Warfarin: time in therapeutic range, a single centre study on patients using warfarin for stroke prevention in non-valvular atrial fibrillation and prosthetic heart valves

Background: Two common indications for oral anticoagulants are patients with non-valvular atrial fibrillation (AF) or prosthetic heart valves (PHV). The degree of anticoagulation is monitored by evaluating the international normalised ratio (INR); however, the quality of anticoagulation, determined by the time in therapeutic range (TTR), is less often evaluated. TTR has significant clinical implications in patient outcomes. Objectives: We sought to identify the indications for anticoagulation and determine its quality via the TTR at a single centre, community-based and district level hospital in the setting of usual care. We documented the prevalence of thrombo-embolic and haemorrhagic adverse events and we also collected data on factors that may contribute to a poor TTR or increased risk of adverse events. Methods: We conducted a retrospective, descriptive and observational study with chart audits evaluating the anticoagulation indication and control for the preceding 1 year for each patient. Descriptive statistics included mean and standard deviation for quantitative data and frequencies for categorical data. Chi-square tests were used to analyse comparisons of categorical data and the student’s t-test for continuous variables. Two-tailed p-values less than 0.05 were considered significant. Results: TTR was poor for patients with AF and PHV (44.5% and 13.7% respectively). We identified older age, less frequent testing and high target ranges as significant factors associated with poorer outcomes. We demonstrated a high prevalence of adverse events (25.4%). Conclusion: Patients in this setting demonstrated poor quality of anticoagulation and had a high prevalence of adverse events

Racial Discipline Disproportionality in Montessori and Traditional Public Schools: A Comparative Study Using the Relative Rate Index

Research from the past 40 years indicates that African American students are subjected to exclusionary discipline, including suspension and expulsion, at rates two to three times higher than their White peers (Children’s Defense Fund, 1975; Skiba, Michael, Nardo, & Peterson, 2002). Although this phenomenon has been studied extensively in traditional public schools, rates of racially disproportionate discipline in public Montessori schools have not been examined. The purpose of this study is to examine racial discipline disproportionality in Montessori public elementary schools as compared to traditional elementary schools. The Relative Rate Index (RRI) is used as a measure of racially disproportionate use of out-of-school suspensions (Tobin & Vincent, 2011). Suspension data from the Office of Civil Rights Data Collection was used to generate RRIs for Montessori and traditional elementary schools in a large urban district in the Southeast. While statistically significant levels of racial discipline disproportionality are found in both the Montessori and traditional schools, the effect is substantially less pronounced in Montessori settings. These findings suggest that Montessori schools are not immune to racially disproportionate discipline and should work to incorporate more culturally responsive classroom management techniques. Conversely, the lower levels of racially disproportionate discipline in the Montessori schools suggests that further study of discipline in Montessori environments may provide lessons for traditional schools to promote equitable discipline

Lipid profiles of patients presenting with acute myocardial infarction in a South African regional hospital

Background: Cardiovascular disease is an important cause of morbidity and mortality in South Africa and hyperlipidaemia is a major contributing modifiable risk factor.Objectives: To describe the lipid profiles of patients with acute myocardial infarction and to compare values with recommended target levels outlined in the South African Dyslipidaemia Guideline Consensus Statement.Methods: We performed a retrospective chart review of patients admitted with a diagnosis of acute myocardial infarction to a regional hospital in Durban, South Africa, between 1 January and 31 December 2016. Patients had a non-fasting lipogram taken within the first 24 hours of admission.Results: We enrolled 126 subjects. The mean age was 57.6 (SD ± 9.4) years. One hundred and ten subjects (87.3%) met criteria for hyperlipidaemia. Previous statintherapy was associated with lower LDL-cholesterol values (3.43mmol/L vs. 4.03mmol/L, p=0.02), but only 9 (11.2%) of the 80 subjects on therapy (88.8%) fell below the levels recommended for their risk category by the South African Dyslipidaemia Guideline Consensus Statement. Overall, 23 subjects (18.3% of the entire study group) demonstrated LDL-C values at presentation that were below the recommended values.Conclusions: A high proportion of subjects presenting with acute myocardial infarction show evidence of suboptimal control of pre-existing hyperlipidaemia

Addressing Health Literacy for Improved Outcomes: A Focus on Pregnancy

Health literacy influences how messages are received and understood by patient or population groups. In Europe, incomprehension of health information is common, affecting the ability of many individuals to make informed decisions about their health. In addition, incomprehension of health information may impact the effectiveness of interventions and subsequently, health outcomes. In this article, we illustrate the importance of health literacy in the context of maternity services, a time during which, health interventions affect both maternal and child health. Through this, we suggest that health literacy should be recognised in healthcare settings as a tool to facilitate behaviour change. To support this, we provide practical recommendations for clinicians and researchers on how to address aspects of health literacy in their practice

Results from a Prospective Study of Widowhood

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142735/1/Brown-Nesse-Religion-PSPB-2004.pd

Results from a Prospective Study of Mortality

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142734/1/Brown-Nesse-Social_Supp-PsychSci-2003.pd

