Adherence, adaptation and acceptance of elderly chronic heart failure patients to receiving healthcare via telephone-monitoring

Background: Although the potential to reduce hospitalisation and mortality in chronic heart failure (CHF) is well reported, the feasibility of receiving healthcare by structured telephone support or telemonitoring is not. Aims: To determine; adherence, adaptation and acceptability to a national nurse-coordinated telephone-monitoring CHF management strategy. The Chronic Heart Failure Assistance by Telephone Study (CHAT). Methods: Triangulation of descriptive statistics, feedback surveys and qualitative analysis of clinical notes. Cohort comprised of standard care plus intervention (SC + I) participants who completed the first year of the study. Results: 30 GPs (70% rural) randomised to SC + I recruited 79 eligible participants, of whom 60 (76%) completed the full 12 month follow-up period. During this time 3619 calls were made into the CHAT system (mean 45.81 SD ± 79.26, range 0-369), Overall there was an adherence to the study protocol of 65.8% (95% CI 0.54-0.75; p = 0.001) however, of the 60 participants who completed the 12 month follow-up period the adherence was significantly higher at 92.3% (95% CI 0.82-0.97, p ≤ 0.001). Only 3% of this elderly group (mean age 74.7 ±9.3 years) were unable to learn or competently use the technology. Participants rated CHAT with a total acceptability rate of 76.45%. Conclusion: This study shows that elderly CHF patients can adapt quickly, find telephone-monitoring an acceptable part of their healthcare routine, and are able to maintain good adherence for a least 12 months. © 2007.

[Letter to the Editor] Telemonitoring in Patients with Heart Failure

To the Editor: Chaudhry et al. suggest that enhanced support in the use of a telephone-based interactive voice-response system for patients recently discharged after worsening heart failure does not improve outcomes. This finding is broadly consistent with previous systematic reviews of telephone support1 and contrasts with the substantial effect observed with home telemonitoring of vital signs in similar populations.1 The treatment of patients in the control group was excellent, but unrepresentative of usual clinical care and not inferior to the treatment of patients receiving enhanced support. Monitoring alone is unlikely to improve outcomes but may do so when it improves prescription of or adherence to lifesaving treatments. Given enough resources, traditional methods for delivering care may render an interactive voice-response system or a home telemonitoring system ineffective. Nonetheless, there may be more cost-efficient approaches to ensuring quality care.2 Informal post hoc addition of these data to our recent meta-analysis of telephone support1 does not substantially alter the point estimates for death from any cause or heart-failure−related hospitalizations, but it does nullify the small benefit in hospitalizations for any cause, which may not be reduced by a heart-failure−focused intervention.1 Original article: Telemonitoring in Patients with Heart Failure NEJM. December 9, 2010 | S.I. Chaudhry and Others

Synthesis and thermal stability of hydrotalcites based upon gallium

Hydrotalcites based upon gallium as a replacement for aluminium in hydrotalcite over a Mg/Al ratio of 2:1 to 4:1 were synthesised. The d(003) spacing varied from 7.83 A ° for the 2:1 hydrotalcite to 8.15 A ° for the 3:1 gallium containing hydrotalcite. A comparison is made with the Mg Al hydrotalcite in which the d(003) spacing for the Mg/Al hydrotalcite varied from 7.62 A ° for the 2:1Mg hydrotalcite to 7.98 A ° for the 4:1 hydrotalcite. The thermal stability of the gallium containing hydrotalcite was determined using thermogravimetric analysis. Four mass loss steps at 77, 263–280,485 and 828 degrees C with mass losses of 10.23, 21.55, 5.20 and 7.58% are attributed to dehydration, dehydroxylation and decarbonation. The thermal stability of the galliumcontaining hydrotalcite is slightly less than the aluminium hydrotalcite.

Unintended consequences of regulatory reporting requirements for small and medium size construction entities : Australian evidence

The Queensland Building Services Authority (QBSA) regulates the construction industry in Queensland, Australia, with licensing requirements creating differential financial reporting obligations, depending on firm size. Economic theories of regulation and behaviour provide a framework for investigating effects of the financial constraints and financial reporting requirements imposed by QBSA licensing. Data are analysed for all small and medium construction entities operating in Queensland between 2001 and 2006. Findings suggesting that construction licensees are categorizing themselves as smaller to avoid the more onerous and costly financial reporting of higher licensee categories are consistent with US findings from the 2002 Sarbanes-Oxley (SOX) regulation which created incentives for small firms to stay small to avoid the costs of compliance with more onerous financial reporting requirements. Such behaviour can have the undesirable economic consequences of adversely affecting employment, investment, wealth creation and financial stability. Insights and implications from the analysed QBSA processes are important for future policy reform and design, and useful to be considered where similar regulatory approaches are planned.

Police misconduct and crime : bad apples or systems failure?

