The views of parents concerning the planning of services for rehabilitation of families of children with congenital cardiac disease

Background and purpose: Although much previous research has focused on the medical aspects of congenital cardiac disease, there is a growing body of research which suggests that families may need help and support with the wider issues associated with the medical condition. We have previously ascertained from young people with congenital cardiac disease their views on this subject. The purpose of this study was to obtain the views of their parents about the need for, and shape of, services for rehabilitation. Methods: This was a qualitative study using semi-structured interviews. We interviewed 17 parents in their own home. Interviews were tape-recorded and transcribed. Results: Parents would welcome more help and support from health professionals to enable them to manage more effectively the condition with their children. Particular areas of concern relate to the information they receive about the condition; communication between themselves and health professionals; establishing safe levels of activity; and managing the condition at school. Conclusions: This is a small study of the experiences and views of parents, which provides some important information on ways in which health professionals. could address the current lack of services for rehabilitation

A simple screening method for determining knowledge of the appropriate levels of activity and risk behaviour in young people with congenital cardiac conditions

Objective: To assess a novel method for assessing risk and providing advice about activity to children and young people with congenital cardiac disease and their parents. Design and setting: Questionnaire survey in outpatient clinics at a tertiary centre dealing with congenital cardiac disease, and 6 peripheral clinics. Interventions: Children or their parents completed a brief questionnaire. If this indicated a desire for help, or a serious mismatch between advised and real level of activity, they were telephoned by a physiotherapist. Main measures of outcome: Knowledge about appropriate levels of activity, and identification of the number exercising at an unsafe level, the number seeking help, and the type of help required. Results: 253/258 (98.0%) questionnaires were returned, with 119/253 (47.0%) showing incorrect responses in their belief about their advised level of exercise; 17/253 (6.7%) had potentially dangerous overestimation of exercise. Asked if they wanted advice 93/253 (36.8%) said “yes”, 43/253 (17.0%) “maybe”, and 117/253 (46.2%) “no”. Of those contacted by phone to give advice, 72.7% (56/77) required a single contact and 14.3% (11/77) required an intervention that required more intensive contact lasting from 2 up to 12 weeks. Of the cohort, 3.9% (3/77) were taking part in activities that put them at significant risk. Conclusions: There is a significant lack of knowledge about appropriate levels of activity, and a desire for further advice, in children and young people with congenital cardiac disease. A few children may be at very significant risk. These needs can be identified, and clinical risk reduced, using a brief self-completed questionnaire combined with telephone follow-up from a suitably knowledgeable physiotherapist

Adherence to cardiac rehabilitation guidelines: a survey of rehabilitation programmes in the United Kingdom

Two key recommendations of recent guidelines are that cardiac rehabilitation requires the skills of a range of professionals and that the patient should receive a menu based programme after an individual assess­ ment of needs. A previous survey of 25 cardiac rehabilitation programmes found little congruence with these guidelines and noted that physicians were particularly unlikely to be involved. We extended this inquiry to include all of the discoverable rehabilitation programmes in the United Kingdom

Decision making processes in people with symptoms of acute myocardial infarction: qualitative study

Objective To identify, the themes that influence decision making processes used by patients with symptoms of acute myocardial infarction. Design Qualitative study using semistructured interviews. Setting Two district hospitals in North Yorkshire. Participants 22 patients admitted to hospital with confirmed second, third, or fourth acute myocardial infarction. Main outcome measure Patients' perceptions of their experience between the onset of symptoms and the decision to seek medical help. Results Six main themes that influence the decision making process were identified: appraisal of In symptoms, perceived risk, previous experience, psychological and emotional factors, use of the NHS, and context of the event. Conclusions Knowledge of symptoms may not be enough to promote prompt action in the event of an acute myocardial infarction. Cognitive and emotional processes, individual beliefs and values, and the influence of the context of the event should also be considered in individual interventions designed to reduce delay in the event of symptoms of acute myocardial infarction

