Development of a health-related lifestyle self-management intervention for patients with coronary heart disease

Risk-factor modification after an acute coronary event is imperative, and intervention strategies are continuously being developed to assist patients with behavioral change and, consequently, decreasing the risk of further coronary episodes. This article describes the development of the health-related lifestyle self-management (HeLM) intervention, which is a brief structured intervention embedded within the transtheoretical model of behavioral change. The HeLM intervention was developed by undertaking three discrete yet interrelated studies and consisted of the following components: goal-setting, the HeLM booklet, feedback regarding personal risk, team-building and communication with the patient's family physician, three supportive telephone calls, trained interviewers, a refrigerator magnet, and a health diary for self-monitoring. The HeLM intervention has been successfully implemented in 50 patients with acute coronary syndrome after discharge from hospital and has been demonstrated to be feasible and practical and could easily be delivered by health care professionals

A pilot randomised controlled trial comparing a health-related lifestyle self-management intervention with standard cardiac rehabilitation following an acute cardiac event: Implications for a larger clinical trial

Summary. Purpose: This pilot study was to assess the feasibility of the health-related lifestyle self-management (HeLM) intervention as a strategy to decrease cardiovascular risk following acute coronary syndrome. Methods: Participants in this randomised controlled trial were recruited from a tertiary teaching hospital in metropolitan Sydney Australia. The multifaceted HeLM intervention, using the principles of the transtheoretical model, involved the use of bibliotherapy, a structured evidence-based approach to cardiovascular risk reduction, a communication strategy with general practitioners, three supportive telephone calls to participants and provision of behavioural prompts and a health record diary. Differences in behavioural and clinical outcomes between the HeLM intervention group (n=29) and the standard cardiac rehabilitation group (n=22) were assessed.Results: A total of 125 participants screened were eligible for participation in the study. Fifty-one participants, mean age 57 years (+8.78) were randomised. At the 8-week follow up, participants in the HeLM intervention group had a reduced systolic blood pressure compared to the standard care group (120.3 S.D.: 16.3 vs. 126.4 S.D.: 14.6). There were no significant differences in diastolic blood pressure and cholesterol levels between the two groups. Participants in both the intervention and control group had a reduction in waist circumference although when compared to baseline values, women in the HeLM intervention group had a greater reduction compared to those receiving standard care. Patients reported high levels of satisfaction with this intervention. Conclusions: Findings support the feasibility of implementing the health-related lifestyle self-management intervention for risk factor modification in patients with acute coronary syndrome. An adequately powered randomised controlled trial is required to test the impact of the intervention on cardiovascular risk reduction

The distribution of Polychlorinated Biphenyls (PCBs) in the River Thames Catchment under the scenarios of climate change

Measurements have shown low levels of PCBs in water but relatively high concentrations in the resident fish of the River Thames (UK). To better understand the distribution and behaviour of PCBs in the Thames river basin and their potential risks, a level III fugacity model was applied to selected PCB congeners (PCB 52, PCB 118 and PCB 153). The modelling results indicated that fish and sediments represent environmental compartments with the highest PCB concentrations; but the greatest mass of PCBs (over 70%) is likely to remain in the soil. As emissions decline, soil could then act as a significant secondary source of PCBs with the river bed-sediment functioning as a long-term reservoir of PCBs. The predicted changes in temperature and rainfall forecast in the UK Climate Projections 2009 (UKCP09) over the next 80 years had only a modest influence on PCB fate in the model. The most significant result was a tendency for climate change to enhance the evaporation of PCBs from soil to air in the Thames catchment. (C) 2015 Elsevier B.V. All rights reserved

Component-Level Electronic-Assembly Repair (CLEAR) Analysis of the Problem Reporting and Corrective Action (PRACA) Database of the International Space Station On-Orbit Electrical Systems

The NASA Constellation Program is investigating and developing technologies to support human exploration of the Moon and Mars. The Component-Level Electronic-Assembly Repair (CLEAR) task is part of the Supportability Project managed by the Exploration Technology Development Program. CLEAR is aimed at enabling a flight crew to diagnose and repair electronic circuits in space yet minimize logistics spares, equipment, and crew time and training. For insight into actual space repair needs, in early 2008 the project examined the operational experience of the International Space Station (ISS) program. CLEAR examined the ISS on-orbit Problem Reporting and Corrective Action database for electrical and electronic system problems. The ISS has higher than predicted reliability yet, as expected, it has persistent problems. A goal was to identify which on-orbit electrical problems could be resolved by a component-level replacement. A further goal was to identify problems that could benefit from the additional diagnostic and test capability that a component-level repair capability could provide. The study indicated that many problems stem from a small set of root causes that also represent distinct component problems. The study also determined that there are certain recurring problems where the current telemetry instrumentation and built-in tests are unable to completely resolve the problem. As a result, the root cause is listed as unknown. Overall, roughly 42 percent of on-orbit electrical problems on ISS could be addressed with a component-level repair. Furthermore, 63 percent of on-orbit electrical problems on ISS could benefit from additional external diagnostic and test capability. These results indicate that in situ component-level repair in combination with diagnostic and test capability can be expected to increase system availability and reduce logistics. The CLEAR approach can increase the flight crew s ability to act decisively to resolve problems while reducing dependency on Earth-supplied logistics for future Constellation Program missions