There is a debate in the research literature whether to view police misconduct and crime as acts of individuals perceived as 'rotten apples' or as an indication of systems failure in the police force. Based on an archival analysis of court cases where police employees were prosecuted, this paper attempts to explore the extent of rotten apples versus systems failure in the police. Exploratory research of 57 prosecuted police officers in Norway indicate that there were more rotten apple cases than system failure cases. The individual failures seem to be the norm rather than the exception of ethical breaches, therefore enhancing the rotten apple theory. However as exploratory research, police crime may still be explained at the organizational level as well.

A descriptive approach for power system stability and security assessment

Power system dynamic analysis and security assessment are becoming more significant today due to increases in size and complexity from restructuring, emerging new uncertainties, integration of renewable energy sources, distributed generation, and micro grids. Precise modelling of all contributed elements/devices, understanding interactions in detail, and observing hidden dynamics using existing analysis tools/theorems are difficult, and even impossible. In this chapter, the power system is considered as a continuum and the propagated electomechanical waves initiated by faults and other random events are studied to provide a new scheme for stability investigation of a large dimensional system. For this purpose, the measured electrical indices (such as rotor angle and bus voltage) following a fault in different points among the network are used, and the behaviour of the propagated waves through the lines, nodes, and buses is analyzed. The impact of weak transmission links on a progressive electromechanical wave using energy function concept is addressed. It is also emphasized that determining severity of a disturbance/contingency accurately, without considering the related electromechanical waves, hidden dynamics, and their properties is not secure enough. Considering these phenomena takes heavy and time consuming calculation, which is not suitable for online stability assessment problems. However, using a continuum model for a power system reduces the burden of complex calculations

United we stand, divided we fall: the failure of an accounting information system in a major radiology provider

This article explores the way in which a major Australian radiology organization implemented a complex accounting information system and how workers in the 72 radiology practises that had to use it resisted the change. The study reports on the issues that led to the circumvention of the system by individuals and, after only three years, complete withdrawal of the accounting information system by the parent organization. This article has implications for firms in the health care and other sectors considering implementing new accounting information systems. Organizations need to incorporate change management techniques and provide open communication to all stakeholders to minimize disruption and potential problems.

Success and failure factors of shared services : an IS literature analysis

Organizations seeking improvements in their performance are increasingly exploring alternative models and approaches for providing support services; one such approach being Shared Services. Because of the possible consequential impact of Shared Services on organizations, and given that information systems (IS) is both an enabler of Shared Services (for other functional areas) as well as a promising area for Shared Services application, Shared Services is an important area for research in the IS field. Though Shared Services has been extensively adopted on the promise of economies of scale and scope, factors of Shared Services success (or failure) have received little research attention. This paper reports the distillation of success and failure factors of Shared Services from an IS perspective. Employing NVIVO and content analysis of 158 selected articles, 9 key success factors and 5 failure factors are identified, suggesting important implications for practice and further research.

Thermal stability of the ‘cave’ mineral ardealite Ca2(HPO4)(SO4)•4H2O

Thermogravimetry combined with evolved gas mass spectrometry has been used to characterise the mineral ardealite and to ascertain the thermal stability of this ‘cave’ mineral. The mineral ardealite Ca2(HPO4)(SO4)•4H2O is formed through the reaction of calcite with bat guano. The mineral shows disorder and the composition varies depending on the origin of the mineral. Thermal analysis shows that the mineral starts to decompose over the temperature range 100 to 150°C with some loss of water. The critical temperature for water loss is around 215°C and above this temperature the mineral structure is altered. It is concluded that the mineral starts to decompose at 125°C, with all waters of hydration being lost after 226°C. Some loss of sulphate occurs over a broad temperature range centred upon 565°C. The final decomposition temperature is 823°C with loss of the sulphate and phosphate anions.

Stability and change in prosocial and antisocial behavior across the transition to school : Teacher and peer perspectives

Research Findings: The transition to school is a major developmental milestone, and behavior tendencies already evident at the point of school entry can impact upon a child's subsequent social and academic adjustment. The current study aimed to investigate stability and change in the social behavior of girls and boys across the transition from day care to 1st grade. Teacher ratings and peer nominations for prosocial and antisocial behavior were obtained for 248 children belonging to 2 cohorts: school transitioning (n = 118) and day care remaining (n = 130). Data were gathered again from all children 1 year later, following the older group's entry into school. Teacher ratings of prosocial and antisocial behavior significantly predicted teacher ratings of the same behavior at Time 2 for both cohorts. Peer reports of antisocial behavior also showed significant stability, whereas stability of peer-reported prosocial behavior varied as a function of behavior type. Practice or Policy: The results contribute to understanding of trends in early childhood social behavior that potentially influence long-term developmental trajectories. Identification of some behaviors as more stable in early childhood than others, regardless of school entry, provides useful information for both the type and timing of early interventions. © 2010 Taylor & Francis Group, LLC.

