A Closer Examination of the Patient Experience in the Ambulatory Space: A Retrospective Qualitative Comparison of Specialty Care to Primary Care Experiences

With the advent of consumerism in one of the most complex and fragmented industries in the United States, the healthcare space now has a collective interest to further understand its consumers and help to shape their experiences. In this qualitative research study, we explore the key patient experience impressions responsible for driving quality. Differences between primary care patient perspectives and specialty care patient perspectives were analyzed using a mixed methods design in high, median and low quality performing practices. We found that primary care patients highly value (a) provider listening, (b) time spent with provider, and (c) consistent and effective coordination of care (i.e. provider handoffs, referrals, prescription refills, etc.). Specialty care patients were found to highly value (a) provider clinical skill acumen and outcomes, (b) being kept informed with timely updates and care instructions, and (c) a stress and pain-free experience. Both patient types also highly value a patient- and family- centered care team approach. We did find a direct association between patient experience quantitative scores and patient comments ratings. We conclude that differing patient types attach greater value to different elements of their health care experiences

Dynamique de la nappe et qualités physico-chimiques des eaux souterraines du lac Fetzara (Nord-Est algérien)

Le lac Fetzara est l'un des plus importants lacs de l'extrême Nord-Est Algérien, avec une superficie de 18600 ha. Il a été officiellement classe sur la liste des zones humides d'importance internationale, ce qui impose une protection de ce site. Cette étude a été menée afin d'étudier l'état actuel de la chimie des eaux souterraines et de déterminer l'origine de la salinité. Les résultats analytiques montrent la présence de trois facies chimiques : chlorure sodique, chlorure calcique et bicarbonate sodique. La conductivité électrique des eaux oscille entre 350 et 3500 μS/cm avec de fortes valeurs enregistrées dans les régions Nord-Est (Oued Zied) et au Sud-Est du lac (Cheurfa). L'étude statistique par l'analyse en composantes principales (ACP) montre que les chlorures et le sodium sont les principaux éléments responsables de la forte minéralisation des eaux. Cet excès de minéralisation serait lie éventuellement au lessivage des terrains traverses ou par l'infiltration des eaux de surface qui sont fortement influencées par la forte évaporation en période estivale et les échanges ioniques avec la matrice argileuse.Mots clés: Salinité - Minéralisation - Contamination - Piézométrie - Facies chimique -ACP. Fetzara lake is one of the most important lakes in the North-Eastern of Algeria; with an area of about 18600 ha, it was officially classified on the list of Wetlands of International Importance. This dictates the protection of this location. This study was conducted to examine the current state of groundwater chemistry and the origin of their salinity. The results obtained show a presence of three chemicals facies: sodium chloride, calcium chloride and sodium bicarbonate. The electrical conductivity of groundwater oscillates from 350 to 3500 μS I cm where high values are recorded in the North-East (Oued Zied) and the South-East of the lake (Cheurfa). Statistical study by principal component analysis (PCA) showed that chloride and sodium are the main elements responsible for the high mineralization of the water. This excess of mineralization is due to the leaching of subsurface formations and surface waters infiltration; these are strongly influenced by evaporation and ionic exchanges with clay matrix.Keywords: Salinity - Mineralization - Contamination - Piezometry - Chemical facies - PCA

Extraction of the Volatile Oils of Dictyopteris membranacea Batters 1902 by Focused Microwave-assisted Hydrodistillation and Supercritical Carbon Dioxide: Empirical Kinetic Modelling Approach, Apparent Solubility and Rate Constants

Supercritical carbon dioxide extraction (SCCO2) and focused microwave-assisted hydrodistillation (FMAHD) were used comparatively to isolate the volatile oils of the brown alga Dictyopteris membranacea from the crude ether extract. The volatiles fractions were analysed by GC/MS, the major compounds were: dictyopterene A, 6-butyl-1,4-cycloheptadiene, 1-undecen-3-one, 1,4-undecadien-3-one, (3-oxoundec-4-enyl) sulphur, tetradecanoic acid, hexadecanoic acid, 3-hexyl-4,5-dithiacycloheptanone, and albicanol. A kinetics study of the extraction of the volatile fractions obtained by the two processes was carried out, an external calibration allowed to quantify the content of the main metabolites. Empirical models were applied to adjust the experimental kinetics values but also to determine the values of apparent solubilities for SCCO2 and the rate constants for FMAHD. The results obtained revealed that the SCCO2 process was characterized by the coexistence of three distinct phases. For FMAHD, the extraction mechanism included two steps. This work is licensed under a Creative Commons Attribution 4.0 International License

Noninvasive Molecular Imaging of Disease Activity in Atherosclerosis.

