Can the Cardiac ARIA Index improve cardiac care for Australia's indigenous population?

Abstract 12893 from Core 2. Epidemiology and Prevention of CV Disease: Physiology, Pharmacology and Lifestyle Session Title: A Global Look at Cardiovascular Risk.Background Aims: Timely access to appropriate cardiac care is critical for optimizing outcomes. Our aim was to derive an objective, comparable, geographic measure reflecting access to cardiac services for Australia’s 20,387 population locations. Methods: An expert panel defined the patient care pathway. Using geographic information systems (GIS) the numeric/alpha index was modeled in two phases. The acute phase index (numeric) ranged from 1 (access to specialist centre with PCI ≤ 1 hour) to 8 (no ambulance service, > 3 hours to medical facility, air transport required). The aftercare index was modeled into 5 alphabetic categories; A (Access to general practitioner, pharmacy, cardiac rehabilitation, pathology ≤ 1 hour) to E (no services available within 1 hour). Results: Approximately 70% or 13.9 million people lived within a Cardiac ARIA category 1A location. Disparity continues in access to category 1A cardiac services for 5.8 million (30%) of all Australians, 60% of Aboriginal and Torres Strait Islander people and 32% of people over 65 years of age. In a cardiac emergency only 40% of the Indigenous population reside within 1 hour of category 1 hospital. Approximately 30% (81,491 Indigenous persons) are more than 1 to 3 hours from basic cardiac services. Conclusion: Geographically, the majority of Australian’s have timely access for survival of a cardiac event. The Cardiac ARIA index objectively demonstrates that the healthcare system may not be providing for the needs of 60% of Indigenous people residing outside the 1A geographic radius. Innovative clinical practice is required to address these disparities.Robyn A Clark, Neil Coffee, Dorothy Turner, Kerena Eckert, Simon Stewart, David Wilkinson, Deborah van Gaans and Andrew Tonki

Новые языковые реальности употребления претерита в немецком гипотаксисе

Целью статьи являются обобщение и теоретическое обоснование нового употребления претерита в относительном значении в конкретных видах придаточных предложений с презенсом в главном предложении. В статье анализируются коннотативные нюансы относительного значения претерита, регулярность замены префекта-пассива и перфекта именного составного сказуемого с глаголом "sein" на претеритальные формы в гипотаксисе, а также особое место претерита в системе немецких временных форм.Метою статті є узагальнення та теоретичне обґрунтування нового вживання претериту у релятивному значенні у конкретних видах сурядно-підрядних речень з презентом у сурядному реченні. У статті подано аналіз конототивні нюанси претериту і регулярність зміни перфекту пасиву та іменного присудка з дієсловом "sein" на претеритальні форми у гіпотаксису, а також особливе місце претериту у системі німецьких часових форм.The article aims at generalization and theoretical Explanation of modern preterit usage in relative meaning in certain types of clauses, with the Present tense in the main clause. The article deals with the analysis of connotative component meanings of the relative preterit and the regularity of substitution of preterit forms in hypotaxes for the passive perfect tense and the perfect form of the nominal compound predicate with the verb 'sein' as well as the specificity of preterit in the system of German tenses

Development of a standardized and validated flow cytometry approach for monitoring of innate myeloid immune cells in human blood

Innate myeloid cell (IMC) populations form an essential part of innate immunity. Flow cytometric (FCM) monitoring of IMCs in peripheral blood (PB) has great clinical potential for disease monitoring due to their role in maintenance of tissue homeostasis and ability to sense micro-environmental changes, such as inflammatory processes and tissue damage. However, the lack of standardized and validated approaches has hampered broad clinical implementation. For accurate identification and separation of IMC populations, 62 antibodies against 44 different proteins were evaluated. In multiple rounds of EuroFlow-based design-testing-evaluation-redesign, finally 16 antibodies were selected for their non-redundancy and separation power. Accordingly, two antibody combinations were designed for fast, sensitive, and reproducible FCM monitoring of IMC populations in PB in clinical settings (11-color; 13 antibodies) and translational research (14-color; 16 antibodies). Performance of pre-analytical and analytical variables among different instruments, together with optimized post-analytical data analysis and reference values were assessed. Overall, 265 blood samples were used for design and validation of the antibody combinations and in vitro functional assays, as well as for assessing the impact of sample preparation procedures and conditions. The two (11- and 14-color) antibody combinations allowed for robust and sensitive detection of 19 and 23 IMC populations, respectively. Highly reproducible identification and enumeration of IMC populations was achieved, independently of anticoagulant, type of FCM instrument and center, particularly when database/software-guided automated (vs. manual "expert-based") gating was used. Whereas no significant changes were observed in identification of IMC populations for up to 24h delayed sample processing, a significant impact was observed in their absolute counts after >12h delay. Therefore, accurate identification and quantitation of IMC populations requires sample processing on the same day. Significantly different counts were observed in PB for multiple IMC populations according to age and sex. Consequently, PB samples from 116 healthy donors (8-69 years) were used for collecting age and sex related reference values for all IMC populations. In summary, the two antibody combinations and FCM approach allow for rapid, standardized, automated and reproducible identification of 19 and 23 IMC populations in PB, suited for monitoring of innate immune responses in clinical and translational research settings