Decontextualizing contextual inversion

Contextual inversion, introduced as an analytical tool by David Lewin, is a concept of wide reach and value in music theory and analysis, at the root of neo-Riemannian theory as well as serial theory, and useful for a range of analytical applications. A shortcoming of contextual inversion as it is currently understood, however, is, as implied by the name, that the transformation has to be defined anew for each application. This is potentially a virtue, requiring the analyst to invest the transformational system with meaning in order to construct it in the first place. However, there are certainly instances where new transformational systems are continually redefined for essentially the same purposes. This paper explores some of the most common theoretical bases for contextual inversion groups and considers possible definitions of inversion operators that can apply across set class types, effectively decontextualizing contextual inversions.Accepted manuscrip

Transformer Oil Passivation and Impact of Corrosive Sulphur

In recent years a significant volume of research has been undertaken in order to understand the recent failures in oil insulated power apparatus due to deposition of copper sulphide on the conductors and in the insulation paper. Dibenzyl Disulfide (DBDS) has been found to be the leading corrosive sulphur compound in the insulation oil [1]. The process of copper sulphide formation and the deposition in the paper is still being investigated, but a recently proposed method seems to be gaining some confidence [1]. This method suggests a two-step process; initially the DBDS and some oil soluble copper complexes are formed. Secondly the copper complexes are absorbed in the paper insulation, where they then decompose into copper sulphide [2]. The most commonly used mitigating technique for corrosive sulphur contaminated oil is passivation, normally using Irgamet 39 or 1, 2, 3-benzotriazole (BTA). The passivator is diluted into the oil to a concentration of around 100ppm, where it then reacts with the copper conductors to form a complex layer around the copper, preventing it from interacting with DBDS compounds and forming copper sulphide. This research project will investigate the electrical properties of HV transformers which have tested positive for corrosive sulphur, and the evolution of those properties as the asset degrades due to sulphur corrosion. Parallel to this the long term properties of transformers with passivated insulation oil will be analysed in order to understand the passivator stability and whether it is necessary to keep adding the passivator to sustain its performance. Condition monitoring techniques under investigation will include dielectric spectroscopy, frequency response analysis, recovery voltage method (aka interfacial polarisation) amongst others. Partial discharge techniques will not be investigated, as the voltage between the coil plates is low and therefore it will not contribute significantly to the overall insulation breakdown, in corrosive oil related faults [3]. The goal of this research is to establish key electrical properties in both passivated and non-passivated power transformers that demonstrate detectable changes as the equipment degrades due to the insulation oil being corrosive

The development of a new measure of quality of life for children with congenital cardiac disease

The purpose of the study was to develop a questionnaire measuring health-related R1 quality of life for children and adolescents with congenital heart disease, the ConQol, that would have both clinical and research applications. We describe here the process of construction of a questionnaire, the piloting and the development of a weighted scoring system, and data on the psychometric performance of the measure in a sample of 640 children and young people recruited via 6 regional centres for paediatric cardiology from across the United Kingdom. The ConQol has two versions, one designed for children aged from 8 to 11 years, and the other for young people aged from 12 to 16 years. Initial findings suggest that it is a valid and reliable instrument, is acceptable to respondents, and is simple to administer in both a research and clinical context

INTEGRAL/RossiXTE high-energy observation of a state transition of GX 339-4

On 2004 August 15, we observed a fast (shorter than 10 hours) state transition in the bright black-hole transient GX 339-4 simultaneously with RossiXTE and INTEGRAL. This transition was evident both in timing and spectral properties. Combining the data from PCA, HEXTE and IBIS, we obtained good quality broad-band (3-200 keV) energy spectra before and after the transition. These spectra indicate that the hard component steepened. Also, the high-energy cutoff that was present at ~70 keV before the transition was not detected after the transition. This is the first time that an accurate determination of the broad-band spectrum across such a transition has been measured on a short time scale. It shows that, although some spectral parameters do not change abruptly through the transition, the high-energy cutoff increases/disappears rather fast. These results constitute a benchmark on which to test theoretical models for the production of the hard component in these systems.Comment: Accepted for publication in MNRAS (9 pages, 6 figures