Coronary artery disease prevalence amongst patients undergoing valve replacement surgery: A South African perspective

Background: The prevalence of coronary artery disease (CAD) amongst patients presented for valve surgery has important implications for routine angiography. Information on the frequency of CAD in predominantly black patients presented for valve surgery in South Africa has not been published.Methods: A retrospective, descriptive study of 116 patients presented for valve surgery that underwent coronary angiography between 2010 and 2011 was performed. CAD was defined as stenosis of 70% or greater in one or more epicardial vessels or ≥50% in the left main coronary artery, as defined by quantitative coronary angiography.Results: Median age was 57.4 (IQR 43 - 67) years (56.9% females). Black patients represented 66.4%, whites 19.8%, and, coloured and Indian patients 13.8%. Hypertension and smoking were the most common cardiovascular risk factors (26.7% and 16.4% respectively). Diabetes mellitus, dyslipidaemia, chronic kidney disease and prior CAD occurred collectively in 15.5% of study subjects. HIV prevalence was 12%, half of whom were on antiretroviral therapy. An isolated valve lesion occurred in 69% of patients, with the remainder having 2 or more lesions. The most common valve lesion was aortic stenosis (43.1%), followed by mitral stenosis (36.2%), aortic regurgitation (29.3%), mitral regurgitation (25.9%) and tricuspid regurgitation (19%). The predominant aetiology was rheumatic heart disease (58.6%), followed by degenerative valve disease (24.1%). CAD was documented in 10 patients (8.6%), of whom 8 had single vessel disease and 2 had double vessel disease.Conclusion: The low prevalence of CAD found in younger, asymptomatic black patients without cardiovascular risk factors referred for valve surgery, raises the question of whether routine pre-operative coronary angiography in this sub-group is appropriate

Shared Decision Making in the Psychiatric Inpatient Setting: An Ethnographic Study about Interprofessional Psychiatric Consultations

Shared decision making is increasingly receiving attention in health care and might improve both the quality of care and patient outcomes. Nevertheless, due to its complexity, implementation of shared decision making in clinical practice seems challenging. This ethnographic study aimed to gain a better understanding of how psychiatric inpatients and the interprofessional care team interact during regular interprofessional psychiatric consultations. Data were collected through participant observation on two different psychiatric wards in a large psychiatric hospital in Switzerland. The observation focused on the contextual aspects of interprofessional patient consultations, the communication and interaction as well as the extent to which patients were involved in decision making. Participants included patients, psychiatrists, junior physicians, nurses, psychologists, social workers and therapists. We observed 71 interprofessional psychiatric consultations and they differed substantially in both wards in terms of context (place and form) and culture (way of interacting). On the contrary, results showed that the level of patient involvement in decision making was comparable and depended on individual factors, such as the health care professionals' communication style as well as the patients' personal initiative to be engaged. The main topics discussed with the patients related to pharmacotherapy and patient reported symptoms. Health care professionals in both wards used a rather unidirectional communication style. Therefore, in order to promote patient involvement in the psychiatric inpatient setting, rather than to focus on contextual factors, consultations should follow a specific agenda and promoting a bidirectional communication style for all parties involved is strongly recommended

The wasp larva's last supper: 100 million years of evolutionary stasis in the larval development of rhopalosomatid wasps (Hymenoptera: Rhopalosomatidae)

Rhopalosomatidae are an unusual family of wasps (Hymenoptera: Aculeata) comprising less than 100 species found in the tropics and subtropics of all continents except Europe and Antarctica. Whereas some species resemble nocturnal Ichneumonidae, others might be mistaken for spider wasps or different groups of brachypterous Hymenoptera. Despite their varied morphology, all members of the family supposedly develop as larval ectoparasitoids of crickets (Orthoptera: Grylloidea). Here, we report on the first record of a fossil rhopalosomatid larva which was discovered in mid-Cretaceous amber from northern Myanmar (Burma). The larva is attached to the lateral side of a cricket between the metafemur and the abdomen, impacting the natural position of the hind leg, exactly as documented for modern species. Additionally, the larval gestalt is strikingly similar to those of extant forms. These observations imply that this behavioral specialization, e.g., host association and positioning on host, likely evolved in the stem of the family at least 100 million years ago

