2,815 research outputs found
Self management of oral anticoagulation: randomised trial
No full textObjective: To determine the clinical effectiveness of self management compared with routine care in patients on long term oral anticoagulants. Design: Multicentre open randomised controlled trial. Setting: Midlands region of the UK. Participants: 617 patients aged over 18 and receiving warfarin randomised to intervention (n = 337) and routine care (n = from 2470 invited; 193/337 (57%) completed the 12 month intervention. Intervention: Intervention patients used a point of care device to measure international normalised ratio twice a week and a simple dosing chart to interpret their dose of warfarin. Main outcome measure: Percentage of time spent within the therapeutic range of international normalised ratio. Results: No significant differences were found in percentage of time in the therapeutic range between self management and routine care (70% v 68%). Self managed patients with poor control before the study showed an improvement in control that was not seen in the routine care group. Nine patients (2.8/100 patient years) had serious adverse events in the self managed group, compared with seven (2.7/100 patient years) in the routine care arm (2(df = 1) = 0.02, P = 0.89). Conclusion: With appropriate training, self management is safe and reliable for a sizeable proportion of patients receiving oral anticoagulation treatment. It may improve the time spent the therapeutic range for patients with initially poor control
A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study
No full textBackground
Atrial fibrillation (AF) is a major risk factor for stroke. This risk can be reduced through treatment with antithrombotic therapy, with a risk reduction of up to 68% observed with warfarin therapy. Guidelines for treatment of AF recommend ages 65 years and over as an indication for treatment with antithrombotic therapy in the presence of AF. This raises the question of whether screening for AF would be a useful policy, and if so what would be the best method for screening. There are no good data on the prevalence of AF in the UK. One small UK study (four practices, n = 3001) demonstrated that systematic nurse-led screening detected more cases than opportunistic case finding; however, most of those cases detected were already diagnosed. Two further single practice-based studies investigated the role of practice nurses in the screening process and whole population screening, but were too small to be meaningful.Objectives
To evaluate the incremental cost-effectiveness of targeted, population and opportunistic screening with prompts compared with routine clinical practice.
To evaluate the relative cost-effectiveness of different methods of recording and interpreting the ECG within a screening programme.
To identify the prevalence and incidence of AF in patients aged 65 years and over.Methods
This multicentred randomised controlled trial involved patients aged 65 years and over from 50 primary care centres across the West Midlands. These purposefully selected general practices were randomly allocated to 25 intervention practices and 25 control practices. GPs and practice nurses in the intervention practices received education on the importance of AF detection and ECG interpretation. Patients in the intervention practices were randomly allocated to systematic (n = 5000) or opportunistic screening (n = 5000). Prospective identification of pre-existing risk factors for AF within the screened population enabled comparison between targeted screening of people at higher risk of AF and total population screening. AF detection rates in systematically screened and opportunistically screened populations in the intervention practices were compared with AF detection rate in 5000 patients in the control practices. The screening period was 12 months.Results
The total number of patients included in each arm was: control 4936, opportunistic screening 4933 and systematic screening 4933. Baseline prevalence of AF was 7.2%, with a higher prevalence in males (7.8%) and patients aged 75 years and over (10.3%). The control population demonstrated higher baseline prevalence (7.9%) than either the systematic (6.9%) or opportunistic (6.9%) intervention population. In the control population 47 new cases were detected (incidence 1.04% per year). In the opportunistic arm 243 patients without a baseline diagnosis of AF were found to have an irregular pulse, with 177 having an ECG, yielding 31 new cases (incidence 0.69% per year). A further 44 cases were detected outside the screening programme (overall incidence 1.64% per year). In the systematic arm 2357 patients had an ECG yielding 52 new cases (incidence 1.1% per year). Of these, 31 were detected by targeted screening and a further 21 by total population screening. A further 22 cases were detected outside the screening programme (overall incidence 1.62% per year).In