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Warfarin remains the preferred anticoagulant for many patients with CHD. The complexity of management led our centre to shift from a nurse-physician-managed model with many providers to a pharmacist-managed model with a centralized anticoagulation team. We aim to describe the patient cohort managed by our Anticoagulation Program and evaluate the impact of implementation of this consistent, pharmacist-managed model on time in therapeutic range, an evidence-based marker for clinical outcomes.
Methods:
A single-centre retrospective cohort study was conducted to evaluate the impact of the transition to a pharmacist-managed model to improve anticoagulation management at a tertiary pediatric heart centre. The percent time in therapeutic range for a cohort managed by both models was compared using a paired t-test. Patient characteristics and time in therapeutic range of the program were also described.
Results:
After implementing the pharmacist-managed model, the time in therapeutic range for a cohort of 58 patients increased from 65.7 to 80.2% (p < .001), and our Anticoagulation Program consistently maintained this improvement from 2013 to 2022. The cohort of patients managed by the Anticoagulation Program in 2022 included 119 patients with a median age of 24 years (range 19 months–69 years) with the most common indication for warfarin being mechanical valve replacement (n = 81, 68%).
Conclusions:
Through a practice change incorporating a collaborative, centralized, pharmacist-managed model, this cohort of CHD patients on warfarin had a fifteen percent increase in time in therapeutic range, which was sustained for nine years.
Systemic lupus erythematosus in children generally manifests more severely with a more aggressive disease course. Cardiac involvement in systemic lupus erythematosus often does not show specific signs and symptoms, but speckle-tracking echocardiography can detect cardiac dysfunction. This study aimed to determine the differences in left ventricular function as measured by speckle-tracking echocardiography in children with various severity of systemic lupus erythematosus activity.
Methods:
A cross-sectional study of 49 children diagnosed with systemic lupus erythematosus are currently undergoing outpatient or inpatient care at Dr Hasan Sadikin General Hospital, Bandung, from May 2023 to June 2023. Disease activity was assessed by Mexican Version of the Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) with a score of 2–5 classified as mild activity, 6–9 as moderate, and ≥10 as severe. Each subject underwent conventional echocardiography and speckle-tracking echocardiography with a Philips EPIQ machine performed by a Pediatric Cardiologist Consultant 10 days after inclusion.
Results:
Fifteen (30.6%) subjects had mild disease activity, and 34 (69.4%) subjects had moderate disease activity. Most subjects (81.96%) were female with an average age of 15 years. The mean ejection fraction and fractional shortening as well as the median E/A ratio in the mild and moderate disease activity groups were not significantly different (65.76 versus 67.38%, 35.73 versus 37.11%, 1.6 versus 1.5%, respectively, p > 0.005). The global longitudinal strain in the moderate activity group was reduced more significantly than in the mild activity group (−16.58 versus −19.65, p = 0.008).
Conclusion:
Left ventricular function as measured by speckle-tracking echocardiography was lower in children with moderate systemic lupus erythematosus activity than those with mild disease activity.
Gerbera is an important commercial flower crop in the world. Augmenting the genetic diversity is desirable for further improvement in Gerbera breeding programme. Thirty-seven (37) Gerbera accessions were evaluated and analysed for genetic variability, heritability, correlation and path coefficient analysis using yield and quality traits. Results showed that phenotypic coefficients were higher than genotypic coefficients of variation for all the characters. All the traits, except stalk and flower diameter, had high heritability (>60%) and genetic advance (>20%). Based on cluster analysis, the 37 accessions were grouped into seven clusters. Cluster I consists of the maximum number of genotypes (22), while clusters IV–VII are monogenotypic with unique traits. Cluster analysis (D2) showed wider genetic diversity within and between the clusters. The first four principal components (Eigenvalue >1) contributed 72.3% of the total variation. The number of leaves, number of flowers and flower stalk length contributed the most to genetic divergence. Flower yield showed a significant positive genotypic correlation with the number of leaves and suckers. The path analysis (genotypic) revealed that number of suckers, flower stalk diameter and flower stalk length contribute major positive direct effects on number of flowers. Therefore, the wide genetic variability existing in the germplasm may facilitate improvement in gerbera crops. Superior lines (RCGH-12, -22, -114, -117) with higher yield (>23 flowers/plant) and vase life (>5 days) could be promoted for commercial production under open field conditions. While RCGH 28 has a dwarf flower stalk that can be promoted for pots and decoration purposes.