Major focus has been placed on the identification of vulnerable plaques as a means of improving the prediction of myocardial infarction. However, this strategy has recently been questioned on the basis that the majority of these individual coronary lesions do not in fact go on to cause clinical events. Attention is, therefore, shifting to alternative imaging modalities that might provide a more complete pan-coronary assessment of the atherosclerotic disease process. These include markers of disease activity with the potential to discriminate between patients with stable burnt-out disease that is no longer metabolically active and those with active atheroma, faster disease progression, and increased risk of infarction. This review will examine how novel molecular imaging approaches can provide such assessments, focusing on inflammation and microcalcification activity, the importance of these processes to coronary atherosclerosis, and the advantages and challenges posed by these techniques.M.R.D and D.E.N are supported by the British Heart Foundation (CH/09/002 to D.E.N., FS/14/78/31020 to M.R.D). M.R.D is the recipient of the Sir Jules Thorn Biomedical Research Award 2015 (M.R.D.) E.A. research is supported by R01HL 114805 and R01HL 109506.This is the final version of the article. It first appeared from Lippincott, Williams & Wilkins via http://dx.doi.org/10.1161/CIRCRESAHA.116.30797

Imaging Atherosclerosis.

Advances in atherosclerosis imaging technology and research have provided a range of diagnostic tools to characterize high-risk plaque in vivo; however, these important vascular imaging methods additionally promise great scientific and translational applications beyond this quest. When combined with conventional anatomic- and hemodynamic-based assessments of disease severity, cross-sectional multimodal imaging incorporating molecular probes and other novel noninvasive techniques can add detailed interrogation of plaque composition, activity, and overall disease burden. In the catheterization laboratory, intravascular imaging provides unparalleled access to the world beneath the plaque surface, allowing tissue characterization and measurement of cap thickness with micrometer spatial resolution. Atherosclerosis imaging captures key data that reveal snapshots into underlying biology, which can test our understanding of fundamental research questions and shape our approach toward patient management. Imaging can also be used to quantify response to therapeutic interventions and ultimately help predict cardiovascular risk. Although there are undeniable barriers to clinical translation, many of these hold-ups might soon be surpassed by rapidly evolving innovations to improve image acquisition, coregistration, motion correction, and reduce radiation exposure. This article provides a comprehensive review of current and experimental atherosclerosis imaging methods and their uses in research and potential for translation to the clinic.J.M.T. is supported by a Wellcome Trust research training fellowship (104492/Z/14/Z). M.D is supported by the British Heart Foundation (FS/14/78/31020). N.R.E. is supported by a research training fellowship from the Dunhill Medical Trust (RTF44/0114). A.J.B. is supported by the British Heart Foundation. J.H.F.R. is part-supported by the HEFCE, the NIHR Cambridge Biomedical Research Centre, the British Heart Foundation, and the Wellcome Trust.This is the final version of the article. It first appeared from the American Heart Association via http://dx.doi.org/10.1161/CIRCRESAHA.115.30624

68Ga-DOTATATE PET Identifies Residual Myocardial Inflammation and Bone Marrow Activation After Myocardial Infarction.

Myocardial infarction (MI) healing occurs in two phases: first an inflammatory phase, where clearance of necrotic debris occurs, followed by a reparative phase characterized by angiogenesis, granulation tissue formation and attempts to repair the extracellular matrix. While efficient healing relies on co-ordinated mobilization of monocytes to the damaged myocardium, with resolution of the acute inflammatory response by ~10-14 days, excessive inflammation impairs myocardial salvage and promotes adverse cardiac remodelling

Does Vascular Calcification Accelerate Inflammation?: A Substudy of the dal-PLAQUE Trial.

BACKGROUND: Atherosclerosis is an inflammatory condition with calcification apparent late in the disease process. The extent and progression of coronary calcification predict cardiovascular events. Relatively little is known about noncoronary vascular calcification. OBJECTIVES: This study investigated noncoronary vascular calcification and its influence on changes in vascular inflammation. METHODS: A total of 130 participants in the dal-PLAQUE (Safety and efficacy of dalcetrapib on atherosclerotic disease using novel non-invasive multimodality imaging) study underwent fluorodeoxyglucose positron emission tomography/computed tomography at entry and at 6 months. Calcification of the ascending aorta, arch, carotid, and coronary arteries was quantified. Cardiovascular risk factors were related to arterial calcification. The influences of baseline calcification and drug therapy (dalcetrapib vs. placebo) on progression of calcification were determined. Finally, baseline calcification was related to changes in vascular inflammation. RESULTS: Age >65 years old was consistently associated with higher baseline calcium scores. Arch calcification trended to progress more in those with calcification at baseline (p = 0.055). There were no significant differences between progression of vascular calcification with dalcetrapib compared to that with placebo. Average carotid target-to-background ratio indexes declined over 6 months if carotid calcium was absent (single hottest slice [p = 0.037], mean of maximum target-to-background ratio [p = 0.010], and mean most diseased segment [p < 0.001]), but did not significantly change if calcification was present at baseline. CONCLUSIONS: Across multiple arterial regions, higher age is consistently associated with higher calcium scores. The presence of vascular calcification at baseline is associated with progressive calcification; in the carotid arteries, calcification appears to influence vascular inflammation. Dalcetrapib therapy did not affect vascular calcification.The study was supported by F. Hoffmann-La Roche Ltd, Basel, Switzerland. Some editorial assistance was provided by Prime Healthcare and was funded by F. Hoffmann-La Roche Ltd, Basel, Switzerland. Partial support is acknowledged from NIH/NHLBI R01 HL071021 (ZAF). We thank Elisabetta Damonte for helping with statistical analyses.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.jacc.2015.10.05