519 research outputs found
Remote haemodynamic‐guided care for patients with chronic heart failure: a meta‐analysis of completed trials
No full textECONOMIC INEQUALITY AND FUTURE THOUGHT AMONG OLDER ADULTS
No full textThis is a pre-copyedited, author-produced version of an article accepted for publication in Innovation in Aging following peer review. The version of record Adamson, E. M., Ekerdt, D. J., & Adamson, E. M. (2019). ECONOMIC INEQUALITY AND FUTURE THOUGHT AMONG OLDER ADULTS. Innovation in Aging, 3(Suppl 1), S749–S750. https://doi.org/10.1093/geroni/igz038.2750 is available online at: doi.org/10.1093/geroni/igz038.2750
This work is licensed under a Creative Commons Attribution 4.0 International License
Novel approaches to the diagnostic and prognostic assessment of coronary heart disease
No full textBACKGROUND
Cardiovascular disease, principally manifest as myocardial infarction or stroke, is the
dominant cause of death worldwide and despite therapeutic advances, the global
burden of these conditions continues to increase. In order to address this ongoing
disease burden, there is a clear need to more effectively target the use of existing and
novel diagnostic investigations and medical therapies. Emerging cardiovascular
biomarkers include the biochemical, such as high-sensitivity cardiac troponin, and the
radiological, such as computed tomography coronary angiography (CTCA) and 18Ffluoride
positron emission tomography (PET). Cardiac troponins can now be reliably
quantified in clinically stable or asymptomatic populations and provide information
about myocardial pathophysiology, whilst CTCA can non-invasively quantify
atherosclerotic burden and 18F-fluoride PET imaging offers insight into plaque
vulnerability. Improved targeting of diagnostic investigations requires more reliable
estimation of pre-test probability of coronary disease whilst optimizing the use of
pharmacological or interventional treatments requires more accurate prognostic
stratification. Achieving both objectives in an equitable manner across all population
groups will depend upon updated clinical guidelines containing improved risk models
and enhanced management pathways.
The objective of this thesis was to investigate the potential clinical benefit of novel
approaches to the diagnostic and prognostic assessment of coronary heart disease. EVALUATION OF THE 2016 NATIONAL INSTITUTE FOR HEALTH AND CARE
EXCELLENCE (NICE) GUIDANCE ON THE ASSESSMENT OF SUSPECTED STABLE
ANGINA.
A post-hoc analysis was undertaken of the Scottish COmputed Tomography of the
HEART (SCOT-HEART) trial of 4,146 participants with suspected angina
randomised to assessment with computed tomography coronary angiography or
standard care. Patients were dichotomised according to guideline definitions into
groups representing possible angina and non-anginal presentations. The primary
(diagnostic) endpoint was diagnostic certainty of angina at 6 weeks and the prognostic
endpoint comprised fatal and non-fatal myocardial infarction.
In 3,770 eligible participants, CTCA increased diagnostic certainty more in those with
possible angina (relative risk [RR] 2.22 (95% CI 1.91-2.60), p<0.001) than those with
non-anginal symptoms (RR 1.30 (1.11-1.53), p=0.002; pinteraction<0.001). In the
possible angina cohort, CTCA did not change rates of invasive angiography (p=0.481)
but markedly reduced rates of normal coronary angiography (hazard ratio [HR] 0.32
(0.19-0.52), p<0.001). In the non-anginal cohort, rates of invasive angiography
increased (HR 1.82 (1.13-2.92), p=0.014) without reducing rates of normal coronary
angiography (HR 0.78 (0.30-2.05), p=0.622). At 3.2 years of follow-up, fatal or nonfatal
MI was reduced in patients with possible angina (3.2% to 1.9%; HR 0.58 (0.34-
0.99), p=0.045) but not in those with non-anginal symptoms (HR 0.65 (0.25-1.69),
p=0.379).
Overall the updated NICE guidance on patient assessment maximises the benefits of
CTCA with respect to diagnostic certainty, the use of invasive coronary angiography,
and reductions in fatal and non-fatal myocardial infarction. Patients with non-anginal chest pain derive minimal benefit from CTCA, which instead increases rates of
invasive investigation.