Stability of hydrotalcites formed from Bayer refinery environmental control processes

Bauxite refinery residues (red mud) are derived from the Bayer process by the digestion of crushed bauxite in concentrated sodium hydroxide at elevated temperatures and pressures. This slurry residue, if untreated, is unsuitable for discharge directly into the environment and is usually stored in tailing dams. The liquid portion has the potential for discharge, but requires pre-treatment before this can occur. The seawater neutralisation treatment facilitates a significant reduction in pH and dissolved metal concentrations, through the precipitation of hydrotalcite-like compounds and some other Mg, Ca, and Al hydroxide and carbonate minerals. The hydrotalcite-like compounds, precipitated during seawater neutralisation, also remove a range of transition metals, oxy-anions and other anionic species through a combination of intercalation and adsorption reactions: smaller anions are intercalated into the hydrotalcite matrix, while larger molecules are adsorbed on the particle surfaces. A phenomenon known as ‘reversion’ can occur if the seawater neutralisation process is not properly controlled. Reversion causes an increase in the pH and dissolved impurity levels of the neutralised effluent, rendering it unsuitable for discharge. It is believed that slow dissolution of components of the red mud residue and compounds formed during the neutralisation process are responsible for reversion. This investigation looked at characterising natural hydrotalcite (Mg6Al2(OH)16(CO3)∙4H2O) and ‘Bayer’ hydrotalcite (synthesised using the seawater neutralisation process) using a variety of techniques including X-ray diffraction, infrared and Raman spectroscopy, and thermogravimetric analysis. This investigation showed that Bayer hydrotalcite is comprised of a mixture of 3:1 and 4:1 hydrotalcite structures and exhibited similar chemical characteristic to the 4:1 synthetic hydrotalcite. Hydrotalcite formed from the seawater neutralisation of Bauxite refinery residues has been found not to cause reversion. Other components in red mud were investigated to determine the cause of reversion and this investigation found three components that contributed to reversion: 1) tricalcium aluminate, 2) hydrocalumite and 3) calcium hydroxide. Increasing the amount of magnesium in the neutralisation process has been found to be successful in reducing reversion.

Thermal stability of newberyite Mg(PO3OH)•3H2O – a cave mineral from Skipton lava tubes, Victoria, Australia.

The mineral newberyite Mg(PO3OH)•3H2O is a mineral that has been found in caves such as the Skipton Lava Tubes (SW of Ballarat, Victoria, Australia), Moorba cave, Jurien Bay, Western Australia, and in the Petrogale Cave (Madura , Eucla, Western Australia). Because these minerals contain water, the minerals lend themselves to thermal analysis. The mineral newberyite is found to decompose at 145°C with a water loss of 31.96%, a result which is very close to the theoretical value. The result shows that the mineral is not stable in caves where the temperature exceeds this value. The implication of this result rests with the removal of kidney stones, which have the same composition as newberyite. Point heating focussing on the kidney stone results in the destruction of the kidney stone.

Thermal stability of stercorite H(NH4)Na(PO4)·4H2O – a cave mineral from Petrogale Cave, Madura, Eucla, Western Australia

Thermogravimetric analysis has been used to determine the thermal stability of the mineral stercorite H(NH4)Na(PO4)·4H2O. The mineral stercorite originated from the Petrogale Cave, Madura, Eucla, Western Australia. This cave is one of many caves in the Nullarbor Plain in the South of Western Australia. The mineral is formed by the reaction of bat guano chemicals on calcite substrates. Upon thermal treatment the mineral shows a strong decomposition at 191°C with loss of water and ammonia. Other mass loss steps are observed at 158, 317 and 477°C. Ion current curves indicate a gain of CO2 at higher temperature and are attributed to the thermal decomposition of calcite impurity.

Thermal stability of crandallite CaAl3(PO4)2(OH)5•(H2O) – a ‘cave’ mineral from the Jenolan Caves

Thermogravimetry combined with evolved gas mass spectrometry has been used to characterise the mineral crandallite CaAl3(PO4)2(OH)5•(H2O) and to ascertain the thermal stability of this ‘cave’ mineral. X-ray diffraction proves the presence of the mineral and identifies the products after thermal decomposition. The mineral crandallite is formed through the reaction of calcite with bat guano. Thermal analysis shows that the mineral starts to decompose through dehydration at low temperatures at around 139°C while dehydroxylation occurs over the temperature range 200 to 700°C with loss of OH units. The critical temperature for OH loss is around 416°C and above this temperature the mineral structure is altered. Some minor loss of carbonate impurity occurs at 788°C. This study shows the mineral is unstable above 139°C. This temperature is well above the temperature in caves, which have a maximum temperature of 15°C. A chemical reaction for the synthesis of crandallite is offered and the mechanism for the thermal decomposition is given.