Regional differences in access to acute ischaemic stroke care and patient outcomes.

BACKGROUND: Advances in stroke management such as acute stroke units and thrombolysis are not uniformly distributed throughout our population, with rural areas being relatively disadvantaged. It remains unclear, however, whether such disparities have led to corresponding differences in patient outcomes. AIMS: To describe the regional differences in acute ischaemic stroke care and outcomes within the Australian state of Tasmania. METHODS: A retrospective case note audit was used to assess the care and outcomes of 395 acute ischaemic stroke patients admitted to Tasmania's four major public hospitals. Sixteen care processes were recorded, which covered time-critical treatment, allied health interventions and secondary prevention. Outcome measures were assessed using 30-day mortality and discharge destination, both of which were analysed for differences between urban and rural hospitals using logistic regression. RESULTS: No patients in rural hospitals were administered thrombolysis; these hospitals also did not have acute stroke units. With few exceptions, patients' access to the remaining care indicators was comparable between regions. After adjusting for confounders, there were no significant differences between regions in terms of 30-day mortality (odds ratio (OR) = 0.99, 95% confidence interval (CI) 0.46-2.18) or discharge destination (OR = 1.24, 95% CI 0.81-1.91). CONCLUSIONS: With the exception of acute stroke unit care and thrombolysis, acute ischaemic stroke care within Tasmania's urban and rural hospitals was broadly similar. No significant differences were found between regions in terms of patient outcomes. Future studies are encouraged to employ larger data sets, which capture a broader range of urban and rural sites and record patient outcomes at extended interval.

Psychosocial adjustment and quality of life in children undergoing screening in a specialist paediatric hypertrophic cardiomyopathy clinic.

OBJECTIVE: This study aimed to assess the psychological well-being and quality of life in children with hypertrophic cardiomyopathy and the potential psychosocial impact of screening. METHODS: A total of 152 children (aged 3-18 years) attending a specialist paediatric hypertrophic cardiomyopathy clinic, and their parents completed the Generic Core Scales and Cardiac Module of the Paediatric Quality of Life Inventory (PedsQL) questionnaire as well as the Strengths and Difficulties Questionnaire; 21 patients (14%) had hypertrophic cardiomyopathy (group A); 23 children (15%) harboured hypertrophic cardiomyopathy-causing sarcomeric mutations with normal echocardiograms (group G); and 108 children (71%) had a family history of hypertrophic cardiomyopathy with normal investigations and attended for clinical cardiological screening (group S). RESULTS: In group A, mean PedsQLTM total scores reported by children and parents were lower than those reported by unaffected children (p<0.001). There was no significant difference between unaffected and gene-positive patients. Mean Cardiac module PedsQLTM total scores by children and parents were lower in children with hypertrophic cardiomyopathy compared with unaffected patients [mean child-reported total score 86.4 in group S versus 72.3 in group A (p<0.001) and 80.2 in group G (p=0.25); mean parent-reported total score 91.6 in group S versus 71.4 in group A (p<0.001) and 87 in group G (p=0.4)]. There was no significant difference between group S and group G on any of the scales, or between the three groups of patients in the mean Strengths and Difficulties Questionnaire scores. CONCLUSIONS: Children with hypertrophic cardiomyopathy have a significantly reduced quality of life. Importantly, Quality-of-Life scores among unaffected children attending for screening were not different compared with scores from a normative UK population.

Mobile health is worth it! Economic benefit and impact on health of a population-based mobile screening program in new Mexico.

BACKGROUND: HABITS for Life was a 3-year initiative to broadly deliver a statewide biometric and retinal screening program via a mobile unit throughout New Mexico at no charge to participants. The program goal-to identify health risk and improve population health status-was tested over a 3-year period. Value to participants and impact to the healthcare system were measured to quantify impact and value of investing in prevention at the community level. MATERIALS AND METHODS: We used the Mobile Health Map Return-on-Investment Calculator, a mobile screening unit, biometric screening, retinography, and community coordination. Our systems included satellite, DSL, and 3G connectivity, a Tanita® (Arlington Heights, IL) automated body mass index-measuring scale, the Cholestec® (Alere™, Waltham, MA) system for biomarkers and glycosylated hemoglobin, a Canon (Melville, NY) CR-1 Mark II camera, and the Picture Archiving Communication System. RESULTS: In this report for the fiscal year 2011 time frame, 6,426 individuals received biometric screening, and 5,219 received retinal screening. A 15:1 return on investment was calculated; this excluded retinal screening for the under-65 year olds, estimated at $10 million in quality-adjusted life years saved. Statistically significant improvement in health status evidenced by sequential screening included a decrease in total cholesterol level (p=0.002) (n=308) and an increase in high-density lipoprotein level after the first and second screening (p=0.02 and p=0.01, respectively), but a decrease in mean random glucose level was not statistically significant (p=0.62). Retinal results indicate 28.4% (n=1,482) with a positive/abnormal finding, of which 1.79% (n=93) required immediate referral for sight-threatening retinopathy and 27% (n=1,389) required follow-up of from 3 months to 1 year. CONCLUSIONS: Screening programs are cost-effective and provide value in preventive health efforts. Broad use of screening programs should be considered in healthcare redesign efforts. Community-based screening is an effective strategy to identify health risk, improve access, provide motivation to change health habits, and improve physical status while returning significant value.