EXTERNAL VALIDATION OF THE PROSPECTIVE MULTICENTER IMAGING STUDY FOR
EVALUATION OF CHEST PAIN (PROMISE) TOOL FOR DETERMINING MINIMAL-RISK
OF CORONARY ARTERY DISEASE.
The PROspective Multicenter Imaging Study for Evaluation of chest pain (PROMISE)
minimal-risk tool was recently developed to identify patients with suspected stable
angina at very low risk of coronary artery disease and clinical events. The external
validity of this tool was investigated within the context of the Scottish Computed
Tomography of the HEART multicenter randomised controlled trial of patients with
suspected stable angina due to coronary artery disease. Model discrimination and
calibration was determined amongst 1,764 patients in whom complete CCTA data
were available and compared with the European Society of Cardiology guideline-endorsed
Coronary Artery Disease Consortium (CADC) risk score.
The PROMISE minimal-risk tool improved discrimination compared with the CADC
model (c-statistic 0.785 vs 0.730, p<0.001) and was improved further following re-estimation
of covariate coefficients (c-statistic 0.805, p<0.001). Model calibration was
initially poor (c2 197.6, Hosmer-Lemeshow [HL] p<0.001), with significant
overestimation of probability of minimal risk, but improved significantly following
revision of the PROMISE minimal-risk intercept and covariate coefficients (c2 5.6,
HL p=0.692). HIGH-SENSITIVITY CARDIAC TROPONIN I IN THE DIAGNOSIS OF STABLE CORONARY
ARTERY DISEASE
In a pre-specified sub-study of the Scottish COmputed Tomography of the Heart trial,
plasma cardiac troponin was measured using a high-sensitivity single molecule
counting assay in 943 adults with suspected stable angina who had undergone coronary
computed tomography angiography. Rates of obstructive coronary artery disease were
compared with the pre-test probability determined by the European Society of
Cardiology Coronary Artery Disease Consortium risk model with and without cardiac
troponin concentrations. External validation was undertaken in an independent study
population from Denmark comprising 487 patients with suspected stable angina.
Higher cardiac troponin concentrations were associated with obstructive coronary
artery disease with a 5-fold increase across quintiles (9 to 48%, p<0.001) independent
of known cardiovascular risk factors (odds ratio [OR] 1.35 [95% confidence interval
(CI) 1.25-1.46] per doubling of troponin). Cardiac troponin concentrations improved
the discrimination of the ESC model for identifying obstructive coronary artery disease
(c-statistic 0.785 to 0.800, p=0.003) and improved classification into ESCrecommended
categories of clinical risk (net reclassification improvement 0.143 [95%
CI, 0.093-0.193]). The revised model achieved similar improvements in
discrimination and net reclassification when applied in the external validation cohort.
HIGH-SENSITIVITY CARDIAC TROPONIN I IN CARDIOVASCULAR RISK
STRATIFICATION OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
AND HEIGHTENED CARDIOVASCULAR RISK.
The association between plasma high-sensitivity cardiac troponin I concentration and
cardiovascular events in patients with chronic obstructive pulmonary disease and
heightened cardiovascular risk was examined within the context of a double-blind randomised controlled trial of inhaled corticosteroids and bronchodilators (1 placebo
arm and 3 different treatment arms). Plasma cardiac troponin I concentrations were
measured with a high-sensitivity assay in a subgroup of 1,599 patients. The
cardiovascular endpoint was a composite of cardiovascular death, myocardial
infarction, stroke, unstable angina and transient ischaemic attack during follow-up of
1.5 years.
Baseline plasma cardiac troponin I concentrations were above the lower limit of
detection (1.0 ng/L) in 1,559 (97.5%) patients and were unaffected by inhaled
therapies at 3 months (p>0.05 for all). Compared with the lowest tertile (cardiac
troponin I ≤3.0 ng/L), patients in the highest tertile (≥ 5.5 ng/L) were at greater risk of
cardiovascular events (hazard ratio 3.0, 95% confidence interval 1.5 to 6.2, p=0.002)
and cardiovascular death (hazard ratio 9.6, 95% confidence interval 2.6 to 35.6,
p<0.001) after adjustment for cardiovascular risk factors. There were no differences in
COPD exacerbations between tertiles even after adjustment (p>0.05).