Effect of core cross-linking on the physical properties of poly(dimethylsiloxane)-based diblock copolymer worms prepared in silicone oil

A trithiocarbonate-capped poly(dimethylsiloxane) (PDMS) precursor is chain-extended via reversible addition–fragmentation chain transfer dispersion polymerization of 2-(dimethylamino)ethyl methacrylate (DMA) in decamethylcyclopentasiloxane (D5) silicone oil at 90 °C. For a fixed mean degree of polymerization (DP) of 66 for the PDMS steric stabilizer block, targeting core-forming PDMA block DPs of between 105 and 190 enables the preparation of either well-defined worms or vesicles at a copolymer concentration of 25% w/w. The as-synthesized linear PDMS66–PDMA100 worms exhibit thermoresponsive behavior in D5, undergoing a worm-to-sphere transition on heating to 100 °C. Variable temperature 1H NMR spectroscopy indicates that this thermal transition is driven by reversible solvent plasticization of the PDMA cores. This change in copolymer morphology is characterized by transmission electron microscopy (TEM) studies, variable temperature dynamic light scattering and small-angle X-ray scattering experiments. Oscillatory rheology studies indicate that degelation occurs at 32 °C, but shear-induced polarized light imaging measurements suggest that full conversion of worms into spheres requires significantly higher temperatures (∼110 °C). 1,2-Bis(2-iodoethoxy)ethane (BIEE) is evaluated as a cross-linker for PDMS66–PDMAx diblock copolymer nano-objects in D5. This bifunctional reagent quaternizes the tertiary amine groups on the DMA residues within the worm cores, introducing cross-links via the Menshutkin reaction. TEM studies confirm that such covalently-stabilized worms no longer undergo a worm-to-sphere transition when heated to 100 °C. Kinetic studies performed on PDMS66–PDMA176 vesicles suggest that cross-linking requires approximately 13 h at 20 °C to ensure that these nano-objects remain intact when dispersed in chloroform, which is a good solvent for both blocks. Oscillatory rheology studies of a PDMS66–PDMA100 worm gel indicated that covalent stabilization using a BIEE/DMA molar ratio of 0.15 increased its dynamic elastic modulus (G′) by almost two orders of magnitude. Furthermore, such cross-linked worms exhibit a much lower critical gelation concentration (∼2% w/w) compared to that of the linear precursor worms (∼12% w/w)

Use of electrical impedance spectroscopy for intraoperative tissue differentiation during thyroid and parathyroid surgery

Background Electrical impedance (EI) measures tissue resistance to alternating current across several frequencies and may help identify tissue type. A recent rabbit model demonstrated that electrical impedance spectroscopy (EIS) may facilitate identification of parathyroid glands and potentially improve outcomes following surgery. This study looks at the EI patterns of soft tissues in the human neck to determine whether parathyroid tissue can be accurately identified. Methods This was a phase 1, single-arm interventional study involving 56 patients undergoing thyroid and/or parathyroid surgery. Up to 12 EI readings were taken from in vivo and ex vivo thyroid and parathyroid glands, adipose tissue and muscle of each patient. Each reading consists of a series of measurements over 14 frequencies from each tissue. EI patterns were analysed. Two patients were excluded due to data loss due to device malfunction. Results The median age of participants was 53.5 (range 20–85) years. Thirty-five participants had surgery for thyroid pathology, 17 for parathyroid pathology and four for both. Six hundred and six EIS spectra were reviewed for suitability. One hundred and eighty-four spectra were rejected leaving 422 spectra for analysis. The impedance patterns of the soft tissues differed by histological type. The EI ratio of low (152 Hz) to high (312 kHz) frequencies demonstrated a significant difference between the soft tissues (p = 0.006). Using appropriate thresholds, parathyroid tissue can be distinguished from thyroid tissue with a sensitivity of 76% and specificity of 60%. Conclusions This study demonstrates the feasibility of using EIS to aid parathyroid identification and preservation. Further changes to the device and modelling of the EI patterns across the range of frequencies may improve accuracy and facilitate intraoperative use

Alternative job search strategies in remote rural and peri-urban labour markets: the role of social networks

This paper examines the importance of informal methods (especially social networking) to the job search strategies used by unemployed people. It compares three areas: a small rural town; a larger, more sparsely populated, remote rural area; and a centrally-located, peri-urban labour market. The analysis is based first on survey research undertaken with 490 job seekers across the study areas. Emerging issues were then followed up during a series of twelve focus groups. The survey research showed that job seekers in the rural study areas were significantly more likely to use social networks to look for work. However, those who had experienced repeated or long-term periods out of work, the unskilled and young people were significantly less likely to use such networks. Focus groups confirmed the perceived importance of social networking to the job search process in rural areas, in contrast to the more marginal role such methods appear to play in peri-urban settings. For many rural job seekers, formal job search activities conducted through Jobcentres were seen as largely symbolic, lacking the practical value of social networking. These results suggest that service providers seeking to assist unemployed people in rural areas need to address the problems faced by many disadvantaged job seekers who are currently caught between their lack of social network relations and the absence of local public employment service facilities in more remote communities