Exploration of Cardiology Patient Hospital Presentations, Health Care Utilisation and Cardiovascular Risk Factors During the COVID-19 Pandemic

Objectives: COVID-19 and the lockdowns have affected health care provision internationally, including medical procedures and methods of consultation. We aimed to assess the impact of COVID-19 at two Australian hospitals, focussing on cardiovascular hospital admissions, the use of community resources and cardiovascular risk factor control through a mixed methods approach. Methods: Admissions data from the quaternary referral hospital were analysed, and 299 patients were interviewed from July 2020 to December 2021. With the admissions data, the number, complexity and mortality of cardiology hospital admissions, prior to the first COVID-19 lockdown (T0=February 2018–July 2019) were compared to after the introduction of COVID-19 lockdowns (T1=February 2020–July 2021). During interviews, we asked patients about hospital and community health resource use, and their control of cardiovascular risk factors from the first lockdown. Results: Admission data showed a reduction in hospital presentations (T0=138,099 vs T1=128,030) and cardiology admissions after the lockdown period began (T0=4,951 vs T1=4,390). After the COVID-19-related lockdowns began, there was an increased complexity of cardiology admissions (T0=18.7%, 95% CI 17.7%–19.9% vs T1=20.3%, 95% CI 19.1%–21.5%, chi-square test: 4,158.658, p<0.001) and in-hospital mortality (T0=2.3% of total cardiology admissions 95% CI 1.9%–2.8% vs T1=2.8%, 95% CI 2.3%–3.3%, chi-square test: 4,060.217, p<0.001). In addition, 27% of patients delayed presentation due to fears of COVID-19 while several patients reported reducing their general practitioner or pathology/imaging appointments (27% and 11% respectively). Overall, 19% reported more difficulty accessing medical care during the lockdown periods. Patients described changes in their cardiovascular risk factors, including 25% reporting reductions in physical activity. Conclusion: We found a decrease in hospital presentations but with increased complexity after the introduction of COVID-19 lockdowns. Patients reported being fearful about presenting to hospital and experiencing difficulty in accessing community health services

Component-Level Electronic-Assembly Repair (CLEAR) System Architecture

This document captures the system architecture for a Component-Level Electronic-Assembly Repair (CLEAR) capability needed for electronics maintenance and repair of the Constellation Program (CxP). CLEAR is intended to improve flight system supportability and reduce the mass of spares required to maintain the electronics of human rated spacecraft on long duration missions. By necessity it allows the crew to make repairs that would otherwise be performed by Earth based repair depots. Because of practical knowledge and skill limitations of small spaceflight crews they must be augmented by Earth based support crews and automated repair equipment. This system architecture covers the complete system from ground-user to flight hardware and flight crew and defines an Earth segment and a Space segment. The Earth Segment involves database management, operational planning, and remote equipment programming and validation processes. The Space Segment involves the automated diagnostic, test and repair equipment required for a complete repair process. This document defines three major subsystems including, tele-operations that links the flight hardware to ground support, highly reconfigurable diagnostics and test instruments, and a CLEAR Repair Apparatus that automates the physical repair process

Component-Level Electronic-Assembly Repair (CLEAR) Operational Concept

This Component-Level Electronic-Assembly Repair (CLEAR) Operational Concept document was developed as a first step in developing the Component-Level Electronic-Assembly Repair (CLEAR) System Architecture (NASA/TM-2011-216956). The CLEAR operational concept defines how the system will be used by the Constellation Program and what needs it meets. The document creates scenarios for major elements of the CLEAR architecture. These scenarios are generic enough to apply to near-Earth, Moon, and Mars missions. The CLEAR operational concept involves basic assumptions about the overall program architecture and interactions with the CLEAR system architecture. The assumptions include spacecraft and operational constraints for near-Earth orbit, Moon, and Mars missions. This document addresses an incremental development strategy where capabilities evolve over time, but it is structured to prevent obsolescence. The approach minimizes flight hardware by exploiting Internet-like telecommunications that enables CLEAR capabilities to remain on Earth and to be uplinked as needed. To minimize crew time and operational cost, CLEAR exploits offline development and validation to support online teleoperations. Operational concept scenarios are developed for diagnostics, repair, and functional test operations. Many of the supporting functions defined in these operational scenarios are further defined as technologies in NASA/TM-2011-216956

