Pharmacist intervention in primary care to improve outcomes in patients with left ventricular systolic dysfunction

<b>Background</b> Meta-analysis of small trials suggests that pharmacist-led collaborative review and revision of medical treatment may improve outcomes in heart failure.<p></p> <b>Methods and results</b> We studied patients with left ventricular systolic dysfunction in a cluster-randomized controlled, event driven, trial in primary care. We allocated 87 practices (1090 patients) to pharmacist intervention and 87 practices (1074 patients) to usual care. The intervention was delivered by non-specialist pharmacists working with family doctors to optimize medical treatment. The primary outcome was a composite of death or hospital admission for worsening heart failure. This trial is registered, number ISRCTN70118765. The median follow-up was 4.7 years. At baseline, 86% of patients in both groups were treated with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. In patients not receiving one or other of these medications, or receiving less than the recommended dose, treatment was started, or the dose increased, in 33.1% of patients in the intervention group and in 18.5% of the usual care group [odds ratio (OR) 2.26, 95% CI 1.64–3.10; P< 0.001]. At baseline, 62% of each group were treated with a β-blocker and the proportions starting or having an increase in the dose were 17.9% in the intervention group and 11.1% in the usual care group (OR 1.76, 95% CI 1.31–2.35; P< 0.001). The primary outcome occurred in 35.8% of patients in the intervention group and 35.4% in the usual care group (hazard ratio 0.97, 95% CI 0.83–1.14; P = 0.72). There was no difference in any secondary outcome.<p></p> <b>Conclusion</b> A low-intensity, pharmacist-led collaborative intervention in primary care resulted in modest improvements in prescribing of disease-modifying medications but did not improve clinical outcomes in a population that was relatively well treated at baseline

Stability of anhysteretic remanent magnetization in fine and coarse magnetite and maghemite particles

Further experiments have been performed to investigate the biasing-field dependency of alternating field demagnetization curves of anhysteretic remanent magnetization as a simple test for the domain state of magnetite and maghemite particles. The biasing-field dependency in fine-grained particles was opposite to that in coarse-grained particles. The experiments were conducted on well sized synthetic specimens in the single domain, pseudo-single domain and multi-domain grain size ranges. A single domain-like biasing-field dependency was observed in equidimensional particles up to 0.2µ mean grain size and up to 0.4µ elongated grains. Either the single domain/pseudo-single domain boundary lies above at least 0.2µ grain size or this field dependency test does not distinguish between single domain and pseudo-single domain states. A multidomainlike trend was observed in very coarse magnetite. The test may possibly distinguish the change from pseudo-single domain to multi-domain states. If both fine and coarse fractions are present a confusing overlap of the demagnetization curves occurs

A 3D radiative transfer framework: II. line transfer problems

Higher resolution telescopes as well as 3D numerical simulations will require the development of detailed 3D radiative transfer calculations. Building upon our previous work we extend our method to include both continuum and line transfer. We present a general method to calculate radiative transfer including scattering in the continuum as well as in lines in 3D static atmospheres. The scattering problem for line transfer is solved via means of an operator splitting (OS) technique. The formal solution is based on a long-characteristics method. The approximate $\Lambda$ operator is constructed considering nearest neighbors {\em exactly}. The code is parallelized over both wavelength and solid angle using the MPI library. We present the results of several test cases with different values of the thermalization parameter and two choices for the temperature structure. The results are directly compared to 1D spherical tests. With our current grid setup the interior resolution is much lower in 3D than in 1D, nevertheless the 3D results agree very well with the well-tested 1D calculations. We show that with relatively simple parallelization that the code scales to very large number of processors which is mandatory for practical applications. Advances in modern computers will make realistic 3D radiative transfer calculations possible in the near future. Our current code scales to very large numbers of processors, but requires larger memory per processor at high spatial resolution.Comment: A&A, in press, 9 pages, 9 Figures. Full resolution version available at ftp://phoenix.hs.uni-hamburg.de/preprints/3DRT_paper2.pd

Sharp interface limits of phase-field models

The use of continuum phase-field models to describe the motion of well-defined interfaces is discussed for a class of phenomena, that includes order/disorder transitions, spinodal decomposition and Ostwald ripening, dendritic growth, and the solidification of eutectic alloys. The projection operator method is used to extract the ``sharp interface limit'' from phase field models which have interfaces that are diffuse on a length scale $\xi$. In particular,phase-field equations are mapped onto sharp interface equations in the limits $\xi \kappa \ll 1$ and $\xi v/D \ll 1$, where $\kappa$ and $v$ are respectively the interface curvature and velocity and $D$ is the diffusion constant in the bulk. The calculations provide one general set of sharp interface equations that incorporate the Gibbs-Thomson condition, the Allen-Cahn equation and the Kardar-Parisi-Zhang equation.Comment: 17 pages, 9 figure

Magnetostratigraphy and biostratigraphy of the Carnian/Norian boundary interval from the Pizzo Mondello section (Sicani Mountains, Sicily)

The 146.5 m-thick Upper Triassic limestone section at Pizzo Mondello in the Sicani Mountains of western Sicily is characterized by high quality of exposure, accessibility, and stratigraphic continuity. Magnetostratigraphic results delineate 12 normal and reverse polarity magnetozones, labelled successively from the base upwards as PM1n, PM1r, PM6n, PM6r. The Carnian/Norian boundary, based on conodont biostratigraphy, falls somewhere in the PM3n to PM5n interval which corresponds to the E14n to E16n magnetozone interval in the Newark reference sequence of polarity reversals. Comparison of magnetobiostratigraphic data from the Newark basin, Pizzo Mondello and other Late Triassic marine sections available from the literature suggests the existence of a reduction in sedimentation rate in the Tethyan marine domain at around the Carnian/Norian boundary. Although the Newark and the expanded Pizzo Mondello sections correlate well with each other, correlation with the condensed Kavur Tepe and Scheiblkogel sections is unsatisfactory. A re-interpretation of the Kavur Tepe results suggests that the section is younger than its previous correlation with the Newark section, and that it was deposited in the northern instead of the southern hemisphere. Most of the condensed Tethyan marine sections are seen to be highly discontinuous, as evidenced by concantenated conodont total range zones