REPRODUCIBILITY OF CORONARY 18F-FLUORIDE PET-CT IMAGING
The inter-observer and scan-rescan reproducibility of coronary 18F-fluoride PET-CT
imaging was investigated in 20 patients with clinically stable but high risk multi-vessel
coronary artery disease who underwent repeated 18F-fluoride PET-CT scans 11.5±4.5
days apart. Scan analysis using the currently accepted approach of normalisation to a
referent coronary segment (TBRREFERENT) identified 10 (50%) patients with evidence
of focal coronary 18F-fluoride uptake and demonstrated moderate agreement across
observers on a per-patient level (k = 0.56). This was similar to the level of agreement
achieved with visual assessment alone (k = 0.64). Reproducibility was improved by
semi-quantitative reporting combining visual assessment with a threshold uptake value for determining the presence of tracer uptake (k = 0.84). Using the optimised approach
achieved excellent agreement on overall segmental uptake counts (intra-class
correlation = 0.97).
CONCLUSION
Cardiovascular diagnostic and prognostic assessments represent a complex endeavour
and established tools for risk prediction can demonstrate suboptimal predictive
accuracy when evaluated in patient cohorts that are independent of the population used
for model derivation. The process of risk stratification has important potential for
improvement through the integration of existing approaches with novel biochemical
and non-invasive diagnostic imaging technologies that provide unique insights into
structural and pathophysiological processes. The promise such developments hold
requires rigorous assessment in well-designed trials involving patients who closely
reflect the population most likely to receive treatment. Such trials are difficult and
costly to conduct with traditional methods and careful consideration should be given
to more pragmatic clinical trial designs
Ternary ACd4P3 (A = Na, K) Nanostructures via a Hydride Solution-Phase Route
No full textComplex pnictides such as I–II4–V3 compounds (I = alkali metal; II = divalent transition metal; V = pnictide element) display rich structural chemistry and interesting optoelectronic properties, but can be challenging to synthesize using traditional high-temperature solid-state synthesis. Soft chemistry methods can offer control over particle size, morphology, and properties. However, the synthesis of multinary pnictides from solution remains underdeveloped. Here, we report the colloidal hot-injection synthesis of ACd4P3 (A = Na, K) nanostructures from their alkali metal hydrides (AH). Control studies indicate that NaCd4P3 forms from monometallic Cd0 seeds and not from binary Cd3P2 nanocrystals. IR and ssNMR spectroscopy reveal tri-n-octylphosphine oxide (TOPO) and related ligands are coordinated to the ternary surface. Computational studies show that competing phases with space group symmetries R3̅m and Cm differ by only 30 meV/formula unit, indicating that synthetic access to either of these polymorphs is possible. Our synthesis unlocks a new family of nanoscale multinary pnictide materials that could find use in optoelectronic and energy conversion devices.This article is published as Medina-Gonzalez, Alan M., Philip Yox, Yunhua Chen, Marquix AS Adamson, Maranny Svay, Emily A. Smith, Richard D. Schaller, Aaron J. Rossini, and Javier Vela. "Ternary ACd4P3 (A= Na, K) Nanostructures via a Hydride Solution-Phase Route." ACS Materials Au 1, no. 2 (2021): 130-139.
DOI: 10.1021/acsmaterialsau.1c00018.
Copyright 2021 The Author(s).
Attribution-NonCommercial-ShareAlike 4.0 (CC BY-NC-SA 4.0).
DOE Contract Number(s): AC02-07CH11358; AC02-06CH11357.
