Home medicines reviews following acute coronary syndrome: study protocol for a randomized controlled trial

Background: Despite continual improvements in the management of acute coronary syndromes, adherence to guideline-based medications remains suboptimal. We aim to improve adherence with guideline-based therapy following acute coronary syndrome using an existing service that is provided by specifically trained pharmacists, called a Home Medicines Review. We have made two minor adjustments to target the focus of the existing service including an acute coronary syndrome specific referral letter and a training package for the pharmacists providing the service.Methods/Design: We will be conducting a randomized controlled trial to compare the directed home medicines review service to usual care following acute coronary syndromes. All patients aged 18 to 80 years and with a working diagnosis of acute coronary syndrome, who are admitted to two public, acute care hospitals, will be screened for enrolment into the trial. Exclusion criteria will include: not being discharged home, documented cognitive decline, non-Medicare eligibility, and presence of a terminal malignancy. Randomization concealment and sequence generation will occur through a centrally-monitored computer program. Patients randomized to the control group will receive usual post-discharge care. Patients randomized to receive the intervention will be offered usual post-discharge care and a directed home medicines review at two months post-discharge. The study endpoints will be six and twelve months post-discharge. The primary outcome will be the proportion of patients who are adherent to a complete, guideline-based medication regimen. Secondary outcomes will include hospital readmission rates, length of hospital stays, changes in quality of life, smoking cessation rates, cardiac rehabilitation completion rates, and mortality.Discussion: As the trial is closely based on an existing service, any improvements observed should be highly translatable into regular practice. Possible limitations to the success of the trial intervention include general practitioner approval of the intervention, general practitioner acceptance of pharmacists' recommendations, and pharmacists' ability to make appropriate recommendations. A detailed monitoring process will detect any barriers to the success of the trial. Given that poor medication persistence following acute coronary syndrome is a worldwide problem, the findings of our study may have international implications for the care of this patient group.Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12611000452998. © 2012 Bernal et al; licensee BioMed Central Ltd

Fully scaled transonic turbine rotor heat transfer measurements

The heat transfer to an uncooled transonic singlestage turbine has been measured in a short-duration facility, which fully simulates all the nondimensional quantities of interest for fluid flow and heat transfer (Reynolds number, Prandtl number, Rossby number, temperature ratios, and corrected speed and weight flow). Data from heat flux gages about the midspan of the rotor profile, measured from d-c to more than 10 times blade passing frequency (60 kHz), are presented in both time-resolved and mean heat transfer form. These rotating blade data are compared to previously published heat transfer measurements taken at Oxford University on the same profile in a two-dimensional cascade with bar passing to simulate blade row interaction effects. The results are qualitatively quite similar at midspan. The data are also compared to a two-dimensional Navier-Stokes calculation of the blade mean section and the implications for turbine design are discussed

Retention and damage in 3C-β SiC irradiated with He and H ions.

3C-β SiC was implanted with He and H ions using plasma immersion ion implantation (PIII). Regions of damage were created at various depths by applying a sample stage bias of 5 kV, 10 kV, 20 kV or 30 kV. Raman spectroscopy results indicate that He irradiation leads to more damage compared to H irradiation, as observed via increased disordered C and Si signals, as well as broadening of the SiC peaks. X-ray photoelectron spectroscopy (XPS) and near edge X-ray absorption fine structure spectroscopy (NEXAFS) results indicate significant change to the SiC structure and that surface oxidation has occurred following irradiation, with the degree of change varying dependent on impinging He fluence. The distributions of implanted species were measured using elastic recoil detection analysis. Despite the varying degree and depth of damage created in the SiC by the He ion irradiations, the retained H distribution was observed to not be affected by preceding He implantation. © 2015 Elsevier B.V

Retention and damage in 3C-β SiC irradiated with He and H ions

3C-β SiC was implanted with He and H ions using plasma immersion ion implantation (PIII). Regions of damage were created at various depths by applying a sample stage bias of 5 kV, 10 kV, 20 kV or 30 kV. Raman spectroscopy results indicate that He irradiation leads to more damage compared to H irradiation, as observed via increased disordered C and Si signals, as well as broadening of the SiC peaks. X-ray photoelectron spectroscopy (XPS) and near edge X-ray absorption fine structure spectroscopy (NEXAFS) results indicate significant change to the SiC structure and that surface oxidation has occurred following irradiation, with the degree of change varying dependent on impinging He fluence. The distributions of implanted species were measured using elastic recoil detection analysis. Despite the varying degree and depth of damage created in the SiC by the He ion irradiations, the retained H distribution was observed to not be affected by preceding He implantation. © 2015, Elsevier B.V

Diamond structure recovery during ion irradiation at elevated temperatures

CVD diamond is irradiated by 5 MeV carbon ions, with each sample held at a different temperature (300–873 K) during irradiations. The defect structures resulting from the irradiations are evident as vacancy, interstitial and amorphous carbon signals in Raman spectra. The observed variation of the full width at half maximum (FWHM) and peak position of the diamond peak suggests that disorder in the diamond lattice is reduced for high temperature irradiations. The dumbbell interstitial signal is reduced for irradiations at 873 K, which suggests this defect is unstable at these temperatures and that interstitials have migrated to crystal surfaces. Near edge X-ray absorption fine structure (NEXAFS) spectroscopy results indicate that damage to the diamond structure at the surface has occurred for room temperature irradiations, however, this structure is at least partially recovered for irradiations performed at 473 K and above. The results suggest that, in a high temperature irradiation environment such as a nuclear fusion device, in situ annealing of radiation-created defects can maintain the diamond structure and prolong the lifetime of diamond components. © 2015 Elsevier B.V

Ion irradiated graphite exposed to fusion-relevant deuterium plasma

Graphite samples were irradiated with 5 MeV carbon ions to simulate the damage caused by collision cascades from neutron irradiation in a fusion environment. The ion irradiated graphite samples were then exposed to a deuterium plasma in the linear plasma device, MAGPIE, for a total ion fluence of ∼1 × 1024 ions m−2. Raman and near edge X-ray absorption fine structure (NEXAFS) spectroscopy were used to characterize modifications to the graphitic structure. Ion irradiation was observed to decrease the graphitic content and induce disorder in the graphite. Subsequent plasma exposure decreased the graphitic content further. Structural and surface chemistry changes were observed to be greatest for the sample irradiated with the greatest fluence of MeV ions. D retention was measured using elastic recoil detection analysis and showed that ion irradiation increased the amount of retained deuterium in graphite by a factor of four. © 2014, Elsevier B.V