Curricular orientations to real-world contexts in mathematics

A common claim about mathematics education is that it should equip students to use mathematics in the ‘real world’. In this paper, we examine how relationships between mathematics education and the real world are materialised in the curriculum across a sample of eleven jurisdictions. In particular, we address the orientation of the curriculum towards application of mathematics, the ways that real-world contexts are positioned within the curriculum content, the ways in which different groups of students are expected to engage with real-world contexts, and the extent to which high-stakes assessments include real-world problem solving. The analysis reveals variation across jurisdictions and some lack of coherence between official orientations towards use of mathematics in the real world and the ways that this is materialised in the organisation of the content for students

Developing Markov models from real-world data: A case study of heart failure modeling using administrative data

Objectives Markov models characterize disease progression as specific health states based on clinical or biological measures. However, these measures are not always collected outside clinical trials. In this article, an alternative approach is presented that uses real-world data to define the health states and to model transitions between them, specific to a local setting, to estimate the cost-effectiveness of telemonitoring (TM) versus no TM for heart failure. Methods The incidence of hospitalization for usual care was estimated from hospital episode statistics (HES) data in the United Kingdom and converted into a monthly transition matrix with 5 health states (4 states are defined based on the number of hospitalizations in the previous year and death) to estimate the cost-effectiveness of TM in a local UK primary care trust (PCT) using probabilistic sensitivity analysis from a healthcare perspective. Results Geographical variation in hospitalization rates were present, which led to different health state transition matrices in different localities. In the PCT that was evaluated, TM accrued mean additional costs of £3610 and 0.075 additional quality-adjusted life-years (QALYs) compared with usual care per patient, resulting in a mean incremental cost effectiveness ratio of £48 172/QALY. Conclusions The use of administrative data to define health states and transition matrices based on health service events is feasible, and TM was not cost-effective in our analysis. Given the increasing emphasis on using real-world evidence, it is likely that these approaches will be used more in the future

The relative stabilities of the reverse and normal polarity states of the earth's magnetic field

Recent analyses of the geomagnetic reversal sequence have led to different conclusions regarding the important question of whether there is a discernible difference between the properties of the two polarity states. The main differences between the two most recent studies are the statistical analyses and the possibility of an additional 57 reversal events in the Cenozoic. These additional events occur predominantly during reverse polarity time, but it is unlikely that all of them represent true reversal events. Nevertheless the question of the relative stabilities of the polarity states is examined in detail, both for the case when all 57 "events" are included in the reversal chronology and when they are all excluded. It is found that there is not a discernible difference between the stabilities of the two polarity states in either case. Inclusion of these short events does, however, change the structure of the non-stationarity in reversal rate, but still allows a smooth non-stationarity. Only 7 of the 57 short events are pre-38 Ma, but the evidence suggests that this is a real geomagnetic phenomenon rather than degradation of the magnetic recording or a bias in observation. This could be tested by detailed magnetostratigraphic and oceanic magnetic surveys of the Paleogene and Late Cretaceous. Overall it would appear that the present geomagnetic polarity timescale for 0-160 Ma is probably a very good representation of the actual history, and that different timescales and additional events now represent only changes in detail

Exploring rationales for branding a university: Should we be seeking to measure branding in UK universities?

Although branding is now widespread among UK universities, the application of branding principles in the higher education sector is comparatively recent and may be controversial for internal audiences who question its suitability and efficiency. This paper seeks to investigate how and whether the effectiveness of branding activity in the higher education sector should be evaluated and measured, through exploratory interviews with those who often drive it; UK University marketing professionals. Conclusions suggest that university branding is inherently complex and therefore application of commercial approaches may be over simplistic. Whilst marketing professionals discuss challenges they do not necessarily have a consistent view of the objectives of branding activity although all were able to clearly articulate branding objectives for their university, including both qualitative and, to some extent, quantitative metrics. Some measures of the real value of branding activity are therefore suggested but a key debate is perhaps whether the objectives and role of branding in higher education needs to be clarified, and a more consistent view of appropriate metrics reached? Various challenges in implementing branding approaches are also highlighted

Cavalier King Charles Spaniels with Chiari-like malformation and Syringomyelia have increased variability of spatio-temporal gait characteristics

Abstract Background Chiari-like malformation in the Cavalier King Charles Spaniel is a herniation of the cerebellum and brainstem into or through the foramen magnum. This condition predisposes to Syringomyelia; fluid filled syrinxes within the spinal cord. The resulting pathology in spinal cord and cerebellum create neuropathic pain and changes in gait. This study aims to quantify the changes in gait for Cavalier King Charles Spaniel with Chiari-like malformation and Syringomyelia. Methods We compared Cavalier King Charles Spaniel with Chiari-like malformation with (n = 9) and without (n = 8) Syringomyelia to Border Terriers (n = 8). Two video cameras and manual tracking was used to quantify gait parameters. Results and conclusions We found a significant increase in coefficient of variation for the spatio-temporal characteristics and ipsilateral distance between paws and a wider base of support in the thoracic limbs but not in the pelvic limbs for Cavalier King Charles Spaniels compared with the border terrier