Perceived Quality of Care and Lifestyle Counseling Among Patients With Heart Disease

Background: To examine patients' perceived quality of care and reported receipt of information on diet and exercise related to cardiovascular disease prevention. Methods: Patients admitted with acute coronary syndromes or elective cardiac catheterization were eligible for enrollment. Baseline medical information was collected through medical-record review. Patients completed surveys at the time of hospitalization that included items on perceived quality of care and whether they had received information from a healthcare provider on diet and exercise as related to their heart. Perceived quality of care was grouped into 3 categories: (1) poor to fair, (2) good, and (3) very good to excellent. Results: Among the 182 cardiac patients who completed the survey, those who reported poor to fair quality of care were more likely to report that they had received no advice regarding diet as compared with those who perceived their quality of care as good or very good to excellent (61%, 59%, and 26%, respectively, P < 0.0001). A similar pattern was observed for exercise (71%, 74%, and 36%, respectively, P < 0.0001). Conclusions: Patients with low perceived quality of care were less likely to have discussed diet and exercise habits with healthcare providers. Improving receipt of lifestyle counseling is warranted given the central role that diet and exercise play in secondary prevention. Copyright © 2010 Wiley Periodicals, Inc. Dr. Jackson receives support from the National Heart, Lung, and Blood Institute of the National Institutes of Health (K23 HL073310-01). The authors have no other funding, financial relationships, or conflicts of interest to disclose.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78479/1/20839_ftp.pd

The classicism of Hugh Trevor-Roper

Hugh Trevor-Roper was educated as a classicist until he transferred to history, in which he made his reputation, after two years at Oxford. His schooling engendered in him a classicism that was characterised by a love of classical literature and style, but rested on a repudiation of the philological tradition in classical studies. This reaction helps to explain his change of intellectual career. His classicism, however, endured: it influenced his mature conception of the practice of historical studies, and can be traced throughout his life. This essay explores a neglected aspect of Trevor-Roper's intellectual biography through his ‘Apologia transfugae’ (1973), which explains his rationale for abandoning classics, and published and unpublished writings attesting to his classicism, especially his first publication ‘Homer unmasked!’ (1936) and his wartime notebooks

The Ursinus Weekly, January 15, 1962

Shadowy figure of Ursinus\u27 past publishes volume of 66 poems • Dr. Snyder, Forum speaker, outlines seven strong forces in Africa today • Spontaneous fun object of new social committee • Prof casts critical eye over Lantern; Discovers sound creative instincts • Bursting water pipe sends Alumni Office to 620 Main • Student teachers\u27 light-hearted talk explains what\u27s not in the Ed. book • Best-dressed co-ed sought by Weekly • Shares of the pecuniary pie • Pre-medders hear about corneal transplant work • Editorial: Appeal of wrestling • Ursinus in the past • Letters to the editor • Obituary for a timid intellectual • Dryfoos sets two Ursinus cage marks; Dean ties record with quick pin • Pair of heartbreaking losses catch grapplers last week • Basketball begins • Frymen flounder; Lose to PMC, 92-80; Drop thriller to Swarthmore, 89 to 85 • Greek gleaningshttps://digitalcommons.ursinus.edu/weekly/1309/thumbnail.jp

Visual orbit of GJ 164 AB

We report seven successful observations of the astrometric binary GJ 164 AB system with aperture masking interferometry. The companion, with a near infrared contrast of 5:1 was detected beyond the formal diffraction limit. Combined with astrometric observations from the literature, these observations fix the parallax of the system, and allow a model-independent mass determination of both components. We find the mass of GJ 164B to be 0.086 \pm 0.007 M_{\sun}. An infrared spectroscopic study of a sample of M-Dwarfs outlines a method for calibrating metallicity of M-Dwarfs. Results from the newly commissionned TripleSpec spectrograph reveal that the GJ 164 system is at least of Solar metallicity. Models are not consistent with color and mass, requiring a very young age to accommodate a secondary too luminous, a scenario ruled out by the kinematics.Comment: 9 pages, 8 figures. Submitted to Ap

Biotic carbon feedbacks in a materially-closed soil-vegetation-atmosphere system

The magnitude and direction of the coupled feedbacks between the biotic and abiotic components of the terrestrial carbon cycle is a major source of uncertainty in coupled climate–carbon-cycle models1, 2, 3. Materially closed, energetically open biological systems continuously and simultaneously allow the two-way feedback loop between the biotic and abiotic components to take place4, 5, 6, 7, but so far have not been used to their full potential in ecological research, owing to the challenge of achieving sustainable model systems6, 7. We show that using materially closed soil–vegetation–atmosphere systems with pro rata carbon amounts for the main terrestrial carbon pools enables the establishment of conditions that balance plant carbon assimilation, and autotrophic and heterotrophic respiration fluxes over periods suitable to investigate short-term biotic carbon feedbacks. Using this approach, we tested an alternative way of assessing the impact of increased CO2 and temperature on biotic carbon feedbacks. The results show that without nutrient and water limitations, the short-term biotic responses could potentially buffer a temperature increase of 2.3 °C without significant positive feedbacks to atmospheric CO2. We argue that such closed-system research represents an important test-bed platform for model validation and parameterization of plant and soil biotic responses to environmental changes

Is the pharmacy profession innovative enough?: meeting the needs of Australian residents with chronic conditions and their carers using the nominal group technique

