Newborn screening is important for early diagnosis and effective treatment of inborn errors of metabolism (IEM). In response to a 2008 coroners' report of a 14-year-old boy who died of an undiagnosed ...IEM, the OPathPaed service model was proposed. In the present study, we investigated the feasibility of the OPathPaed model for delivering expanded newborn screening in Hong Kong. In addition, health care professionals were surveyed on their knowledge and opinions of newborn screening for IEM.
The present prospective study involving three regional hospitals was conducted in phases, from 1 October 2012 to 31 August 2014. The 10 steps of the OPathPaed model were evaluated: parental education, consent, sampling, sample dispatch, dried blood spot preparation and testing, reporting, recall and counselling, confirmation test, treatment and monitoring, and cost-benefit analysis. A fully automated online extraction system for dried blood spot analysis was also evaluated. A questionnaire was distributed to 430 health care professionals by convenience sampling.
In total, 2440 neonates were recruited for newborn screening; no true-positive cases were found. Completed questionnaires were received from 210 respondents. Health care professionals supported implementation of an expanded newborn screening for IEM. In addition, there is a substantial need of more education for health care professionals. The majority of respondents supported implementing the expanded newborn screening for IEM immediately or within 3 years.
The feasibility of OPathPaed model has been confirmed. It is significant and timely that when this pilot study was completed, a government-led initiative to study the feasibility of newborn screening for IEM in the public health care system on a larger scale was announced in the Hong Kong Special Administrative Region Chief Executive Policy Address of 2015.
The current study aims to examine the effects of mental health programs on well-being among highly engaged workers.
Participants were randomly allocated to body-mind-spiritual or peer support ...program. Of the whole sample, we examined participants' work engagement and positive affect from the highest quarter and the lowest quarter of work engagement at baseline. Measures were taken at baseline and 1-month intervals during 3-month programs and 3-month follow-up.
The programs had decreasing effects on work engagement in the HWE subgroup. There is an increasing trend of positive affect on the HWE group only in the body-mind-spiritual program. The trajectories of work engagement in the HWE group moved toward a moderate level.
Our results suggest that the work engagement's decrease in the HWE group could be a sign of recovery and relaxation.
Patients with three-vessel coronary artery disease have been found to have better outcomes with coronary-artery bypass grafting (CABG) than with percutaneous coronary intervention (PCI), but studies ...in which PCI is guided by measurement of fractional flow reserve (FFR) have been lacking.
In this multicenter, international, noninferiority trial, patients with three-vessel coronary artery disease were randomly assigned to undergo CABG or FFR-guided PCI with current-generation zotarolimus-eluting stents. The primary end point was the occurrence within 1 year of a major adverse cardiac or cerebrovascular event, defined as death from any cause, myocardial infarction, stroke, or repeat revascularization. Noninferiority of FFR-guided PCI to CABG was prespecified as an upper boundary of less than 1.65 for the 95% confidence interval of the hazard ratio. Secondary end points included a composite of death, myocardial infarction, or stroke; safety was also assessed.
A total of 1500 patients underwent randomization at 48 centers. Patients assigned to undergo PCI received a mean (±SD) of 3.7±1.9 stents, and those assigned to undergo CABG received 3.4±1.0 distal anastomoses. The 1-year incidence of the composite primary end point was 10.6% among patients randomly assigned to undergo FFR-guided PCI and 6.9% among those assigned to undergo CABG (hazard ratio, 1.5; 95% confidence interval CI, 1.1 to 2.2), findings that were not consistent with noninferiority of FFR-guided PCI (P = 0.35 for noninferiority). The incidence of death, myocardial infarction, or stroke was 7.3% in the FFR-guided PCI group and 5.2% in the CABG group (hazard ratio, 1.4; 95% CI, 0.9 to 2.1). The incidences of major bleeding, arrhythmia, and acute kidney injury were higher in the CABG group than in the FFR-guided PCI group.
In patients with three-vessel coronary artery disease, FFR-guided PCI was not found to be noninferior to CABG with respect to the incidence of a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year. (Funded by Medtronic and Abbott Vascular; FAME 3 ClinicalTrials.gov number, NCT02100722.).
Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary disease not involving the left main have shown ...significantly lower rates of death, myocardial infarction (MI), or stroke after CABG. These studies did not routinely use current-generation drug-eluting stents or fractional flow reserve (FFR) to guide PCI.
FAME 3 (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) is an investigator-initiated, multicenter, international, randomized trial involving patients with 3-vessel coronary artery disease (not involving the left main coronary artery) in 48 centers worldwide. Patients were randomly assigned to receive FFR-guided PCI using zotarolimus drug-eluting stents or CABG. The prespecified key secondary end point of the trial reported here is the 3-year incidence of the composite of death, MI, or stroke.
A total of 1500 patients were randomized to FFR-guided PCI or CABG. Follow-up was achieved in >96% of patients in both groups. There was no difference in the incidence of the composite of death, MI, or stroke after FFR-guided PCI compared with CABG (12.0% versus 9.2%; hazard ratio HR, 1.3 95% CI, 0.98-1.83;
=0.07). The rates of death (4.1% versus 3.9%; HR, 1.0 95% CI, 0.6-1.7;
=0.88) and stroke (1.6% versus 2.0%; HR, 0.8 95% CI, 0.4-1.7;
=0.56) were not different. MI occurred more frequently after PCI (7.0% versus 4.2%; HR, 1.7 95% CI, 1.1-2.7;
=0.02).