Enriching Business Process Models with Decision Rules

Making the right decisions in time is one of the key tasks in every business. In this context, decision theory fosters decision-making based on well-defined decision rules. The latter evaluate a given set of input parameters and utilize evidenced data in order to determine an optimal alternative out of a given set of choices. In particular, decision rules are relevant in the context business processes as well. Contemporary process modeling languages, however, have not incorporated decision theory yet, but mainly consider rather simple, guard-based decisions that refer to process-relevant data. To remedy this drawback, this paper introduces an approach that allows embedding decision problems in business process models and applying decision rules to deal with them. As a major benefit, it becomes possible to automatically determine optimal execution paths during run time

'It's a big deal, being given a person': why people who experience infertility may choose not to adopt

This article explores why individuals and couples who experience infertility and undergo treatment through new technologies do not subsequently go on to become parents via adoption. It does this in three ways: a review of the literature; interviews with those affected; and an online survey of views on adoption among people who have experienced infertility. It was found that couples do consider adoption alongside infertility treatment but it is usually a fallback choice. If adoption is to be perceived as an equal option, agencies need to offer support and advice at an earlier stage than is usual. Couples who are emotionally exhausted by medical interventions for their childlessness can then be helped off the infertility treadmill in order to become parents

Development of a cost-effective optical sensor for continuous monitoring of turbidity and suspended particulate matter in marine environment

A cost-effective optical sensor for continuous in-situ monitoring of turbidity and suspended particulate matter concentration (SPM), with a production cost in raw materials less than 20 €, is presented for marine or fluvial applications. The sensor uses an infrared LED and three photodetectors with three different positions related to the light source-135º, 90º and 0º-resulting in three different types of light detection: backscattering, nephelometry and transmitted light, respectively. This design allows monitoring in any type of environment, offering a wide dynamic range and accuracy for low and high turbidity or SPM values. An ultraviolet emitter-receiver pair is also used to differentiate organic and inorganic matter through the differences in absorption at different wavelengths. The optical transducers are built in a watertight structure with a radial configuration where a printed circuit board with the electronic signal coupling is assembled. An in-lab calibration of the sensor was made to establish a relation between suspended particulate matter (SPM) or the turbidity (NTU) to the photodetectors' electrical output value in Volts. Two different sizes of seashore sand were used (180 µm and 350 µm) to evaluate the particle size susceptibility. The sensor was tested in a fluvial environment to evaluate SPM change during sediment transport caused by rain, and a real test of 22 days continuous in-situ monitoring was realized to evaluate its performance in a tidal area. The monitoring results were analysed, showing the SPM change during tidal cycles as well as the influence of the external light and biofouling problems.Funding Agency Programa Operacional Regional do Norte (NORTE2020), through Fundo Europeu de Desenvolvimento Regional (FEDER) NORTE-01-0145-FEDER-000032 European Union through the European Regional Development Fund, based on COMPETE 2020 (Programa Operacional da Competitividade e Internacionalizacao), project ICT UID/GEO/04683/2013 POCI-01-0145-FEDER-007690 Fundacao para a Ciencia e a Tecnologia (FCT)info:eu-repo/semantics/publishedVersio

Top quark physics in hadron collisions

The top quark is the heaviest elementary particle observed to date. Its large mass makes the top quark an ideal laboratory to test predictions of perturbation theory concerning heavy quark production at hadron colliders. The top quark is also a powerful probe for new phenomena beyond the Standard Model of particle physics. In addition, the top quark mass is a crucial parameter for scrutinizing the Standard Model in electroweak precision tests and for predicting the mass of the yet unobserved Higgs boson. Ten years after the discovery of the top quark at the Fermilab Tevatron top quark physics has entered an era where detailed measurements of top quark properties are undertaken. In this review article an introduction to the phenomenology of top quark production in hadron collisions is given, the lessons learned in Tevatron Run I are summarized, and first Run II results are discussed. A brief outlook to the possibilities of top quark research a the Large Hadron Collider, currently under construction at CERN, is included.Comment: 84 pages, 32 figures, accepted for publication by Reports on Progress in Physic