Background Community pharmacies are ideally located as a source of support for people with chronic conditions. Yet, we have limited insight into what innovative pharmacy services would support this consumer group to manage their condition/s. The aim of this study was to identify what innovations people with chronic conditions and their carers want from their ideal community pharmacy, and compare with what pharmacists and pharmacy support staff think consumers want. Methods We elicited ideas using the nominal group technique. Participants included people with chronic conditions, unpaid carers, pharmacists and pharmacy support staff, in four regions of Australia. Themes were identified via thematic analysis using the constant comparison method. Results Fifteen consumer/carer, four pharmacist and two pharmacy support staff groups were conducted. Two overarching themes were identified: extended scope of practice for the pharmacist and new or improved pharmacy services. The most innovative role for Australian pharmacists was medication continuance, within a limited time-frame. Consumers and carers wanted improved access to pharmacists, but this did not necessarily align with a faster or automated dispensing service. Other ideas included streamlined access to prescriptions via medication reminders, electronic prescriptions and a chronic illness card. Conclusions This study provides further support for extending the pharmacist’s role in medication continuance, particularly as it represents the consumer’s voice. How this is done, or the methods used, needs to optimise patient safety. A range of innovative strategies were proposed and Australian community pharmacies should advocate for and implement innovative approaches to improve access and ensure continuity of care

The morphology and kinematics of the Fine Ring Nebula, planetary nebula Sp 1, and the shaping influence of its binary central star

We present the first detailed spatio-kinematical analysis and modelling of the planetary nebula Shapley 1 (Sp 1), which is known to contain a close-binary central star system. Close-binary central stars have been identified as a likely source of shaping in planetary nebulae, but with little observational support to date. Deep narrowband imaging in the light of [O III] {\lambda}5007A suggests the presence of a large bow-shock to the west of the nebula, indicating that it is undergoing the first stages of an interaction with the interstellar medium. Further narrowband imaging in the light of H{\alpha}+[NII] {\lambda}6584A combined with longslit observations of the H{\alpha} emission have been used to develop a spatio-kinematical model of Sp 1. The model clearly reveals Sp 1 to be a bipolar, axisymmetric structure viewed almost pole-on. The symmetry axis of the model nebula is within a few degrees of perpendicular to the orbital plane of the central binary system - strong evidence that the central close-binary system has played an important role in shaping the nebula. Sp 1 is one of very few nebulae to have this link, between nebular symmetry axis and binary plane, shown observationally.Comment: 10 pages, 5 figures. Accepted for publication in MNRA

Patient-Related Diet and Exercise Counseling: Do Providers’ Own Lifestyle Habits Matter?

The goal of this research was to evaluate the personal health behaviors of physicians in training and attending physicians in association with patient-related lifestyle counseling. Physicians at a major teaching hospital were surveyed regarding their personal lifestyle behavior, perceived confidence, and frequency of counseling patients regarding lifestyle behaviors. One hundred eighty-three total responses were received. Trainees were more likely to consume fast food and less likely to consume fruits and vegetables than attendings. Attending physicians were more likely to exercise 4 or more days per week and more than 150 minutes per week. Attending physicians were more likely to counsel their patients regarding a healthy diet (70.7% vs 36.3%, P150 minutes per week, being overweight, and reported adequate training in counseling. Only adequate training in counseling was a predictor of strong self-efficacy for counseling in diet. Many physicians lack confidence in their ability to counsel patients regarding lifestyle. Personal behaviors including regular exercise and better training in counseling techniques may improve patient counseling. Prev Cardiol. 2010;13:180–185. © 2010 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79167/1/j.1751-7141.2010.00079.x.pd

Estimating the Impact of Adding C-Reactive Protein as a Criterion for Lipid Lowering Treatment in the United States

BACKGROUND: There is growing interest in using C-reactive protein (CRP) levels to help select patients for lipid lowering therapy—although this practice is not yet supported by evidence of benefit in a randomized trial. OBJECTIVE: To estimate the number of Americans potentially affected if a CRP criteria were adopted as an additional indication for lipid lowering therapy. To provide context, we also determined how well current lipid lowering guidelines are being implemented. METHODS: We analyzed nationally representative data to determine how many Americans age 35 and older meet current National Cholesterol Education Program (NCEP) treatment criteria (a combination of risk factors and their Framingham risk score). We then determined how many of the remaining individuals would meet criteria for treatment using 2 different CRP-based strategies: (1) narrow: treat individuals at intermediate risk (i.e., 2 or more risk factors and an estimated 10–20% risk of coronary artery disease over the next 10 years) with CRP > 3 mg/L and (2) broad: treat all individuals with CRP > 3 mg/L. DATA SOURCE: Analyses are based on the 2,778 individuals participating in the 1999–2002 National Health and Nutrition Examination Survey with complete data on cardiac risk factors, fasting lipid levels, CRP, and use of lipid lowering agents. MAIN MEASURES: The estimated number and proportion of American adults meeting NCEP criteria who take lipid-lowering drugs, and the additional number who would be eligible based on CRP testing. RESULTS: About 53 of the 153 million Americans aged 35 and older meet current NCEP criteria (that do not involve CRP) for lipid-lowering treatment. Sixty-five percent, however, are not currently being treated, even among those at highest risk (i.e., patients with established heart disease or its risk equivalent)—62% are untreated. Adopting the narrow and broad CRP strategies would make an additional 2.1 and 25.3 million Americans eligible for treatment, respectively. The latter strategy would make over half the adults age 35 and older eligible for lipid-lowering therapy, with most of the additionally eligible (57%) coming from the lowest NCEP heart risk category (i.e., 0–1 risk factors). CONCLUSION: There is substantial underuse of lipid lowering therapy for American adults at high risk for coronary disease. Rather than adopting CRP-based strategies, which would make millions more lower risk patients eligible for treatment (and for whom treatment benefit has not yet been demonstrated in a randomized trial), we should ensure the treatment of currently defined high-risk patients for whom the benefit of therapy is established

Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial

To determine the effects of digoxin on all-cause mortality and heart failure (HF) hospitalizations, regardless of ejection fraction, accounting for serum digoxin concentration (SDC)