1,355 research outputs found
āFor review and managementā: The role of the referral letter in surgical consultations
Background: The referral letter serves a central role in the transfer of patients from referring doctors to specialist care in Australia. Aim: We analysed the form and function of referral letters and examined their role in surgical consultations to better understand the information in the letter and what impact that may or may not have on consultation openings. Methods: Thirteen referral letters and their associated recorded surgical consultations were analysed with an iterative, multi-methods qualitative approach. Using inductive and deductive linguistic methods, we considered clinical and paraclinical information as well as contextual factors in the lettersā alignment with referral guidelines as well as overall relevance to the consultation. Results: The analysis showed that surgeons tend to have a āset pieceā when opening a consultation that is independent of the content or style of the referral. While referral letters fell short of guidelines, additional patient information was frequently discussed in the consultation. Discussion: Patients and surgeons are generally able to work around interactional challenges related to patient information. However, recognising the need to supplement referral information particularly around paraclinical information and contextual factors is important. Conclusions: Future changes to referral letter guidelines could reflect these realities
Highly accurate dating of micrometre-scale baddeleyite domains through combined focused ion beam extraction and UāPb thermal ionization mass spectrometry (FIB-TIMS)
Ultrasound-guided percutaneous delivery of tissue-engineered endothelial cells to the adventitia of stented arteries controls the response to vascular injury in a porcine model
Objective
High restenosis rates are a limitation of peripheral vascular interventions. Previous studies have shown that surgical implantation of a tissue-engineered endothelium onto the adventitia surface of injured vessels regulates vascular repair. In the present study, we developed a particulate formulation of tissue-engineered endothelium and a method to deliver the formulation perivascular to injured blood vessels using a percutaneous, minimally invasive technique.
Methods
Stainless steel stents were implanted in 18 balloon-injured femoral arteries of nine domestic swine, followed by ultrasound-guided percutaneous perivascular injection of gelatin particles containing cultured allogeneic porcine aortic endothelial cells (PAE). Controls received injections of empty particles (matrix) or no perivascular injection (sham) after stent deployment. Animals were sacrificed after 90 days.
Results
Angiographic analysis revealed a significantly greater lumen diameter in the stented segments of arteries treated with PAE/matrix (4.72 Ā± 0.12 mm) compared with matrix (4.01 Ā± 0.20 mm) or sham (4.03 Ā± 0.16 mm) controls (P < .05). Similarly, histologic analysis revealed that PAE/matrix-treated arteries had the greatest lumen area (20.4 Ā± 0.7 mm[superscript 2]; P < .05) compared with controls (16.1 Ā± 0.9 mm[superscript 2] and 17.1 Ā± 1.0 mm[superscript 2] for sham and matrix controls, respectively) and the smallest intimal area (3.3 Ā± 0.4 mm[superscript 2]; P < .05) compared with controls (6.2 Ā± 0.5 mm[superscript 2] and 4.4 Ā± 0.5 mm[superscript 2] for sham and matrix controls, respectively). Overall, PAE-treated arteries had a 33% to 50% decrease in percent occlusion (P < .05) compared with controls. Histopathological analysis revealed fewer leukocytes present in the intima in the PAE/matrix group compared with control groups, suggesting that the biological effects were in part due to inhibition of the inflammatory phase of the vascular response to injury.
Conclusions
Minimally invasive, perivascular delivery of PAE/matrix to stented arteries was performed safely using ultrasound-guided percutaneous injections and significantly decreased stenosis. Application at the time of or subsequent to peripheral interventions may decrease clinical restenosis rates
Performance Characterisation and Optimisation of a Building Integrated Photovoltaic (BIPV) System in a Maritime Climate
A seasonal analysis of a long-term dataset produced by an off-grid classroom facility showcasing several solar orientated renewable technologies is presented. The performance of the buildingās BIPV and battery storage system is characterised and optimisation strategies are discussed. The building experiences a typical oceanic climate defined by a relatively narrow annual temperature range and a high level of annual precipitation, resulting in significant fluctuation in PV performance throughout the year. On clear days, the battery system reaches capacity quickly and PV power output drops to the base load of the building. This curtailment of solar generation highlights the importance of developing control strategies to optimise system performance. Maximising the performance of the building requires accurate methodologies for predicting PV generationĀ and detailed knowledge of building demand profiles. Significant correlation is observed between the solar irradiance, battery state of charge and PV power output, demonstrating the importance of these variables in any solar forecasting model. Demand profiles are deterministic and follow classroom routine. A baseline accounts for persistent systems such as the building management system that are active throughout the day, with demand peaking during occupancy. This information could be incorporated into scheduling algorithms to optimise performance. Consumption is more aligned with the solar generation profile than typical residential buildings that peak in the evening as levels of solar generation fall. The synergistic effect of buildings with different demand profiles could be a mitigation method to minimise the temporal mismatch between solar generation and consumption
Agency and ageing in place in rural Ireland
This report explores the experiences and
preferences of older adults on ageing in place
in rural Ireland. This exploration is undertaken
through a participatory mixed-methods approach
that seeks to foreground the voices of older
adults themselves. The research study involved
two phases. Phase one entailed a nationwide
online and postal survey co-constructed
with Age Actionās GlĆ³r advocacy group and
University of the Third Age (U3A) membership
and distributed to Age Action members living
in rural areas across Ireland. 218 people aged
55 and older who live in rural areas took part in
the survey and every county was represented,
with 45% of respondents from Munster, 36%
from Leinster, 12% from Connaught, and 7% from
Ulster. Phase two involved a series of four focus
groups in which 19 people took part. The focus
groups explored the survey themes
in more depth.
