Technology-Enabled Remote Monitoring and Self-Management - Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol.

BACKGROUND: Tens of thousands of cardiac and vascular surgeries (CaVS) are performed on seniors in Canada and the United Kingdom each year to improve survival, relieve disease symptoms, and improve health-related quality of life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection of hemodynamic compromise, complications, and related poor functional status are major problems for substantial numbers of patients during the recovery process. To tackle this problem, we aim to refine and test the effectiveness of an eHealth-enabled service delivery intervention, TecHnology-Enabled remote monitoring and Self-MAnagemenT-VIsion for patient EmpoWerment following Cardiac and VasculaR surgery (THE SMArTVIEW, CoVeRed), which combines remote monitoring, education, and self-management training to optimize recovery outcomes and experience of seniors undergoing CaVS in Canada and the United Kingdom. OBJECTIVE: Our objectives are to (1) refine SMArTVIEW via high-fidelity user testing and (2) examine the effectiveness of SMArTVIEW via a randomized controlled trial (RCT). METHODS: CaVS patients and clinicians will engage in two cycles of focus groups and usability testing at each site; feedback will be elicited about expectations and experience of SMArTVIEW, in context. The data will be used to refine the SMArTVIEW eHealth delivery program. Upon transfer to the surgical ward (ie, post-intensive care unit [ICU]), 256 CaVS patients will be reassessed postoperatively and randomly allocated via an interactive Web randomization system to the intervention group or usual care. The SMArTVIEW intervention will run from surgical ward day 2 until 8 weeks following surgery. Outcome assessments will occur on postoperative day 30; at week 8; and at 3, 6, 9, and 12 months. The primary outcome is worst postop pain intensity upon movement in the previous 24 hours (Brief Pain Inventory-Short Form), averaged across the previous 14 days. Secondary outcomes include a composite of postoperative complications related to hemodynamic compromise-death, myocardial infarction, and nonfatal stroke- all-cause mortality and surgical site infections, functional status (Medical Outcomes Study Short Form-12), depressive symptoms (Geriatric Depression Scale), health service utilization-related costs (health service utilization data from the Institute for Clinical Evaluative Sciences data repository), and patient-level cost of recovery (Ambulatory Home Care Record). A linear mixed model will be used to assess the effects of the intervention on the primary outcome, with an a priori contrast of weekly average worst pain intensity upon movement to evaluate the primary endpoint of pain at 8 weeks postoperation. We will also examine the incremental cost of the intervention compared to usual care using a regression model to estimate the difference in expected health care costs between groups. RESULTS: Study start-up is underway and usability testing is scheduled to begin in the fall of 2016. CONCLUSIONS: Given our experience, dedicated industry partners, and related RCT infrastructure, we are confident we can make a lasting contribution to improving the care of seniors who undergo CaVS

War diplomacy and the Turkish Republic: a study in neutrality.

As war approached, Kemalist Turkey sought safety through collective security arrangements. Despite her proclamation of non-belligerency in 1939, she remained during the first phase of the world conflict a willing ally of Britain and France. In the second period she became increasingly cautious, and in the third (that of the Axis zenith) she embraced neutrality. From early in 1943 until the declaration of war, she returned to a pro-Allied partiality, although this was much complicated by Russian presence among the Allies. Indeed, throughout the war her main fear was of Soviet imperialism

Accumulation and tissue distribution of radioiodine (131I) from algal phytoplankton by the freshwater clam Corbicula manilensis

Radioactive wastes discharged from establishments involved in the use of radioisotopes such as nuclear powered industries, tracer research and nuclear medicine are a potential public health hazard. Such wastes contain radionuclides, particularly Iodine-131 (131I), produced in fission with a yield of about 3%. It is a beta emitter (Bmax = 0.61MeV); it also emits gamma photons. It has a short half-life (8.04 d) (Dutton 1975), hence it is difficult to detect unless accumulated by indicator organisms. Radionuclides in waste waters are known to be taken up by molluscs such as mussels (Van der Borght and Van Puymbroeck 1970; Fowler et al. 1975; Hetherington et al. 1976; Helt et al. 1980; and Sombrito et al. 1982), oyster (Romeril 1971; Cranmore and Harrison 1975) and clams (Cuvin and Umaly 1988). This study aims to determine the uptake of 131I from algal phytoplankton (Choroococcus dispersus) fed to the freshwater clam Corbicula manillensis as well as the organ/tissue distribution. The results will be compared with our previous study on 131I uptake from water by the same clams (Cuvin and Umaly 1988)

Testing process for the WEAVE prime focus corrector lenses for the William Herschel Telescope

A new prime focus corrector for the WEAVE project for the William Herschel Telescope is being produced. The corrector consists of six lens elements, the largest being 1.1 m in diameter. It also incorporates an Atmospheric Dispersion Corrector. Testing procedures for the WEAVE prime focus corrector lens elements are described here. Critical issues encountered in practice, including the influence of the lens size, wedge and weight on the testing procedure are discussed. Due to large lens dimensions, a dedicated test tower and lens support system has been developed to measure the optical surface form errors of the concave surfaces and the transmitted wavefront of each lens. For some of the lens elements, sub-aperture measurements have been performed using an off-axis Hindle sphere and the resultant OPD maps have been stitched together. The challenge of testing a wedged lens with a combination of a long radius convex surface and a short radius concave surface has been resolved by using another lens from the system as an auxiliary lens. The practice of testing convex surfaces via internal reflection/transmission through the lens element has been avoided entirely in this case and some discussion justifying the choices of metrology approach taken is given. The fabrication and acceptance testing of the lens elements has been completed within the expected time and budget, and all elements have been shown to meet requirements

International Myeloma Working Group recommendations for global myeloma care

Recent developments have led to remarkable improvements in the assessment and treatment of patients with multiple myeloma (MM). New technologies have become available to precisely evaluate the biology and extent of the disease, including information about cytogenetics and genetic abnormalities, extramedullary manifestations and minimal residual disease. New, more effective drugs have been introduced into clinical practice, which enable clinicians to significantly improve the outcome of patients but also pose new challenges for the prevention and management of their specific side effects. Given these various new options and challenges, it is important to identify the minimal requirements for diagnosis and treatment of patients, as access to the most sophisticated advances may vary depending on local circumstances. Here, we propose the minimal requirements and possible options for diagnosis, monitoring and treatment of patients with multiple myeloma. © 2014 Macmillan Publishers Limited. All rights reserved

International Myeloma Working Group recommendations for global myeloma care.

Recent developments have led to remarkable improvements in the assessment and treatment of patients with multiple myeloma (MM). New technologies have become available to precisely evaluate the biology and extent of the disease, including information about cytogenetics and genetic abnormalities, extramedullary manifestations and minimal residual disease. New, more effective drugs have been introduced into clinical practice, which enable clinicians to significantly improve the outcome of patients but also pose new challenges for the prevention and management of their specific side effects. Given these various new options and challenges, it is important to identify the minimal requirements for diagnosis and treatment of patients, as access to the most sophisticated advances may vary depending on local circumstances. Here, we propose the minimal requirements and possible options for diagnosis, monitoring and treatment of patients with multiple myeloma