Improving health care accessibility for older adults with frailty: the role of Geographical Information Systems

Elsa Dent, Deborah van Gaan

A survey of accessibility to Australia's Phase 2 Cardiac Rehabilitation Programs to patient barriers

Online Published: April 28, 2017Despite the evidence to support cardiac rehabilitation, existing services remain underutilised. Accessibility to those services is a major factor in the underutilisation of current programs. Available literature on barriers to the accessibility of out-patient cardiac rehabilitation services were reviewed. Using Penchansky and Thomas’ (1981) five dimensions of accessibility as a structural framework, the information obtained from this review was then used to create a formal questionnaire which was sent to each of the Cardiac Rehabilitation Programs within Australia in 2007-2008 (n=401). The survey highlighted that the need for a referral, the disease the patient has, the distance required for travel, whether group and individual sessions are provided, flexibility in service delivery setting, hours of operation, cost, and the range of program components, significantly limit patient accessibility to Phase 2 Cardiac Rehabilitation Programs. Completion rates were low for most programs. The Survey revealed that patient accessibility to Phase 2 Cardiac Rehabilitation Programs includes various socio-economic and geographic impediments that can prevent or limit service use. While barriers to cardiac rehabilitation are well known, service providers need to ensure these patient barriers are taken into consideration when providing a Phase 2 Cardiac Rehabilitation Program to improve their accessibility.Deborah van Gaans and Andrew Tonki

Application of geographic modeling techniques to quantify spatial access to health services before and after an acute cardiac event: The Cardiac Accessibility and Remoteness Index for Australia (ARIA) Project

BACKGROUND: Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services. METHODS AND RESULTS: An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), the team developed a numeric/alphabetic index at 2 points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alphabetic) measured access to 4 basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) when a patient returned to his or her community. The numeric index ranged from 1 (access to principal referral center with cardiac catheterization service ≤1 hour) to 8 (no ambulance service, >3 hours to medical facility, air transport required). The alphabetic index ranged from A (all 4 services available within a 1-hour drive-time) to E (no services available within 1 hour). The panel found that 13.9 million Australians (71%) resided within Cardiac ARIA 1A locations (hospital with cardiac catheterization laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were overrepresented by people >65 years of age (32%) and indigenous people (60%). CONCLUSIONS: The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and could be applied to other common disease states within other regions of the world.Robyn A. Clark, Neil Coffee, Dorothy Turner, Kerena A. Eckert, Deborah van Gaans, David Wilkinson, Simon Stewart, Andrew M. Tonkin, on behalf of the Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) Project Grou

Access to cardiac rehabilitation does not equate to attendance

Background/Aims: Timely access to appropriate cardiac care is critical for optimizing positive outcomes after a cardiac event. Attendance at cardiac rehabilitation (CR) remains less than optimal (10%–30%). Our aim was to derive an objective, comparable, geographic measure reflecting access to cardiac services after a cardiac event in Australia. Methods: An expert panel defined a single patient care pathway and a hierarchy of the minimum health services for CR and secondary prevention. Using geographic information systems a numeric/alpha index was modelled to describe access before and after a cardiac event. The aftercare phase was modelled into five alphabetical categories: from category A (access to medical service, pharmacy, CR, pathology within 1 h) to category E (no services available within 1 h). Results: Approximately 96% or 19 million people lived within 1 h of the four basic services to support CR and secondary prevention, including 96% of older Australians and 75% of the indigenous population. Conversely, 14% (64,000) indigenous people resided in population locations that had poor access to health services that support CR after a cardiac event. Conclusion: Results demonstrated that the majority of Australians had excellent ‘geographic’ access to services to support CR and secondary prevention. Therefore, it appears that it is not the distance to services that affects attendance. Our ‘geographic’ lens has identified that more research on socioeconomic, sociological or psychological aspects to attendance is needed.Robyn A Clark, Neil Coffee, Dorothy Turner, Kerena A Eckert, Deborah van Gaans, David Wilkinson, Simon Stewart and Andrew M Tonki

Cardiac ARIA: using GIS to measure the nation's access to cardiac catheter laboratories

Abstract only publishedAbstract not availabl