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The tech sectors are the least understood portion of the healthcare system, but the ones that supply most of the innovation in healthcare services and generate most revenue. Fully updated for this third edition, The Business of Healthcare Innovation is a wide-ranging analysis of business models and trends in the tech sectors of the healthcare industry. It provides a thorough overview of and introduction to the innovative sectors that fuel improvements in healthcare: pharmaceuticals, biotechnology, life science startups, medical devices and information technology. For each sector, the book examines the trends in scientific innovation, the science behind that innovation, the business and revenue models pursued to commercialize that innovation, the regulatory constraints within which each sector must operate and the growing issues posed by activist payers and consumers. From a combination of academic and industry perspectives, the authors show why healthcare sectors are such an important source of growth in any nation's economy.
The paper surveys open problems and questions related to geodesics defined by Riemannian, Finsler, semi-Riemannian and magnetic structures on manifolds. It is an extended report on problem sessions held during the International Workshop on Geodesics in August 2010 at the Chern Institute of Mathematics in Tianjin.
The Single Ventricle Reconstruction Trial randomised neonates with hypoplastic left heart syndrome to a shunt strategy but otherwise retained standard of care. We aimed to describe centre-level practice variation at Fontan completion.
Centre-level data are reported as median or median frequency across all centres and range of medians or frequencies across centres. Classification and regression tree analysis assessed the association of centre-level factors with length of stay and percentage of patients with prolonged pleural effusion (>7 days).
The median Fontan age (14 centres, 320 patients) was 3.1 years (range from 1.7 to 3.9), and the weight-for-age z-score was −0.56 (−1.35 + 0.44). Extra-cardiac Fontans were performed in 79% (4–100%) of patients at the 13 centres performing this procedure; lateral tunnels were performed in 32% (3–100%) at the 11 centres performing it. Deep hypothermic circulatory arrest (nine centres) ranged from 6 to 100%. Major complications occurred in 17% (7–33%). The length of stay was 9.5 days (9–12); 15% (6–33%) had prolonged pleural effusion. Centres with fewer patients (<6%) with prolonged pleural effusion and fewer (<41%) complications had a shorter length of stay (<10 days; sensitivity 1.0; specificity 0.71; area under the curve 0.96). Avoiding deep hypothermic circulatory arrest and higher weight-for-age z-score were associated with a lower percentage of patients with prolonged effusions (<9.5%; sensitivity 1.0; specificity = 0.86; area under the curve 0.98).
Fontan perioperative practices varied widely among study centres. Strategies to decrease the duration of pleural effusion and minimise complications may decrease the length of stay. Further research regarding deep hypothermic circulatory arrest is needed to understand its association with prolonged pleural effusion.
A 64-year-old, obese patient is admitted to the critical care unit. He presents with hypotension and evidence of shock. He has pneumonia and acute-on-chronic renal disease. He has a history of ischaemic heart disease and had a pacemaker inserted following coronary angioplasty 2 years ago. He is also diabetic with known autonomic neuropathy.
The goals of the present study were to examine the associations between depressive symptoms, sleep problems and the risk of developing heart disease in a Canadian community sample.
Baseline data were from the CARTaGENE study, a community health survey of adults aged 40–69 years in Quebec, Canada. Incidence of heart disease was examined in N = 33 455 participants by linking survey data with administrative health insurance data. Incident heart disease was identified using the World Health Organization's International Classification of Diseases, 9th or 10th edition (ICD-9 and ICD-10) diagnostic codes for heart disease. Sleep problems were assessed with diagnostic codes for sleep disorders within the 2 years preceding the baseline assessment. Average sleep duration was assessed by self-report. Depressive symptoms were assessed with the nine-item Patient Health Questionnaire.
In total, 2448 (7.3%) participants developed heart disease over an average follow-up period of 4.6 years. Compared to those without depressive symptoms and with no sleep disorders, those with elevated depressive symptoms and a sleep disorder (HR = 2.60, 95% CI 1.83–3.69), those with depressive symptoms alone (HR = 1.40, 95% CI 1.25–1.57) and those with sleep disorders alone (HR = 1.33, 95% CI 1.03–1.73) were more likely to develop heart disease. Test of additive interaction suggested a synergistic interaction between depressive symptoms and sleep disorders (synergy index = 2.17 [95% CI 1.01–4.64]). When sleep duration was considered, those with long sleep duration and elevated depressive symptoms were more likely to develop heart disease than those with long sleep alone (HR = 1.77, 95% CI 1.37–2.28; and HR = 1.16, 95% CI 0.99–1.36, respectively).
Depression and diagnosed sleep disorders or long sleep duration are independent risk factors for heart disease and are associated with a stronger risk of heart disease when occurring together.
