Adapted cardiac rehabilitation programme to improve uptake in patients of Moroccan and Turkish origin in The Netherlands:a qualitative study

Aim. To explore the treatment experiences in patients of Moroccan and Turkish origin and their rehabilitation therapists regarding an adapted outpatient cardiac rehabilitation programme. Background. Non-native patients who participated in a cardiac rehabilitation programme at a Dutch rehabilitation centre had more difficulties to achieve the treatment aims than native Dutch patients. Therefore, an adapted programme for non-native patients, lacking proficiency in Dutch, has been instigated. The programme contains six adapted treatment modules and additional strategies: adapted education regarding (1) the heart and the vascular system and (2) the use of healthy food, with use the of (audio) visual educational materials, (3) adapted physical exercise module with explicit involvement of the patients relatives, (4) standard use of professional interpreters, (5) increase in the number and length of consultations and (6) individual treatment instead of a group programme. Design. Qualitative study. Method. Semi-structured, face-to-face interviews were conducted with eight patients of Moroccan and Turkish origin and five native Dutch rehabilitation therapists. By comparison, three native Dutch patients were interviewed regarding the regular programme. Results. The results indicate that the patients disease symptoms reduced and that patients adopted lifestyle changes. Therapists experienced that the number and length of the consultations, the structural use of interpreters and (audio) visual educational materials contributed to the achievement of the treatment aims. Conclusion. An adapted cardiac rehabilitation programme with separate modules and additional strategies for non-native patients appears to lead to satisfied patients who adopted lifestyle changes. Relevance to clinical practice. The findings of this study are important as the study highlights the practical actions that may be taken by physicians and healthworkers to adjust rehabilitation treatment to the needs of patients of non-native origin

The Remains of the Fray: Nascent Colonialism and Heterogeneous Hybridity

Investigations at the Native American site complex of Stark Farms in Mississippi, USA, have yielded numerous examples of metal artifacts of European origin. Our study suggests that they derive from contact between the AD 1540–1541 winter encampment of the Spanish Hernando de Soto expedition and the local Indigenous polity. The artifacts display a wide range of modifications, uses, and depositional contexts congruent with hybrid practices. We argue that the early colonial setting of Stark Farms requires a different perspective on cultural mixing than is often applied in studies of European colonialism. This is highlighted by the strongly improvisational nature of the modification of the metal objects, embodying a political climate in which European incursions were precarious and in which hybridity and power were heterogeneous and fluid

Non-Abelian Excitations of the Quark-Gluon Plasma

We present new, non-abelian, solutions to the equations of motion which describe the collective excitations of a quark-gluon plasma at high temperature. These solutions correspond to spatially uniform color oscillations.Comment: 8 pages LaTex, 1 figure (not included; available upon request), Saclay preprint T94/0

Superconducting instability in 3 band metallic nanotubes

Motivated by recent experiments on small radius nanotubes, we study the superconducting instabilities of cylindrical (5,0) nanotubes. According to band structure calculations, thesenanotubes possess three bands at the Fermi energy. Using a fermionic renormalization group approach and a careful bosonization treatment,we consider the effect of different attractive interactions, mediated by phonons, within the Luttinger Liquid framework. We particularly focus on a superconducting instability specific to the three bands model we consider for the description of these (5,0) cylindrical nanotubes.Comment: RevTeX 4, 17 pages, 10 EPS figure

Assessing simulation ecosystem processes for climate variability research at Glacier National Park

Glacier National Park served as a test site for ecosystem analyses that involved a suite of integrated models embedded within a geographic information system. The goal of the exercise was to provide managers with maps that could illustrate probable shifts in vegetation, net primary production (NPP), and hydrologic responses associated with two selected climatic scenarios. The climatic scenarios were (a) a recent 12-yr record of weather data, and (b) a reconstituted set that sequentially introduced in repeated 3-yr intervals wetter–cooler, drier–warmer, and typical conditions. To extrapolate the implications of changes in ecosystem processes and resulting growth and distribution of vegetation and snowpack, the model incorporated geographic data. With underlying digital elevation maps, soil depth and texture, extrapolated climate, and current information on vegetation types and satellite-derived estimates of leaf area indices, simulations were extended to envision how the park might look after 120 yr. The predictions of change included underlying processes affecting the availability of water and nitrogen. Considerable field data were acquired to compare with model predictions under current climatic conditions. In general, the integrated landscape models of ecosystem processes had good agreement with measured NPP, snowpack, and streamflow, but the exercise revealed the difficulty and necessity of averaging point measurements across landscapes to achieve comparable results with modeled values. Under the extremely variable climate scenario significant changes in vegetation composition and growth as well as hydrologic responses were predicted across the park. In particular, a general rise in both the upper and lower limits of treeline was predicted. These shifts would probably occur along with a variety of disturbances (fire, insect, and disease outbreaks) as predictions of physiological stress (water, nutrients, light) altered competitive relations and hydrologic responses. The use of integrated landscape models applied in this exercise should provide managers with insights into the underlying processes important in maintaining community structure, and at the same time, locate where changes on the landscape are most likely to occur

Promoting survival: A grounded theory study of consequences of modern health practices in Ouramanat region of Iranian Kurdistan

