Moving from the margins: The role of narrative and metaphor in health literacy

Narrative and metaphor are now recognised to be central to thought, language and communication, and consequently have relevance to discourse and action in many areas including health and wellbeing. In this paper, narrative and metaphor are examined in relation to areas relevant to health literacy. The ways in which narrative and metaphor relate to dimensions of health literacy identified by Zarcadoolas et al. (Zarcadoolas C, Pleasant A, Greer D. Advancing health literacy – a framework for understanding and action. San Francisco: John Wiley & Sons Inc; 2006.); fundamental, scientific, cultural, and civic are analysed. The work aims to provide a rationale for greater incorporation of narrative and metaphor in discussions and activities related to health literacy

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Problems of the recycling of fresh air (circulating air)

Translated from German (Luft- und Kaeltetechnik 1986 (4) p. 204-206)SIGLEAvailable from British Library Document Supply Centre- DSC:9022.381(HSE-Trans--12201)T / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Untersuchungen zum effektiven Einsatz des Druckluftimpulsabreinigungsverfahrens fuer Grossraumfilterpatronen Schlussbericht

Often the cleaning of large scale cartridge-filters (> 300 mm diameter, 1200 mm length) by pulse-jet-cleaning is critical. Usually the lower cleaning effect is compensated by a reduced filter area load and increased pressure air consumption. The aim of investigation is to improve the cleaning effect, to reduce the pressure air consumption and to extend the field of using of such cartridge filters. The task was solved by reducing of the effective cartridge volume with a geometric adjusted body inside and with an arrangement of a ring slot injector. By the inside body (filter area load 60 m"3m "-"2 h "-"1 ) the pressure air consumption is reduced by about 20%, the pressure drop by about 45% and the energy consumption by about 43% compared to conventional conception. A steady mode of operation was reached at 60 m"3m "-"2 h "-"1 with the used testing-talc-dust (dust mass flux: 3000 gh "-"1 /cartridge). The cleaned air dust concentration was reduced from 1,14 to 0,69 mgm "-"3 . (orig.)Die Abreinigung grosser Filterpatronen (> 300 mm Durchmesser, 1200 mm lang) ist mit der Druckluftimpulsabreinigung oft kritisch. Die geringere Abreinigungswirkung wird deshalb meist durch reduzierte Filterflaechenbelastungen und erhoehten Druckluftverbrauch kompensiert. Ziel des Vorhabens war, die Abreinigungswirkung zu verbessern, den Druckluftverbrauch zu senken und die Einsatzbreite derartiger Filterpatronen zu vergroessern. Geloest wurde die Aufgabe durch das Verkleinern des freien Patroneninnenraumes mit geometrisch angepassten Innenkoerpern und der Zuordnung eines Ringspaltinjektors. Gegenueber der konventionellen Konzeption wird mit den Einbauten (Filterflaechenbelastung: 60 m"3m "-"2 h "-"1 ) der Druckluftverbrauch um ca. 20%, der Druckverlust um ca. 45% und der Energieverbrauch um ca. 43% gesenkt. Mit dem verwendeten Talkum-Teststaub (Staubmassenstrom: 3000 gh "-"1 /Patrone) wurde bei 60 m"3m "-"2 m "-"1 eine stabile Betriebsweise erreicht. Die Reinluftstaubkonzentration konnte von 1,14 auf 0,69 mgm "-"3 gesenkt werden. (orig.)Available from TIB Hannover: F94B0592+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany)DEGerman