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Intracoronary wave intensity analysis in hypertrophic cardiomyopathy has shown a large backward compression wave due to compressive deformation of the intramyocardial coronary arteries in systole. The authors describe the angiographic evidence of this backward compression wave, which has not been described in this physiological context and can be a marker of poor prognosis.
The application of powder X-ray diffraction (PXRD) for the detection and quantification of low levels of a solid-state chemical impurity, BrettPhos oxide, in an active pharmaceutical ingredient is discussed. It is demonstrated that with appropriate methodology and experimentation, the impurity levels of as low as 0.07% w/w could be detected reliably and limit of quantification of 0.10% w/w could be achieved by PXRD, using a laboratory X-ray source. Method development, validation, and benchmarking using conventional high-performance liquid chromatography are presented in the manuscript highlighting the robustness and reproducibility of such measurements.
To discover whether clozapine is being prescribed and monitored according to accepted guidelines.
Sample size 30 with a diagnosis of Schizophrenia generated from a list of patients attending clozapine clinic. Clozapine levels were done prospectively from December 07 to March 08.
Of 30 patients, 73% were male and 27% female. 57% were prescribed >450 mg once daily and 50% had trough plasma levels >0.60mg/l. Only 21% were within the therapeutic range (as recommended by Clozapine Patient Monitoring System) 0.35-0.60 mg/l. 29% of patients had a plasma level < 0.35 mg/l. Only 10% had plasma levels checked within the last 6 months.Among 8 patients taking more than 600 mg of clozapine, 5 had an anticonvulsant prescribed prophylactically. among 14 patients with a plasma level >0.60 mg/l, only five had an anticonvulsant co-prescribed.
The outcome of this audit has wide implications from a medico-legal perspective. There is significant evidence implicating clozapine in the development of metabolic syndrome as well as potentially serious side effects including seizures. It is important that clozapine plasma levels are checked when therapeutic doses (Maudsley guidance: 450mg once daily) are reached and that anticonvulsant prophylaxis is considered at high plasma levels.
Audit on Quality of clinical information sent from secondary care to General Practioner in Merseyside-UK
Home treatment Team deals with high turnover of patients with significant risks on daily basis. There have been complaints by General Practitioner’s that discharge letters have inconsistent information regarding medications, risks and diagnosis.
Aims & Objectives
To standardise the content of discharge letter, improve the communication between primary and secondary care and to reduce medication errors eventually maintaining remission.
It is a retrospective audit done in May 2014 looking at the discharge letters to primary care in the month of October 2013. As there were no standards to compare, internal standards were set up for the purpose of audit based on the discussions with various General Practitioners.
Discharge letters were scrutinised based on the Primary and Secondary diagnosis with ICD 10 category, clear documentation of risk and details of medication including name, dose, frequency and duration. Audit tool was devised looking into this and 54 out of 108 patients were selected randomly and audited.
Although majority had diagnosis stated quality of discharge summaries were variable with lot of psychiatric jargons. Risks were documented in an unstructured manner with inconsistent management plans. Most of the letters had medications with some had no dosage or frequency documented clearly.
Results were discussed and presented in academic programme in the trust. New template was devised with all the relevant information and implemented successfully. Re audit to done after 6 months with the view of replicating trustwide.
This article centers on the persistent notion that female domestics are vulnerable to prostitution. Focusing on Vienna in the last decades of the nineteenth century, the article highlights the underlying fallacies of this notion. The 1810 Vienna Servant Code created a system of policing that made it easier for officials to collect data on maidservants. Compounded by problems in classification, maidservants seemed to form a major contingent in police prostitution data. The data enabled physicians to justify extending their authority over the private lives of a swelling population of occupationally diverse working-class migrant women in fin-de-siècle Vienna.
The last time there was this much carbon dioxide in our atmosphere was three and a half million years ago. While our planetary history evidences cyclical climatic shifts, this time injustice is the cause. The lifestyles of the wealthy few are sustained not only by increasing economic inequality but the systemic collapse of ecosystems. The richest 20 percent consumes 80 percent of the world's natural resources and generates over 90 percent of its pollution and waste. For most people, the poorer 80 percent, their grossly unequal access to natural resources is compounded by also bearing the brunt of the pollution generated by the rich.
Consumption of sugar-sweetened beverages (SSB) by infants and young children are less explored in Asian populations. The Growing Up in Singapore Towards healthy Outcomes cohort study examined associations between SSB intake at 18 months and 5 years of age, with adiposity measures at 6 years of age. We studied Singaporean infants/children with SSB intake assessed by FFQ at 18 months of age (n 555) and 5 years of age (n 767). The median for SSB intakes is 28 (interquartile range 5·5–98) ml at 18 months of age and 111 (interquartile range 57–198) ml at 5 years of age. Association between SSB intake (100 ml/d increments and tertile categories) and adiposity measures (BMI standard deviation scores (sd units), sum of skinfolds (SSF)) and overweight/obesity status were examined using multivariable linear and Poisson regression models, respectively. After adjusting for confounders and additionally for energy intake, SSB intake at age 18 months were not significantly associated with later adiposity measures and overweight/obesity outcomes. In contrast, at age 5 years, SSB intake when modelled as 100 ml/d increments were associated with higher BMI by 0·09 (95 % CI 0·02, 0·16) sd units, higher SSF thickness by 0·68 (95 % CI 0·06, 1·44) mm and increased risk of overweight/obesity by 1·2 (95 % CI 1·07, 1·23) times at age 6 years. Trends were consistent with SSB intake modelled as categorical tertiles. In summary, SSB intake in young childhood is associated with higher risks of adiposity and overweight/obesity. Public health policies working to reduce SSB consumption need to focus on prevention programmes targeted at young children.
Results of an audit study conducted during the 2016 election cycle demonstrate that bias toward Latinos observed during the 2012 election has persisted. In addition to replicating previous results, we show that Arab/Muslim Americans face an even greater barrier to communicating with local election officials, but we find no evidence of bias toward blacks. An innovation of our design allows us to measure whether e-mails were opened by recipients, which we argue provides a direct test of implicit discrimination. We find evidence of implicit bias toward Arab/Muslim senders only.
In recent years, the discovery of massive quasars at
has provided a striking challenge to our understanding of the origin and growth of supermassive black holes in the early Universe. Mounting observational and theoretical evidence indicates the viability of massive seeds, formed by the collapse of supermassive stars, as a progenitor model for such early, massive accreting black holes. Although considerable progress has been made in our theoretical understanding, many questions remain regarding how (and how often) such objects may form, how they live and die, and how next generation observatories may yield new insight into the origin of these primordial titans. This review focusses on our present understanding of this remarkable formation scenario, based on the discussions held at the Monash Prato Centre from November 20 to 24, 2017, during the workshop ‘Titans of the Early Universe: The Origin of the First Supermassive Black Holes’.
At GE Research, we are combining “physics” with artificial intelligence and machine learning to advance manufacturing design, processing, and inspection, turning innovative technologies into real products and solutions across our industrial portfolio. This article provides a snapshot of how this physical plus digital transformation is evolving at GE.