The aim of this qualitative study is to explore the way people using modern health care perceive its consequences in Ouraman-e-Takht region of Iranian Kurdistan. Ouraman-e-Takht is a rural, highly mountainous and dry region located in the southwest Kurdistan province of Iran. Recently, modern health practices have been introduced to the region. The purpose of this study was to investigate, from the Ouramains' point of view, the impact that modern health services and practices have had on the Ouraman traditional way of life. Interview data from respondents were analyzed by using grounded theory. Promoting survival was the core category that explained the impact that modern health practices have had on the Ouraman region. The people of Ouraman interpreted modern health practices as increasing their quality of life and promoting their survival. Results are organized around this core category in a paradigm model consisting of conditions, interactions, and consequences. This model can be used to understand the impact of change from the introduction of modern health on a traditional society

Mediation of the solar wind termination shock by non-thermal ions

Broad regions on both sides of the solar wind termination shock are populated by high intensities of non- thermal ions and electrons. The pre- shock particles in the solar wind have been measured by the spacecraft Voyager 1 ( refs 1 - 5) and Voyager 2 ( refs 3, 6). The post- shock particles in the heliosheath have also been measured by Voyager 1 ( refs 3 - 5). It was not clear, however, what effect these particles might have on the physics of the shock transition until Voyager 2 crossed the shock on 31 August - 1 September 2007 ( refs 7 - 9). Unlike Voyager 1, Voyager 2 is making plasma measurements(7). Data from the plasma(7) and magnetic field(8) instruments on Voyager 2 indicate that non- thermal ion distributions probably have key roles in mediating dynamical processes at the termination shock and in the heliosheath. Here we report that intensities of low- energy ions measured by Voyager 2 produce non- thermal partial ion pressures in the heliosheath that are comparable to ( or exceed) both the thermal plasma pressures and the scalar magnetic field pressures. We conclude that these ions are the >0.028 MeV portion of the non- thermal ion distribution that determines the termination shock structure(8) and the acceleration of which extracts a large fraction of bulk- flow kinetic energy from the incident solar wind(7).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62516/1/nature07030.pd

Coulombian Disorder in Periodic Systems

We study the effect of unscreened charged impurities on periodic systems. We show that the long wavelength component of the disorder becomes long ranged and dominates static correlation functions. On the other hand, because of the statistical tilt symmetry, dynamical properties such as pinning remain unaffected. As a concrete example, we focus on the effect of Coulombian disorder generated by charged impurities, on 3D charge density waves with non local elasticity. We calculate the x-ray intensity and find that it is identical to the one produced by thermal fluctuations in a disorder-free smectic-A. We discuss the consequences of these results for experiments.Comment: 11 pages, 3 figures, revtex

Impact of Appropriate Antimicrobial Therapy for Patients with Severe Sepsis and Septic Shock – A Quality Improvement Study

Background There is ample literature available on the association between both time to antibiotics and appropriateness of antibiotics and clinical outcomes from sepsis. In fact, the current state of debate surrounds the balance to be struck between prompt empirical therapy and care in the choice of appropriate antibiotics (both in terms of the susceptibility of infecting organism and minimizing resistance arising from use of broad-spectrum agents). The objective of this study is to determine sepsis bundle compliance and the appropriateness of antimicrobial therapy in patients with severe sepsis and septic shock and its impact on outcomes. Material This study was conducted in the ICU of a tertiary care, private hospital in São Paulo, Brazil. A retrospective cohort study was conducted from July 2005 to December 2012 in patients with severe sepsis and septic shock. Results A total of 1,279 patients were identified with severe sepsis and septic shock, of which 358 (32.1%) had bloodstream infection (BSI). The inpatient mortality rate was 29%. In evaluation of the sepsis bundle, over time there was a progressive increase in serum arterial lactate collection, obtaining blood cultures prior to antibiotic administration, administration of broad-spectrum antibiotics within 1 hour, and administration of appropriate antimicrobials, with statistically significant differences in the later years of the study. We also observed a significant decrease in mortality. In patients with bloodstream infection, after adjustment for other covariates the administration of appropriate antimicrobial therapy was associated with a decrease in mortality in patients with severe sepsis and septic shock (p = 0.023). Conclusions The administration of appropriate antimicrobial therapy was independently associated with a decline in mortality in patients with severe sepsis and septic shock due to bloodstream infection. As protocol adherence increased over time, the crude mortality rate decreased, which reinforces the need to implement institutional guidelines and monitor appropriate antimicrobial therapy compliance

Production of a Prompt Photon in Association with Charm at Next-to-Leading Order in QCD

A second order, $O(\alpha ^2_s)$, calculation in perturbative quantum chromodynamics of the two particle inclusive cross section is presented for the reaction $p +\bar{p}\rightarrow \gamma + c + X$ for large values of the transverse momentum of the prompt photon and charm quark. The combination of analytic and Monte Carlo integration methods used here to perform phase-space integrations facilitates imposition of photon isolation restrictions and other selections of relevance in experiments. Differential distributions are provided for various observables. Positive correlations in rapidity are predicted.Comment: 27 pages in RevTex plus 14 figures in one compressed PS fil