At 3-year follow-up, there was no difference in the incidence of the composite of death, MI, or stroke after FFR-guided PCI with current-generation drug-eluting stents compared with CABG. There was a higher incidence of MI after PCI compared with CABG, with no difference in death or stroke. These results provide contemporary data to allow improved shared decision-making between physicians and patients with 3-vessel coronary artery disease.
URL: https://www.
gov; Unique identifier: NCT02100722.
A brief daily body-mind-spirit (BMS) workplace well-being program has been developed for community mental health workers (CMHW). Aiming to evaluate the program's efficacy, this study adopted a ...multi-site randomized controlled trial design. Primary outcome measures included work engagement and burnout. The data analysis included 175 participants. ANOVA revealed significant group x time interaction effects on work engagement (η2 = 0.037, p = 0.039) and on one of its sub-scores: absorption (η2 = 0.048, p = 0.014). Regarding burnout, ANOVA revealed that at T4 there were significant group x time effects on burnout total score and all three of its sub-scores, including work-related burnout, client-related burnout and personal burnout. Partial eta squared ranged between 0.028 and 0.071, suggesting a small-to-medium effect size. Overall findings demonstrated the protective effect of the Brief Daily BMS program in preserving work engagement during challenging conditions, and to a lesser extent in reducing burnout among CMHW.
Data management for CBM optimization Tsang, Albert H.C; Yeung, W.K; Jardine, Andrew K.S ...
Journal of quality in maintenance engineering,
01/2006, Letnik:
12, Številka:
1
Journal Article
Recenzirano
Purpose - This paper aims to discuss and bring to the attention of researchers and practitioners the data management issues relating to condition-based maintenance (CBM) optimization.Design ...methodology approach - The common data quality problems encountered in CBM decision analyses are investigated with a view to suggesting methods to resolve these problems. In particular, the approaches for handling missing data in the decision analysis are reviewed.Findings - This paper proposes a data structure for managing the asset-related maintenance data that support CBM decision analysis. It also presents a procedure for data-driven CBM optimization comprising the steps of data preparation, model construction and validation, decision-making, and sensitivity analysis.Practical implications - Analysis of condition monitoring data using the proportional hazards modeling (PHM) approach has been proved to be successful in optimizing CBM decisions relating to motor transmission equipment, power transformers and manufacturing processes. However, on many occasions, asset managers still make sub-optimal decisions because of data quality problems. Thus, mathematical models by themselves do not guarantee that correct decisions will be made if the raw data do not have the required quality. This paper examines the significant issues of data management in CBM decision analysis. In particular, the requirements of data captured from two common condition monitoring techniques - namely vibration monitoring and oil analysis - are discussed.Originality value - This paper offers advice to asset managers on ways to avoid capturing poor data and the procedure for manipulating imperfect data, so that they can assess equipment conditions and predict failures more accurately. This way, the useful life of physical assets can be extended and the related maintenance costs minimized. It also proposes a research agenda on CBM optimization and associated data management issues.
The objective of our study was to report the thin-section CT findings 12 months after the diagnosis of severe acute respiratory syndrome (SARS) in pediatric patients who had recovered clinically but ...had persistent abnormal CT findings 6 months after the diagnosis. The clinical data for these patients were correlated to identify risk factors that might increase the likelihood of the development of CT abnormalities.
The study involved an extended 12-month thin-section CT follow-up of 16 of 47 pediatrics patients with SARS coronavirus-associated pneumonia proven serologically (21 girls and 26 boys; age range, 1.5-17 years; median age, 13.6 years). Patients' clinical information, the extent of radiographic opacification during the acute phase of illness, and conventional pulmonary function test results on follow-up were obtained for correlation. The clinical parameters were compared with other pediatric SARS patients who had normal CT findings at the 6-month follow-up.
Fifteen patients still had abnormal CT findings 12 months after diagnosis, all of whom were older than 10 years (age range, 10-17 years). In seven patients with previous residual ground-glass opacification at the 6-month follow-up, two showed persistent changes and three had a reticular pattern in the area of the previously detected abnormality, whereas two showed complete resolution. The extent of air trapping remained similar to that at the 6-month follow-up in nine of 11 patients while two showed a slight increase in the same segments. Parenchymal scars remained unchanged from the 6- to 12-month follow-up in all six patients with that finding. None of our patients showed any evidence of bronchiectasis or bronchial wall thickening. Lymphopenia (p = 0.03), extent of radiographic opacification at acute illness (p = 0.047), and duration of use of ribavirin (p = 0.03) were significant risk factors in predicting whether abnormal CT features persisted 12 months after diagnosis.
We found that 32% of the children (15/47) affected with SARS showed thin-section CT abnormalities up to 12 months after diagnosis despite clinical remission and unremarkable pulmonary function assessment. Persistent CT abnormalities are more likely to develop in patients who are older and who present with more severe disease. The CT changes in children with SARS are, however, minor.
Oligo(fluorenyleneethynylenegermylene)s and their polyplatinynes are synthesized and photophysically characterized; inclusion of heavy germylene bridges greatly boosts the phosphorescence decay rate ...in metallopolymers.
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