The research highlights the diversity of
experience of home and community among the
older adults in rural Ireland who took part. Most
participants expressed a strong desire to remain
in their homes and communities as they age. The
sense of attachment to home and place had, for
many, strengthened since the pandemic. Some
participants, however, highlighted the tenuous
nature of their living arrangements and their
sense of alienation from place.
This was particularly the case for the
participants who were renting, who had
recently moved locations to be closer to
children, or who found the limited facilities and
social opportunities in their rural environments
restrictive.
Whether they were settled in their homes and
communities or not, all participants highlighted
the uncertainty of their positions and their
fears for being able to have their preference
for remaining in place realised as they aged.
This was related to unpredictable factors such
as their future health needs and availability of
home care, their ongoing ability to drive, or their
capacity to afford to live independently given the
ambiguity surrounding future pension provision
and the escalating costs associated with utilities,
healthcare, home maintenance and expenses
related to rural living, such as security, water,
and sewerage costs.
The general decline of towns and villages was
highlighted by participants, as was the poor
coverage of public transport in rural areas.
These aspects not only heightened the sense
of isolation of participants in terms of access to
services and social activities; they also served
to heighten their sense of marginalisation
and perceived loss of agency in terms of
policy formation and political representation.
Participants also noted the limited options
available to them should they consider moving
from their rural locations, something that would
be particularly challenging for most given
their emotional connection to their homes and
communities. The lack of affordable and suitable
housing for older adults was a particular concern.
Most participants were strongly opposed to
nursing homes, a view which the experience
of the pandemic had often reinforced. While a
small number saw their benefit in cases of critical
care, most were dissatisfied with the current
āFair Dealā Scheme for funding nursing home
care. They argued that, instead of focussing
resources on a nursing home option not favoured
by older adults, the government should develop
an alternative statutory home care scheme that
would support older adults to remain in their
homes as they age.
The supports which were noted as important in
relation to allowing adults to age in their homes
included a more accessible and fit-for-purpose
grant system to fund modifications to the home
ā the most popular of these being an emergency
response system, bathroom modifications, and
improved heating. The need for a properly paid
and resourced home help service, as well as
a home and garden maintenance service, was
emphasised. This was especially the case given
the changing reality of ageing in Irish society and
the fact that many older adults cannot rely on the
availability or ability of family members to care
for them in their homes.
Access to broadband in rural areas was also
noted as crucial, not only given the fact that
more aspects of daily services are being
conducted online but also given the importance
of a reliable broadband connection in facilitating
isolated rural older adults to connect to others.
Participants highlighted their enjoyment of
meeting each other and realising their difficulties
were shared despite their diverse locations as
benefits of the research process in the current
study. They argued for the need for training in
technology which could be a significant enabler
to their remaining in place, as opposed to
presenting a barrier to their doing so. They also
argued that there was a need to tackle the covert
ageism which was seen as endemic in institutions
and everyday interactions, and which served to
marginalise older adults further.
Participants noted their preferences were they
to need additional supports which could not be
provided in their homes in the future. In this case,
their favoured options would be co-operative or
sheltered housing and retirement villages. These
options were available for very few participants
locally, however, meaning that they would be
required to move from their communities, as well
as their homes.