Posted with permission
Cognitive, Emotional and Environmental Mediators of Early Parenting in High Risk Families
No full textA thesis submitted in partial fulfilment of the
requirements of the University of Wolverhampton for
the degree of Doctor of PhilosophyThe UK currently has the highest number of premature births (babies born before 37 weeks gestation age and below 2.5kg) in Europe affecting around 70,000 babies and their caregivers each year. Consequently many interventions have been created to support the development of the preterm newborn and minimise the complications of prematurity. Many of the interventions developed have been predominantly tactile and have almost exclusively focused upon their effect upon the baby and not, for example considered the effect that this type of intervention might have upon the parents; specifically the mother, when they are the ones who perform the therapy. In fact there is a severe lack of systematic studies investigating the latter. Hence, the aim of this thesis was to search for research-based evidence on the benefits of environmental support to both babies (e.g. increased weight gain or awake periods) and their mothers (e.g. higher perceptions of themselves as a mother) during hospital confinement and within the context of Neonatal Health Psychology (NNHP). For this reason, the main hypothesis investigated whether mothers’ cognitions and emotions; specifically Maternal Self-Efficacy, Self-Esteem and Attachment, would be affected by environmental mediators in the form of structured or non-structured tactile sensory nurturing interventions. The empirical work reported in this thesis is divided into 3 distinct phases. Firstly, as their was no appropriate measure of maternal Self-Efficacy for mothers of hospitalised preterm neonates the main aim of Phase-1 was to develop and validate an appropriate measure. Using a prospective survey method and a mixed design (between/within and correlational) a total of 160 mother-preterm dyads (pooled from 2 cohorts; cohort 1, N=100; cohort 2, N=60) were recruited. The results demonstrated that the Perceived Maternal Parenting Self-Efficacy (PMPS-E) tool had good initial psychometric properties (including internal/external reliability and construct validity) for its use with mothers of relatively healthy hospitalised preterm neonates. Secondly, in order to investigate mothers’ perceived maternal parenting self-efficacy beliefs further Phase-2 examined whether the type of feeding a mother chose to give to her baby mediated her self-efficacy beliefs. The results suggested that breastfeeding a preterm neonate during hospital confinement may adversely affect mothers’ perceptions of their efficacy in all aspects of parenting. Finally, using an experimental method Phase-3 tested the main hypothesis of this thesis and used a randomised cluster control trial (RCCT) design to allocate 60 mothers and their preterms equally to one of three cluster groups; consisting of either structured (e.g. TAC-TIC therapy or Using a Toy) or non-structured (Placebo/Control) tactile sensory nurturing interventions. The main findings illustrate that tactile sensory nurturing interventions do mediate maternal cognitions and emotions, preterm weight gain and behavioural state. In particular, mothers who performed TAC-TIC demonstrated significantly higher self-reported perceptions in their self-efficacy, self-esteem and attachment, which was attributed to the fact that these babies spent increased amounts of time in an alert and responsive behavioural state, and gained more weight throughout the study period. Thus, the work presented throughout this thesis has implications for Neonatal Health Psychologists and other Health Care professionals’ practice within neonatal units, the use of Neonatal Health Psychology as a framework to study the preterm neonate and their family, and also the way in which both mothers and their hospitalised preterm neonates are supported during hospital confinement
ELECTRONIC SPECTRA OF TETRAGONAL PLATINUM (II) COMPLEXES
No full text J. R. Perumareddi, A. D. Liehr, and A. W. Adamson; J. Am. Chem. Soc., 85, 249 (1963). D. S. Martin, Jr. and C. A. Lenhardt, in press. J. Chatt, G. A. Gamlen, and L. E. Orgel, J. Chem. Soc. (Lond.) 486 (1958). R. F. Fenske, D. S. Martin, Jr., and K. Ruedenberg, Inorg. Chem. 1, 441 (1962). H. B. Gray and C. J. Ballhausen, J. Am. Chem. Soc., 85, 260 (1963).Author Institution: Mellon Institute; University of Southern CaliforniaThe electronic spectra of some tetragonal platinum (II) complexes have been surveyed and measured, and a number of new features discovered. It is shown that these spectra, both past and present may be rationalized in terms of the same simple ligand field model which recently served so well to correlate the observed spectral features of the nickel (II) tetracyanide and the platinum (II) tetrachloride . The electronic spectra will be presented, and the assignment of the bands discussed. Especial care will be taken to compare and contrast the predictions of the and past assignations. Plans for future advance will be sketched, and some precautionary words uttered
Safety and feasibility of pulmonary artery pressure-guided heart failure therapy: rationale and design of the prospective CardioMEMS Monitoring Study for Heart Failure (MEMS-HF)
No full textSPECTRA OF THE ZERO, ONE, AND TWO ELECTRON (OR HOLE) TRANSITION METAL CYANIDE COMPLEXES PART .
