A propensity matched comparison of return to work and quality of life after stenting or coronary artery bypass surgery

Objectives: We sought to determine (1) return to work (RTW) rates, (2) long-term employment (>12 months postprocedure), (3) time taken to RTW, and (4) quality of life (QoL), in patients treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Methods: Questionnaires regarding RTW were sent to 689 PCI and 169 CABG patients who underwent PCI or CABG at University Hospitals of Leicester Trust, UK, from May 2012 to May 2013. QoL was also measured using the European QoL 5-dimensions questionnaire (EQ-5D). Responses from patients employed preprocedure were analysed using multivariate logistic regression. Propensity score-matching was further used to compare similar patient populations receiving PCI or CABG. Results: The response rate was 38% (235 PCI and 88 CABG patients). 241 respondents (75%) were employed preprocedure. Of these 162 (93%) PCI and 51 (77%) CABG patients returned to work, whereas 147 (85%) PCI and 41 (62%) CABG patients were still employed at >12 months postprocedure. After propensity analysis, there was no significant difference between PCI and CABG patients in RTW, long-term employment, nor QoL. The median time taken to RTW was 6 weeks after PCI and 13 weeks after CABG (p=0.001). The effect remained significant after multivariate analysis (p=0.001) and propensity analysis (p=0.001). Conclusions: In this first propensity score-matched study comparing RTW and QoL after PCI or CABG strict propensity matching indicates that RTW or QoL, is similar for PCI or CABG, albeit the number of matched pairs was small. There are differences, however, in delay in RTW

Trace element mobility during Corg-enhanced denitrification in two different aquifers

Nitrate (NO3−)-polluted groundwater treatment by enhanced denitrification is becoming increasingly important due to rising NO3− concentrations and decreasing degradation capacities in aquifers. Besides evaluating the efficacy of substrates added to trigger denitrification, secondary reactions must be closely monitored. Biodenitrification by applied organic carbon (Corg) can lead to considerable changes in redox potential (Eh) and pH, two decisive parameters for trace element mobility. In this study, two geologically and hydrogeochemically different groundwater catchments important for drinking water production were investigated and compared. Sediments were analyzed for trace elements as well as sulfur (S) and carbon (C) contents. Ongoing hydrogeochemical reactions were evaluated with depth-specific isotope characterization, and the potential for trace element mobilization by Corg addition was determined in column experiments. Results for enhanced denitrification showed up to 3.8 times lower reaction rates with respect to comparable studies, probably due to incomplete formation of the necessary denitrifying bacteria. Concentrations of trace elements such as nickel (Ni) must also be considered when evaluating enhanced denitrification, as these can negatively affect microorganisms. Added ethanol led to Ni concentrations dropping from 0.013 mg/L to below the detection limit. Thus, Corg addition may not only induce denitrification, but also lead to the immobilization of previously released trace elements

Identifying and Defining the Structures That Guide the Implementation of Participant Direction Programs and Support Program Participants: A Document Analysis

This is the author's accepted manuscript. The published version is available at http://dx.doi.org/10.1177/1044207313514112Participant direction (PD) programs offer the individual with a disability or his or her surrogate decision maker varying degrees of choice and control over the individual’s supports and services. We conducted a document analysis using grounded theory methods to identify the design elements of participant direction programs in long-term care. We analyzed 53 documents across multiple disabilities and funding sources. We identified and defined two major components of participant direction programs: policy and aid and assistance. The component of policy was represented by three structures that guide implementation of participant direction programs: (a) option to participant-direct, (b) participation stipulations, and (c) provider qualifications. The component of aid and assistance was represented by 11 structures that support program participants: (a) financial management services, (b) employer of record, (c) emergency back-up, (d) worker registry, (e) advice/counseling, (f) managerial assistance, (g) information dissemination products, (h) service quality monitoring, (i) service coordination, (j) participant training, and (k) provider training. Each structure was represented by one or more continua depicting the range of choice and control participants may have over the structure. The findings of this study have implications for improving the standardization of research on participant direction programs and the development of long-term care policy

Identifying and defining the activities of participant direction programs: A document analysis

This is the author's accepted manuscript. The published version is available at http://dx.doi.org/10.1177/1044207313502538We analyzed the design of various U.S. programs of participant direction offering participants (individual with a disability or his or her surrogate decision-maker) some level of choice and control over the individual’s long-term care supports and services. We used grounded theory methods to conduct a document analysis of 53 documents published from 2004 through 2008 representing multiple disabilities and program funding sources. In our analysis, we identified three major components (planning, budgeting, and employing) over which participants had the opportunity to exercise choice and control and the activities associated with each. Activities were represented by one or more continua illustrating the range of participant choice and control over the indicator. The component of planning consisted of the activity of care plan development. The budgeting component included the activities of (a) development, (b) individualization, and (c) authority. The employing component included the activities of (a) identifying/selecting providers, (b) hiring/employing providers, (c) scheduling providers, (d) training providers, (e) managing/directing/supervising providers, (f) disciplining/dismissing providers, (g) keeping records, (h) managing payroll, (i) locating emergency back-up, and (j) monitoring service quality. The findings of this study have implications for improving policy, practice, and research in the field of long-term care

Variation in emergency percutaneous coronary intervention in ventilated patients in the UK: insights from a national database

