Introduction: Enhanced pharmacy services (EPS) are health related services above those normally available with the supply of medicines. Rural pharmacies could provide a diversity of EPS in response to the limited access and reduced health services available in rural areas. The objective of this study was to evaluate the provision of EPS in rural Western Australian (WA) pharmacies in 2006, compared with findings extracted from a national survey conducted in 2002. Barriers to and facilitators for the provision of ETS in rural settings were also analysed. Methods: The survey was conducted in 2006, using a questionnaire developed from a 2002 Australian national survey questionnaire. The questionnaires were mailed to all 103 pharmacies in rural WA and 51 were returned (49.5%). Chi-squared tests were used to test associations between year of survey and provision of each EPS. Where significant associations were reported, logistic regression analyses that controlled for sex, age, PhARIA location (remoteness), and inclusion of a forward pharmacy area were performed. Results: The WA rural pharmacies offered a range of EPS. There were marked increases in weight testing and weight management services. The availability of smoking cessation services increased from 52% of rural pharmacies in 2002 to 63% in 2006. Other EPS (asthma, diabetes, hypertension, hyperlipidaemia), which correspond to the Australian Government National Health Priorities Areas were offered by 20% to 50% of pharmacies and had not increased between surveys. A continued shortage in the pharmacist workforce was a major barrier to EPS provision. Conclusions: Provision of EPS in rural pharmacies is more important than in metropolitan pharmacies because there is often a lack of other sources for these services in rural and remote locations. A range of defined EPS were provided by 25% to 60% of rural and remote pharmacies, with other services offered in lower percentages. Significant increases were found in some important EPS, such as weight management. Additional support for EPS provision in rural and remote communities is required to increas

Ordering our world: the quest for traces of temporal organization in autobiographical memory

An experiment examined the idea, derived from the Self Memory System model (Conway & Pleydell-Pearce, 2000), that autobiographical events are sometimes tagged in memory with labels reflecting the life era in which an event occurred. The presence of such labels should affect the ease of judgments of the order in which life events occurred. Accordingly, 39 participants judged the order of two autobiographical events. Latency data consistently showed that between-era judgments were faster than within-era judgments, when the eras were defined in terms of either: (a) college versus high school, (b) academic quarter within year, or (c) academic year within school. The accuracy data similarly supported the presence of a between-era judgment effect for the college versus high school dichotomy

Réhabilitation médicale des troubles de la circulation sanguine pendant la période périopératoire chez les patients présentant des lésions pathologiques du rein unique

L'analyse de la littérature, des recherches antérieures ont prouvé de manière convaincante que les lésions unilatérales de l'organe apparié des reins par tout processus pathologique affectent l'état de la circulation sanguine dans le parenchyme rénal. Ce dernier conduit non seulement à une violation de l'état fonctionnel du rein affecté, mais entraîne également le développement de changements morphologiques pathologiques dans le tissu rénal. Cependant, le rein controlatéral est également affecté négativement. L'effet supplémentaire de la chirurgie affecte également la restauration adéquate de la fonction rénale totale. Il existe deux façons d'influencer positivement l'état de la circulation sanguine: améliorer les propriétés rhéologiques du sang et prévenir ou réduire les spasmes vasculaires du parenchyme rénal. Le but de l'étude. Développer et utiliser cliniquement une méthode de correction périopératoire du flux sanguin rénal chez les patients présentant des lésions rénales unilatérales. Matériel et méthodes de recherche. Une étude clinique a été menée chez 108 patients âgés de 18 à 65 ans pour déterminer les modifications du flux sanguin vers le parenchyme rénal dans divers types de pathologie unilatérale, pour lesquelles un traitement chirurgical a été effectué

Ka-Band Radar Terminal Descent Sensor

The terminal descent sensor (TDS) is a radar altimeter/velocimeter that improves the accuracy of velocity sensing by more than an order of magnitude when compared to existing sensors. The TDS is designed for the safe planetary landing of payloads, and may be used in helicopters and fixed-wing aircraft requiring high-accuracy velocity sensin

Timing of Decremental Response During Repetitive Nerve Stimulation in Myasthenia Gravis

Background: A decrement >10% detected during repetitive nerve stimulation (RNS) is supportive of considering a diagnosis of myasthenia gravis (MG). Several studies have found that most of this decrement is seen between 4 to 6 min post-exercise. However, there are not available studies analyzing if shorter timing would be sufficient.   Objective: The objective of this study was to evaluate if RNS up to 2 min post-exercise is sufficient to detect a decrement response >10%. Methods: We performed a retrospective chart review study of patients referred to our neuromuscular clinic at The University of Kansas Medical Center with symptoms suggestive of MG from 2013 to 2017. Results: A total of 76 patients with MG and 100 controls were identified.  A significant decrement was detected in 95% of MG patients with abnormal RNS within 2 minutes post-exercise. Conclusion: RNS up to 2 min post-exercise might be sufficient to detect a significant decrement in MG patients.&nbsp