No full textAuthor Institution: Department of Chemistry, University of Southern California; Bell Telephone Laboratories, Inc., Murray Hill, New Jersey and Mellon InstituteThe magnetic and spectrosopic demeanor of cyano-transition metal compounds is discussed from the standpoint of the modern theory of ligand fields. It is emphasized that for such compounds the naive electrostatic crystal field theory is inapplicable, and the more general molecular orbital based crystal field theory (the so-called ligand field theory) is required to rationalize the existent experimental data. The equations which determine the spectral characteristics of zero, one, and two electron or hole cyanide compounds derived are applied to several newly characterized cyano-complexes, and the issuant experimental and theoretical consequences are critically discussed. The prospects for future progress in this area are commented upon, and the avenues of greatest promise are mapped. Hope is expressed that such progress will soon circumscribe the domain of applicability of simple ligand field techniques. Part I. J. R. Perumareddi, A. W. Adamson, and A. D. Liehr, Symposium on Molecular Structure and Spectroscopy, The Ohio state University Columbus, Ohio, June 12-16, [96], paper H4. Present address
Japanese language teaching in Malaysia and New Zealand: Recent history, current practice and curriculum
No full textComparisons of curriculum have been shown to be useful in terms of finding new ideas to raise the standard of education in one country and to enhance global competitiveness (Adamson & Morris, 2007). The purpose of the research reported in this thesis was to examine Japanese language education in Malaysia and New Zealand. The study compared the approach to Japanese language learning and teaching in both countries and also compared the curriculum and syllabus for both countries. This study employed three methods: semi-structured interview, autoethnography, and document analysis. Semi-structured interviews were conducted to find out the recent history and current practice of Japanese Language teaching in Malaysia and New Zealand. Four participants, one from Malaysia and three from New Zealand were involved in the interviews. Autoethnography was also infused in the research which permitted the author to share her knowledge and experiences as an experienced Japanese language teacher in Malaysia. The analysis of the curriculum and syllabus documents were carried out to look at the content of both countries‟ Japanese Language Curriculum to investigate its underpinning approach to language teaching, and to analyze the similarities and differences between the Malaysian and New Zealand Japanese Language Curricula.
The results show that both Japanese language curricula shared many similarities in terms of their types of syllabus, language learning aims and language areas focused in the curricula content. This indicates that Malaysia and New Zealand, like other countries in the world, follow international trends in language teaching.
Both countries‟ Japanese language syllabi have strong characteristics of Skills-Based and Outcomes-Based Syllabi. The curricula emphasize the acquisition of four very important language skills: listening, writing, reading and speaking. Both curricula promote teachers autonomy in decision-making and designing or planning programs. However, in comparison, New Zealand shows more teacher-autonomy than Malaysia. The findings also indicate that, although Japanese Language Curriculum in both Malaysia and New Zealand follows the global trends in language teaching, each also reflects its nation‟s visions and the needs of its people: Malaysian Japanese Language Curriculum was established to enable students to recognize and embrace the values that had brought Japan to its economic level now. While, Japanese language education in New Zealand starts because of the government‟s desire to trade and do business with Japan, a new economic power at the time
Irrational beliefs in posttraumatic stress responses: A Rational Emotive Behaviour Therapy approach
No full textThe current study aimed to test a key theoretical prediction of Rational Emotive Behaviour Therapy theory by assessing the role of general and trauma-specific irrational beliefs in the prediction of posttraumatic stress responses. A sample (N = 313) of trauma-exposed emergency service workers participated in the study. Structural equation modelling results demonstrated that an REBT-based model provided satisfactory model fit and explained 89% of variance in posttraumatic stress symptomology. Theoretical predictions were supported with results demonstrating that general-level irrationality indirectly impacted posttraumatic stress responses via a set of trauma-specific irrational beliefs. Results indicate the importance of irrational beliefs in predicting posttraumatic stress responses
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