3D Surface Measurement for Medical Application—Technical Comparison of Two Established Industrial Surface Scanning Systems

In 3D mapping of flexible surfaces (e.g. human faces) measurement errors due to movement or positioning occur. Aggravated by equipment- or researcher-caused mistakes considerable deviations can result. Therefore first the appliances' precision handling and reliability in clinical environment must be established. Aim of this study was to investigate accuracy and precision of two contact-free 3D measurement systems (white light vs. laser). Standard specimens of known diameter for sphere deviation, touch deviation and plane deviation were tested. Both systems are appropriate for medical application acquiring solid data (<mm). The more complex white-light system shows better accuracy at 0.2s measuring time. The laser system is superior concerning robustness, while accuracy is poorer and input time (1.5-2.5s) longer. Due to the clinical demand the white-light system is superior in a laboratory environment, while the laser system is easier to handle under non-laboratory condition

Which metal represents the greatest risk to freshwater ecosystem in Bohai Region of China?

Metals discharged from industrial effluents, agricultural wastewater, and sewage runoff by rapid urbanization are of concern as contaminants of freshwater ecosystem because of their persistence and high toxicity to aquatic organisms. This study attempted to identify which metal posed the greatest risk to freshwater ecosystem in the Bohai Region, China. The metals arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), zinc (Zn), lead (Pb), nickel (Ni), mercury (Hg), iron (Fe), and manganese (Mn) were compared against norfloxacin and gamma-hexachlorocyclohexane (lindane). By comparing the median reported environmental and ecotoxicity concentrations, it showed that Cu, Fe, Zn, Mn, and Cr were the top five metals of concern. Of these, Cu was deemed to represent the highest risk and Hg the lowest risk. The risks for all metals were higher than those for norfloxacin and lindane. Almost all the metals except Hg had water concentrations that exceeded levels where ecotoxicity effects had been recorded in the literature. A comparison with the measurements across the UK rivers suggested that all metals examined had water concentrations about 5- to 10- fold higher than the UK median values except for Cu, Fe, Cd, and Pb. The Fuyang River, a tributary of the Haihe River Basin, seemed to be the location with the highest metal concentrations. However, comparing the post- 2010 period to 2000–2009, concentrations of all the metals had fallen except for Fe and Mn, so risks have decreased over the last 7 yr with the greatest improvements for Cd and Pb. While metals still pose high risks to freshwater ecosystem in this region, there is encouragement that some control measures are taken into effect

Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: A serial cardiac MRI study

Aims: Left ventricular (LV) thrombus is a complication of acute ST-segment elevation myocardial infarction (STEMI). We determined the incidence and predictors of LV thrombus formation using serial cardiac magnetic resonance (CMR) and two-dimensional echocardiography studies. Methods and results: Two hundred and ten patients underwent CMR (median 4 days [IQR 3-7]) and transthoracic echocardiography (median 4 days [IQR 3-7]) early after STEMI presentation with serial follow-up CMR (median 55 days [IQR 46-64]) and echocardiography studies (median 54 days [IQR 45-64]) performed subsequently. The incidence of LV thrombus was 12.3% (26/210) by CMR and 6.2% (13/210) by two-dimensional echocardiography. Echocardiography had 50% sensitivity and 100% specificity for LV thrombus detection compared to CMR. LV thrombus was found in 23.6% of patients with anterior STEMI (22/93). Ischaemic stroke occurred in 1.4% of patients (3/210). Patients with LV thrombus had lower baseline LV ejection fraction (LVEF) (34.9% vs 47.4%, p < 0.001). Microvascular obstruction was more common in patients with LV thrombus (77% vs 39%, p < 0.001). Patients with LV thrombus had increased LV dimensions with larger LV end-diastolic (19 ml [IQR 9-44] vs 6 ml [IQR -4-18], p < 0.001) and end-systolic volumes (10 ml [IQR 0–22] vs -4 ml [IQR -12-4], p < 0.001). Conclusion: CMR increases the detection of LV thrombi which standard echocardiography may underestimate. Serial studies post-STEMI may improve detection of LV thrombus, which is more prevalent in patients with anterior infarction, moderate LV dysfunction and adverse LV remodelling. This subgroup of patients may represent a high-risk group for targeted serial screening with CMR