terms of ECG interpretation, computerised decision support software (CDSS) gave a sensitivity of 87.3%, a specificity of 99.1% and a positive predictive value (PPV) of 89.5% compared with the gold standard (cardiologist reporting). GPs and practice nurses performed less well. The only difference in performance between intervention populations and controls was that practice nurses from the control arm performed less well than intervention practice nurses on interpretation of limb-lead (PPV 38.8% versus 20.8%) and single-lead (PPV 37.7% versus 24.0%) ECGs.The within-trial economic evaluation results showed the lowest incremental cost to be for the opportunistic arm, with an incremental cost-effectiveness ratio of £337 for each additional case detected compared to the control arm. Opportunistic screening dominated both more intensive screening strategies. Model-based analyses showed small differences in cost and quality-adjusted life-years for different methods and intensities of screening, but annual opportunistic screening resulted in the lowest number of ischaemic strokes and greatest proportion of cases of AF diagnosed. Probabilistic sensitivity results indicated that there was a probability of approximately 60% that screening from the age of 65 was cost-effective in both men and women.Conclusions
The prevalence of AF in this population was found to be 7.2%. The incidence ranged from 1.04 to 1.64% per annum. Within the trial, in terms of a screening programme, the only strategy that improved on routine practice was opportunistic screening, at a cost of £337 per additional case detected. Model-based analyses indicated that there was a probability of approximately 60% of annual opportunistic screening being cost effective. Use of CDSS may be considered for analysis of ECGs for detection of AF
Design metrics for evaluating the propulsive efficiency of future ships
No full textThere is an increasing need for the ship design process to take account of environmental issues such as the emission of greenhouse gases and the likely extension of a carbon dioxide charging mechanism to international shipping. These issues, together with the need for economic viability, provide further incentives to improve the efficiency of propulsion of ships. The main components of powering are firstly reviewed. Individual components and other power saving devices are identified which should contribute to improvements in the overall efficiency of propulsion. Suitable design metrics and procedures, taking into account economic and environmental factors, are recommended for the design of future ships
Brief note: some observations on oscillating tangential forces and wear in general plane contacts
No full textFor general plane contact of elastically similar materials, including cases where there are multiple regions of contact, general properties of the partial slip solution for conditions of constant normal force and monotonically increasing shearing force have been found recently by the first author. An extension is given here to cover the unloading and cyclic loading cases. Further, it is shown that, if the tangential load varies between two fixed limits, the region of stick does not change, even if relative microslip causes wear, changing continuously the profile of the indenter. The contact area will change, but wear will not enter the original region of adhesion. The theoretical limit to which wear will eventually, asymptotically proceed is established, viz. almost complete contact over what is the initial stick zone, although it may, in practice, take a long time to reach this state
The description of Kabarda by D.A. Milutin in the context of the cauсasus version of russian orien-talism foundation
No full textThe paper pertains to the analysis of a manuscript authored by D.A. Milutin in the first half of the 19th century, regarding the region of Kabarda. This manuscript, hitherto unpublished in academic circles, has been the subject of our examination. Our endeavor was to uncover the utilization of orientalist clichés by the manuscript's author, in order to depict both the geographical delineations of this ethno-political entity and the ethnography, livelihood, societal structure, and customary legal norms of its inhabitants. A remarkable parallel can be observed between certain aspects of the manuscript and the ideas propounded by E. Said in his discourse on European Orientalism. The researcher drew a comparison between the political framework and traditions of the Kabardian people and those prevalent in Europe. Moreover, the researcher romanticized the region's historical past, employing the conceptof "reverse human progress," along with other typical methodologies embraced by Orientalist thinkers of that era. Concomitantly, D.A. Milutin provided detailed descriptions of the political, social, and everyday existence in Kabarda, thereby endowing the manuscript with an intrinsic value as an original historical and cultural resource for contemporary scholars. It is concluded that, similar to numerous analogous texts produced by Orientalist scholars, the significance of D.A. Milutin's man-uscript lies not in its political arguments concerning the military and economic dominion of the Russian Empire over the Caucasian peoples, or the imperative to extend colonial governance to these ethnic territorie