This is a contribution to the study of $\mathrm {Irr}(G)$ as an $\mathrm {Aut}(G)$-set for G a finite quasisimple group. Focusing on the last open case of groups of Lie type $\mathrm {D}$ and $^2\mathrm {D}$, a crucial property is the so-called $A'(\infty )$ condition expressing that diagonal automorphisms and graph-field automorphisms of G have transversal orbits in $\mathrm {Irr}(G)$. This is part of the stronger $A(\infty )$ condition introduced in the context of the reduction of the McKay conjecture to a question about quasisimple groups. Our main theorem is that a minimal counterexample to condition $A(\infty )$ for groups of type $\mathrm {D}$ would still satisfy $A'(\infty )$. This will be used in a second paper to fully establish $A(\infty )$ for any type and rank. The present paper uses Harish-Chandra induction as a parametrization tool. We give a new, more effective proof of the theorem of Geck and Lusztig ensuring that cuspidal characters of any standard Levi subgroup of $G=\mathrm {D}_{ l,\mathrm {sc}}(q)$ extend to their stabilizers in the normalizer of that Levi subgroup. This allows us to control the action of automorphisms on these extensions. From there, Harish-Chandra theory leads naturally to a detailed study of associated relative Weyl groups and other extendibility problems in that context.
This article presents details of the recent discovery of Palaeolithic cave art in Cova Dones, Valencia. The preliminary results reveal a rich graphic assemblage with features that are unusual for Mediterranean Upper Palaeolithic art and were previously unknown for the Pleistocene in the eastern Iberian coast.
The linear temporal and absolute/convective stability characteristics of a thermal plume generated along a heated vertical cylinder are investigated theoretically under the Boussinesq approximation. Special focus is given to the uniform-wall-buoyancy-flux case whereby the cylinder surface sustains the same linear temperature gradient as the environment. A competition between the axisymmetric and helical modes is a remarkable feature of the instability, distinguishing these ‘annular plumes’ from free plumes/jets for which the helical mode is generally dominant. It is found that higher surface curvature stabilises the temporal axisymmetric mode significantly, but only has moderate effects on the helical mode. The most temporally unstable perturbation mode switches from a helical into an axisymmetric mode when the Prandtl number increases beyond a critical value. Both the roles of shear and buoyancy during the destabilisation are identified through an energy analysis which indicates that, while the shear work is usually a major source of perturbation energy, the buoyancy work manifests for long-wave axisymmetric perturbation modes, and for thin cylinders and high Prandtl numbers. For the specific temperature configuration considered herein, an annular plume is always convectively unstable whereas decreasing the cylinder radius from the planar limiting case first decreases and then increases the tendency of the flow towards being absolutely unstable. The helical mode is especially susceptible to being absolutely unstable on very thin cylinders. Several conditions for the onset of cellular thermal convection and plume detrainment are proposed based on our results and a hypothesis which connects the absolute instability to the detrainment phenomenon.
“Actionability” is a key concept in precision oncology. Its precise definition, however, remains contested. This article undertakes a philosophical analysis of “actionability” to aid in conceptual clarification. We map distinct concepts of actionability, arguing that each is best understood as a contextually objective category articulated to mitigate risk of “conceptual slippage.” We defend “interactive pluralism,” acknowledging the need for distinct concepts but also for conceptual interaction in practice. This article thus offers insights for both practitioners and philosophers, clarifying approaches to actionability for scientists and clinicians and serving as a case study to test competing views on scientific pluralism.
How may elites experience a symbolic fall from grace? Elite scholarship has typically described how symbolic structures contribute to consecrate and reinforce existing power relations. Processes of deconsecration are, however, less well described. Deconsecration as a social process is distinct from déclassement, as well as from cultural or juridical processes of exclusion. It is the loss of the very status as “elite.” We address the question of deconsecration through a historical case study of the exclusion of elite groups from the Danish Who’s Who and professional bodies in the wake of the liberation after the German occupation of Denmark 1940–1945.
Mary Midgley challenges the dominant conceptions of human nature, ethics, community and ecology taught at A-Level. This article considers some of the key themes of her thinking.
Let $p$ be a prime number, $k$ a finite field of characteristic $p>0$ and $K/k$ a finitely generated extension of fields. Let $A$ be a $K$-abelian variety such that all the isogeny factors are neither isotrivial nor of $p$-rank zero. We give a necessary and sufficient condition for the finite generation of $A(K^{\mathrm {perf}})$ in terms of the action of $\mathrm {End}(A)\otimes \mathbb {Q}_p$ on the $p$-divisible group $A[p^{\infty }]$ of $A$. In particular, we prove that if $\mathrm {End}(A)\otimes \mathbb {Q}_p$ is a division algebra, then $A(K^{\mathrm {perf}})$ is finitely generated. This implies the ‘full’ Mordell–Lang conjecture for these abelian varieties. In addition, we prove that all the infinitely $p$-divisible elements in $A(K^{\mathrm {perf}})$ are torsion. These reprove and extend previous results to the non-ordinary case.