We make a few observations on the absence of geometric and topological rigidity for acylindrically hyperbolic and relatively hyperbolic groups. In particular, we demonstrate the lack of a well-defined limit set for acylindrical actions on hyperbolic spaces, even under the assumption of universality. We also prove a statement about relatively hyperbolic groups inspired by a remark by Groves, Manning, and Sisto about the quasi-isometry type of combinatorial cusps. Finally, we summarize these results in a table in order to assert a meta-statement about the decay of metric rigidity as the conditions on actions on hyperbolic spaces are loosened.
Action research has become increasingly prevalent in the field of English language teaching over the last two decades. It can be considered as a form of professional learning for language teachers which takes a socio-constructivist approach in which teachers are seen as agentive actors and investigators within their own social contexts. This chapter begins by providing a brief overview of the origins of action research and its development in the field of English language teaching, considering also some of the more recent initiatives that have contributed to the spread of this form of research in the field. It then discusses what various recent studies have shown about the impact on teachers of conducting action research. The discussion ends with a brief consideration of future directions for this research.
Unexpected disasters, such as earthquakes or fires, require preparation to address knowledge gaps that may negatively affect vulnerable patients. Training programs can promote natural disaster readiness to respond and evacuate patients safely, but also require evidence-based information to guide learning objectives.
There is limited evidence on what skills and bedside equipment are most important to include in disaster training and evacuation programs for critically ill infants.
An expert panel was used to create a 13-item mastery checklist of skills for bedside registered nurses (RNs) required to successfully evacuate a critically ill infant. Expert nurses were surveyed, and the Angoff method was used to determine which of the mastery checklist skills a newly graduated nurse (ie, the “minimally competent” nurse) should be able to do. Participants then rated the importance of 26 commonly available pieces of bedside equipment for use in evacuating a hemodynamically unstable, intubated infant during a disaster.
Twenty-three emergency department (ED) and neonatal intensive care unit (NICU) charge RNs responded to the survey with a mean of 19 (SD = 9) years of experience and 30% reporting personal experience with evacuating patients. The skills list scores showed an emphasis on the newly graduated nurse having more complete mastery of skills surrounding thermoregulation, documentation, infection control, respiratory support, and monitoring. Skills for communication, decision making, and anticipating future needs were assessed as less likely for a new nurse to have mastered. On a scale of one (not important) to seven (critically important), the perceived necessity of equipment ranged from a low of 1.6 (breast pump) to a high of 6.9 (face mask). The individual intraclass correlation coefficient (ICC) of 0.55 showed moderate reliability between raters and the average team ICC of 0.97 showed excellent agreement as a group.
Experts rated the ability to manage physiological issues, such as thermoregulation and respiratory support, as skills that every nurse should master. Disaster preparedness activities for nurses in training may benefit from checklists of essential equipment and skills to ensure all nurses can independently manage patients’ physiologic needs when they enter the workforce. Advanced nursing training should include education on decision making, communication during emergencies, and anticipation of future issues to ensure that charge and resource nurses can support bedside nurses during evacuation events.
Long before his election as Pope Benedict XVI, the young Joseph Ratzinger was known among Augustine scholars for his path-breaking studies of Augustine's ecclesiology. Later, as Cardinal Ratzinger, he was known widely for speaking out on political issues and controversies of our day, particularly those related to the future of Europe and the place of Christianity within it. Rarely has anyone connected his interest in politics with his early writings on Augustine. In the past sixty years of scholarship on Augustine's political thought, Ratzinger has received barely a mention, and as far as I am aware, Michael Bruno's valuable 2014 monograph on the past century's interpretations of Augustine's political thought was the first ever to classify Ratzinger as even having offered such an interpretation. But perhaps it would be more accurate to say that Bruno is the second, the first being Ratzinger himself. In a 1990 public lecture titled “Europe: Chances and Dangers,” he made a number of bold claims about the historical importance of the “decisive interpretation” that Augustine had given to the “Platonic tradition … [of] political philosophy” and supported those claims with a footnote to a monograph chapter he wrote in 1961 on Augustine's debate with Roman “political theology.” Drawing on that chapter, Ratzinger now made a series of claims about Augustine (in relation to controversies over the meaning of Europe today) that must be striking to any scholar of Augustine's political thought and are worth quoting at length.
What can and ought Europe really to be, for itself and for the world? We open the path to answering this question when we look somewhat more closely into … the claim that a state without justice is nothing but a robber band grown immeasurably large…. [In its pre-Augustinian form,] this claim took concrete shape on the basis of real experiences of rulers who were in point of fact robbers. But its philosophical presuppositions lie deeper. To examine them, we are led into the heart of Greek and Roman political philosophy, in which the spiritual roots of Europe lie…. [Plato's basic political teaching, which Ratzinger here spends a page summarizing] means that a state that is basically agnostic with respect to God, one that builds justice only on majority opinions, declines in and of itself into a robber band.