Elements of Ethnotaxonomy in Dhule and Nandurbar Districts (Maharashtra)
No full textDhule and Nandurbar districts of Maharashtra are mainly inhabited by tribals and rural folks. The author’s ethnobotanical and floristic forays in these districts brought out certain elements of ethnotaxonomy like ethnotaxonomic markers, classifications, principles of nomenclature and exomorphic features. The facts gathered indicated that the people in the area are fairly flooded with reckonable elements of ethnotaxonomy. And 22 ethnotaxonomic markers are identified. These are evaluated and discussed pertinently in this paper.-----------------------------------------------------------------------------------------------------Post Graduate Department of Botany, S.S.V.P.S’s L.K. P.R.Ghogrey Science College, Dhule-424005 (Maharashtra), India*Corresponding author, Email: [email protected] Cite This Article As: D.A. Patil. 2010. Elements of Ethnotaxonomy in Dhule and Nandurbar Districts (Maharashtra). J. Ecobiotechnol. 2(3): 18-25
Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial
No full textOBJECTIVES: To assess whether screening improves the detection of atrial fibrillation (cluster randomisation) and to compare systematic and opportunistic screening. DESIGN: Multicentred cluster randomised controlled trial, with subsidiary trial embedded within the intervention arm. SETTING: 50 primary care centres in England, with further individual randomisation of patients in the intervention practices. PARTICIPANTS: 14,802 patients aged 65 or over in 25 intervention and 25 control practices. INTERVENTIONS: Patients in intervention practices were randomly allocated to systematic screening (invitation for electrocardiography) or opportunistic screening (pulse taking and invitation for electrocardiography if the pulse was irregular). Screening took place over 12 months in each practice from October 2001 to February 2003. No active screening took place in control practices. MAIN OUTCOME MEASURE: Newly identified atrial fibrillation. RESULTS: The detection rate of new cases of atrial fibrillation was 1.63% a year in the intervention practices and 1.04% in control practices (difference 0.59%, 95% confidence interval 0.20% to 0.98%). Systematic and opportunistic screening detected similar numbers of new cases (1.62% v 1.64%, difference 0.02%, -0.5% to 0.5%). CONCLUSION: Active screening for atrial fibrillation detects additional cases over current practice. The preferred method of screening in patients aged 65 or over in primary care is opportunistic pulse taking with follow-up electrocardiography. TRIAL REGISTRATION: Current Controlled Trials ISRCTN19633732 [controlled-trials.com
Aanteekeningen omtrent de gevolgen van zware stormvloeden, tusschen 1500 en 1825 voorgekomen, voor de dijken en polders langs het Zuidwestelijk deel der Zuiderzee: samengesteld door den ingenieur van den Rijkswaterstaat D.A. van Heyst
No full textOverzicht van stormvloeden (1500 - 1825) die tot overstromingen langs de Zuiderzee geleid hebben. Aanleiding was de overstroming van 1916, en men wilde weten of deze stormvloed inderdaad uniek was
Thromboprophylaxis to prevent hospital-acquired thrombosis:An important opportunity for primary care
No full textIt is clear that hospital admission causes many preventable deaths from venous thromboembolism (VTE) yet the general public and, we would suggest, primary care health workers, still think of air travel as the main risk factor. Is there a role for primary care in helping to reduce the numbers of patients with hospital-acquired VTE
The dynamical influences of a hard transition zone on post-glacial uplifts and rotational signatures
No full textRecent investigations from laboratory and Monte-Carlo inversion of geophysical signatures have suggested that the transition zone of the mantle between 400 and 670 km depth may be stiffer than the lower and the upper mantle. By means of a five-layer viscoelastic spherical Earth model, we have calculated the displacement fields associated with post-glacial rebound, the induced polar motions, the temporal variations of the coefficients of the geopotential up to degree eight and the stress fields induced by deglaciation in the lithosphere and the upper mantle. Temporal variations of stress fields in the lithosphere reveal a non-monotonic behaviour due to the viscosity stratification. The results demonstrate the importance of the coming LAGEOS II geodetic satellite mission on constraining the rheological nature of the transition zone in the mantle. -from Author
- …