The research, while small in scale resonates with
global research on the theme,1
and highlights
that the ability of older adults to age in place
requires coordination among several different
policy areas, not least housing, transport,
technology, and healthcare. There is a need to
adjust the funding focus from moving people
who need help out of their homes to ensuring
that the help they need is available to them in
their homes for as long as possible. There is also
a need to develop housing options, other than
nursing homes, to address peopleās preferences
should staying at home be no longer a feasible
option. Finally, and most importantly, there is
a requirement to listen to older people in rural
areas about where and how they wish to age
in ways that support their sense of agency and
challenge flawed assumptions about ageing. This
research seeks to contribute to that aim both
through its focus and its process
Crystallization and impact history of a meteoritic sample of early lunar crust (NWA 3163) refined by atom probe geochronology
Temporal contiguity requirements for long-term associative potentiation/depression in the hippocampus
Delivery Site of Perivascular Endothelial Cell Matrices Determines Control of Stenosis in a Porcine Femoral Stent Model
PURPOSE: High restenosis rates are a major limitation of peripheral interventions. Endothelial cells, grown within gelatin matrices and implanted onto the adventitia of injured vessels, inhibit stenosis in experimental models. To determine if this technology could be adapted for minimally invasive procedures, we compared the effects of cells in an implantable sponge to an injectable formulation and investigated the importance of delivery site in a stent model.
MATERIALS AND METHODS: Stents were implanted in the femoral arteries of 30 pigs followed
by perivascular implantation of sponges or injection of particles containing allogeneic endothelial cells. Controls received acellular matrices or nothing. The effects of delivery site were assessed by injecting cellular matrices into or adjacent to the perivascular tissue, or into the neighboring muscle. Animals were sacrificed after 28 days. Pre-sacrifice angiograms and tissue sections were evaluated for stenosis.
RESULTS: Arteries treated with cellular matrices had a 55 ā 63% decrease in angiographic stenosis (P<0.05) and a 38 ā 43% reduction (P<0.05) in histologic stenoses compared to controls. Intimal area was greatest when cellular matrices were delivered into the muscle (6.35 Ā± 0.95 mm2) compared to into or adjacent to the perivascular tissue (4.05 Ā± 0.56 mm2 and 4.73 Ā± 0.53 mm2, respectively, P < 0.05).
CONCLUSIONS: Perivascular endothelial-cell matrices reduced stenosis after stent-induced
injury. The effects were not dependent on the formulation but appeared to be dependent upon delivery site. Minimally invasive injections of endothelial-cell matrices to the adventitia of arteries following peripheral interventions may decrease restenosis rates.National Institutes of Health (U.S.) (Grant GM 49039
Case management of malaria fever in Cambodia: results from national anti-malarial outlet and household surveys
BACKGROUND: Continued progress towards global reduction in morbidity and mortality due to malaria requires scale-up of effective case management with artemisinin-combination therapy (ACT). The first case of artemisinin resistance in Plasmodium falciparum was documented in western Cambodia. Spread of artemisinin resistance would threaten recent gains in global malaria control. As such, the anti-malarial market and malaria case management practices in Cambodia have global significance. METHODS: Nationally-representative household and outlet surveys were conducted in 2009 among areas in Cambodia with malaria risk. An anti-malarial audit was conducted among all public and private outlets with the potential to sell anti-malarials. Indicators on availability, price and relative volumes sold/distributed were calculated across types of anti-malarials and outlets. The household survey collected information about management of recent "malaria fevers." Case management in the public versus private sector, and anti-malarial treatment based on malaria diagnostic testing were examined. RESULTS: Most public outlets (85%) and nearly half of private pharmacies, clinics and drug stores stock ACT. Oral artemisinin monotherapy was found in pharmacies/clinics (9%), drug stores (14%), mobile providers (4%) and grocery stores (2%). Among total anti-malarial volumes sold/distributed nationally, 6% are artemisinin monotherapies and 72% are ACT. Only 45% of people with recent "malaria fever" reportedly receive a diagnostic test, and the most common treatment acquired is a drug cocktail containing no identifiable anti-malarial. A self-reported positive diagnostic test, particularly when received in the public sector, improves likelihood of receiving anti-malarial treatment. Nonetheless, anti-malarial treatment of reportedly positive cases is low among people who seek treatment exclusively in the public (61%) and private (42%) sectors. CONCLUSIONS: While data on the anti-malarial market shows favourable progress towards replacing artemisinin monotherapies with ACT, the widespread use of drug cocktails to treat malaria is a barrier to effective case management. Significant achievements have been made in availability of diagnostic testing and effective treatment in the public and private sectors. However, interventions to improve case management are urgently required, particularly in the private sector. Evidence-based interventions that target provider and consumer behaviour are needed to support uptake of diagnostic testing and treatment with full-course first-line anti-malarials
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