Coronary–aortic interaction during ventricular isovolumic contraction

In earlier work, we suggested that the start of the isovolumic contraction period could be detected in arterial pressure waveforms as the start of a temporary pre-systolic pressure perturbation (AICstart, start of the Arterially detected Isovolumic Contraction), and proposed the retrograde coronary blood volume flow in combination with a backwards traveling pressure wave as its most likely origin. In this study, we tested this hypothesis by means of a coronary artery occlusion protocol. In six Yorkshire × Landrace swine, we simultaneously occluded the left anterior descending (LAD) and left circumflex (LCx) artery for 5 s followed by a 20-s reperfusion period and repeated this sequence at least two more times. A similar procedure was used to occlude only the right coronary artery (RCA) and finally all three main coronary arteries simultaneously. None of the occlusion protocols caused a decrease in the arterial pressure perturbation in the aorta during occlusion (P > 0.20) nor an increase during reactive hyperemia (P > 0.22), despite a higher deceleration of coronary blood volume flow (P = 0.03) or increased coronary conductance (P = 0.04) during hyperemia. These results show that the pre-systolic aortic pressure perturbation does not originate from the coronary arteries

Steering for Sustainable Development Goals: A Typology of Sustainable Innovation

Process and product innovation are defined as an organizational ability to discover and translate creative approaches to solve multiple organizational problems. The process and product innovation contribute to the supply of economic, social, and environmental benefits, thus ensuring sustainable environmental growth. It helps companies to achieve greater profits, reduce environmental burden, and use a material that can be more resource-efficient. Process and product innovation have become ubiquitous and part of everyday life. Sustainable process and product innovation are contemplated as an essential means for addressing infrastructure resilience for sustainability challenges. Although the perspective is huge, the governance and capability structure eventually dictate what innovation is likely to be developed.Post-print / Final draf

Physician Burnout and Patient Satisfaction with Consultation in Primary Health Care Settings: Evidence of Relationships from a one-with-many Design

Physician burnout, as a prolonged response to chronic emotional and interpersonal stressors on the job, has been associated with suboptimal patient care and deterioration in the patient-provider relationship. Although prior studies have identified a range of factors associated with decreased patient satisfaction, most have been conducted in tertiary care settings, while staff burnout has been examined at the hospital unit-level. To examine the impact of physician burnout on patient satisfaction from consultation in the primary care setting, a cross-sectional survey was conducted in Western Greece. Using a one-with-many design, 30 physicians and 300 of their patients, randomly selected, responded to the survey. Results showed that patient satisfaction correlated significantly with physician emotional exhaustion (r = -.636, p<.01) and physician depersonalization (r = -.541, p<.01). Mixed-effects multi-level models indicated that 34.4% of total variation in patients' satisfaction occurred at the physician level, after adjustment for patients' characteristics. Moreover, physician emotional exhaustion and depersonalisation remained significant factors associated with patient satisfaction with consultation, after controlling for patient and physician characteristics. Patients of physicians with high-exhaustion and high depersonalisation had significantly lower satisfaction scores, compared with patients of physicians with low-exhaustion and low depersonalisation, respectively. Future studies need to explore the mechanisms by which physician burnout affects patient satisfaction