Health, healing and recovery: therapeutic landscapes and the everyday lives of breast cancer survivors.

Drawing on the theory of therapeutic landscapes, this paper examines the importance of place for shaping health and healing among breast cancer survivors. Semi-structured in-depth interviews were conducted with 14 women in the Greater Toronto Area at various stages of breast cancer recovery to examine where and how they access and create landscapes of healing. The interviews revealed the importance of everyday and extraordinary therapeutic landscapes that are created in bodies and homes, as well as the broader community and nature. Those landscapes with which women interact on an everyday basis appear to be most important for physical and psychological healing. In addition, the research suggests a strong interplay between emotions and place such that emotional geographies, which appear to be embedded within places of healing, play an important role in shaping and maintaining therapeutic landscapes. Further research is needed to understand the place of emotions in creating therapeutic landscapes, particularly for those populations most in need of healing.

Anxiety in children attending a specialist inherited cardiac arrhythmia clinic: a questionnaire study.

OBJECTIVES: Inherited cardiac arrhythmia syndromes are life-threatening conditions. There is a paucity of research examining the psychological impact of these conditions in children. This study had three main aims. The first was to explore how the Cardiac Anxiety Questionnaire (CAQ) performs in a child population. The second aim was to compare the level of anxiety of children with an inherited cardiac arrhythmia syndrome and children being screened due to a family history of an inherited cardiac arrhythmia syndrome to control children. The third aim was to examine associations between a sudden cardiac death in the immediate family and levels of anxiety. METHOD: 47 children with an inherited cardiac arrhythmia syndrome, 78 children with a family history and 75 control children completed the Revised Child Anxiety and Depression Scale (RCADS), the Cardiac Anxiety Questionnaire for Children (CAQ-C) and the Childhood Anxiety Sensitivity Index. Children were between the age of 8 and 16 years. RESULTS: The study found the CAQ-C had promising psychometric properties. There were no significant differences in total anxiety scores (as measured by the RCADS) between the three groups. There were significant differences in cardiac-focused anxiety scores between the three groups. CONCLUSIONS: The CAQ has promising psychometric properties in a child population. However, further research is needed. Children attending specialist inherited cardiac arrhythmia clinics should be targeted for routine psychological screening and offered psychological intervention where necessary.

Preliminary economic analysis of poultry litter gasification option with a simple transportation model.

Several environmental issues are related to the disposal of poultry litter. In an effort to provide a more environmentally friendly alternative than landfill disposal or spreading as a soil amendment, work has been carried out previously at the University of Tennessee Space Institute (UTSI). This past UTSI work was concentrated on developing a catalytic steam gasification concept to produce energy from poultry litter. In the past UTSI studies, preliminary design and economics for a stationary, centralized gasification plant capable of processing approximately 100 ton/day of poultry litter were developed. However, in this preliminary design the economic impact of transporting litter to a centralized gasification plant location was not addressed. To determine the preliminary impact of transporting the poultry litter on the overall economics of this energy conversion plant design, a simple transportation model was developed. This model was used in conjunction with the earlier plant design prepared at UTSI to determine the economic feasibility of a centralized, stationary poultry litter gasification plant. To do so, major variables such as traveling distance, plant feed rate (or capacity), fluctuations in the sales price of the product gas (that means value of the energy), population density of poultry farms, impact of tipping fees, and cost of litter were varied. The study showed that for plant with a capacity of 1000 ton/day to be able to withstand several changes in economic conditions and sustain itself, the poultry farm density would need to be approximately 0.3 houses/mi2. Smaller plants would need either a higher energy price or some kind of subsidy to be economically feasible.

Small-area bends and beamsplitters for lowindex-contrast waveguides.

We explore the use of air trenches to achieve compact high efficiency 90 degrees waveguide bends and beamsplitters for waveguide material systems that have low refractive index and low refractive index contrast between the core and clad materials. For a single air interface, simulation results show that the optical efficiency of a waveguide bend can be increased from 78.4% to 99.2% by simply decreasing the bend angle from 90 degrees to 60 degrees . This can be explained by the angular spectrum of the waveguide mode optical field. For 90 degrees bends we use a micro-genetic algorithm (GA) with a 2-D finite difference time domain (FDTD) method to rigorously design high efficiency waveguide bends composed of multiple air trenches. Simulation results show an optical efficiency of 97.2% for an optimized bend composed of three air trenches. Similarly, a single air trench can be designed to function as a 90 degrees beamsplitter with 98.5% total efficiency.