Aims Pre-procedural ventilation is a marker of high risk in PCI patients. Causes include out-of-hospital cardiac arrest (OHCA) and cardiogenic shock. OHCA occurs in approximately 60,000 patients in the UK per annum. No consensus exists regarding the need/timing of coronary angiography ± revascularization without ST elevation. The aim was to describe the national variation in the rate of emergency PCI in ventilated patients. Methods and Results Using the UK national database for PCI in 2013, we identified all procedures performed as ‘emergency’ or ‘salvage’ for whom ventilation had been initiated before the PCI. Of the 92,589 patients who underwent PCI, 1342 (5.5%) fulfilled those criteria. There was wide variation in practice. There was no demonstrable relationship between the number of emergency PCI patients with pre-procedure ventilation per annum and (i) total number of PPCIs in a unit (r = −0.186), and (ii) availability of 24 h PCI, (iii) on-site surgical cover. Conclusion We demonstrated a wide variation in practice across the UK in rates of pre-procedural ventilation in emergency PCI. The majority of individuals will have suffered an OHCA. In the absence of a plausible explanation for this discrepant practice, it is possible that (a) some patients presenting with OHCA that may benefit from revascularization are being denied treatment and (b) procedures may be being undertaken that are futile. Further prospective data are needed to aid in production of guidelines aiming at standardized care in OHCA

Predisposing and triggering factors of large-scale landslides in Debre Sina area, central Ethiopian highlands

A large number of landslide events have repeatedly struck the border zone of the northwestern plateaus of Ethiopia. Debre Sina area is one of the most tectonically active areas located along the western margin of the Afar depression, which is frequently affected by landslides. Despite that, urban and rural development is currently active in almost the entire area. It is crucial, therefore, to understand the main causes and failure mechanisms of landslides in the Debre Sina area and its surroundings. The present study investigated landslides using field mapping of geological and geomorphological features, remote sensing, geo-morphometric analysis, structural analysis, rainfall data, landslide inventory, and earthquake data. The results of the study indicate that large-scale and deep-seated landslide problems appear to be caused by complex geological settings and rugged topography. In particular, the location and morphology of the Yizaba Wein and Shotel Amba landslides are strongly controlled by geological structures. Their flanks are bounded by high angle faults, and their main basal failure surfaces have developed within a W–E striking eastward-dipping normal fault zone. The complex litho-structural and morphologic settings play a vital role in controlling the geometry of the slip surfaces and the stability of the landslides

Monitoring nitrate reduction: hydrogeochemistry and clogging potential in raw water wells.

The mainly agricultural input of NO3- and compliance with drinking water guideline values pose major challenges for many water suppliers. Additionally, associated changes in hydrochemistry, especially concerning products of NO3- reduction (Fe2+/3+, Mn2+/4+, Ca2+, Mg2+, SO42-, HCO3-) and subsequent reactions, can have a major influence on mineral saturation states and well yield: well productivity can be strongly reduced by mineral precipitation and silting. To evaluate hydrogeochemical evolution and clogging potential for a given well field, thorough hydrochemical and geochemical investigations are required. Therefore, time-dependent and depth-specific ion concentrations in water samples (n = 818) were analysed in a catchment area of a waterworks in western Germany. The sediments of the aquifers were extensively investigated for their geochemistry (CS, scanning electron microscope, aqua regia digestion and dithionite solution; n = 253). In addition, PhreeqC was used to model saturation indices in order to identify possible mineral precipitation in the wells. Results show a high NO3- input into deep wells screened in Tertiary sediments due to an admixture of Quaternary groundwater. Directly at the Quaternary-Tertiary boundary, chemolithotrophic NO3- reduction consuming pyrite occurs. Protons released during the process are pH-buffered by dissolving carbonate minerals. Overall, the hydrochemistry and especially the saturation indices are strongly influenced by NO3- reduction and its degradation products. A change in well yield has not yet been observed, but future clogging by ochre formation or sintering cannot be excluded

The effect of hydrogeological and hydrochemical dynamics on landslide triggering in the central highlands of Ethiopia

The volcanic terrain at the western margin of the Main Ethiopian Rift in the Debre Sina area is known for its slope stability problems. This report describes research on the effects of the hydrogeological and hydrochemical dynamics on landslide triggering by using converging evidence from geological, geomorphological, geophysical, hydrogeochemical and isotopic investigations. The chemical characterization indicates that shallow to intermediate aquifers cause groundwater flow into the landslide mass, influencing long-term groundwater-level fluctuations underneath the landslide and, as a consequence, its stability. The low content of total dissolved solids and the bicarbonate types (Ca–Mg–HCO3 and Ca–HCO3) of the groundwater, and the dominantly depleted isotopic signature, indicate a fast groundwater flow regime that receives a high amount of precipitation. The main causes of the landslide are the steep slope topography and the pressure formed during precipitation, which leads to an increased weight of the loose and weathered materials. The geophysical data indicate that the area is covered by unconsolidated sediments and highly decomposed and weak volcanic rocks, which are susceptible to sliding when they get moist. The heterogeneity of the geological materials and the presence of impermeable layers embodied within the highly permeable volcanic rocks can result in the build-up of hydrostatic pressure at their interface, which can trigger landslides. Intense fracturing in the tilted basalt and ignimbrite beds can also accelerate infiltration of water, resulting to the build-up of high hydrostatic pressure causing low effective normal stress in the rock mass, giving rise to landslides