Older Adults at Risk for Atrial Fibrillation Lack Knowledge and Confidence to Seek Treatment for Signs and Symptoms.

Early detection of atrial fibrillation (AF) is crucial for averting AF-related stroke and heart failure, but treatment is delayed when AF is not recognized. The critical need for early detection and treatment requires education to promote AF awareness. Knowledge deficits, attitudes, and beliefs about AF that should be addressed to improve awareness and reduce treatment-seeking delay in older adults at risk for developing AF have not been well documented. The purpose of this study was to describe knowledge, treatment-seeking attitudes, and beliefs about AF in adults ⩾ 65 years old and identify demographic characteristics associated with knowledge, attitudes, and beliefs. Patients with no history of AF recruited from an academic medical center were interviewed using the Knowledge, Attitudes, and Beliefs about Atrial Fibrillation Survey. Data were analyzed using descriptive statistics and independent t tests. Participants (N = 180) were 63% male with a mean age of ±3.± 6.0 years, and 52% held ⩾ 4-year college degree. About one third could not identify common symptoms of AF including palpitations (31%), chest pain (36%), dyspnea (30%), and fatigue (35%). A majority (84%) lacked confidence to recognize AF, and 58% were not sure when they should seek care for AF symptoms. Nearly a third (32%) believed palpitations are always present with AF, and 74% believed that low energy would not be their only symptom of AF. Higher scores for AF Symptom Knowledge (p = .02) were observed in females, and General Knowledge about AF was greater for younger participants (p < .001). Participants lacked knowledge and confidence to aid decision-making for treatment-seeking for symptoms of AF and held inaccurate beliefs about AF that could hinder early treatment-seeking. Programs to promote AF awareness should explain the spectrum of symptoms that may be manifested by AF and include action plans for responding to symptoms

A Modular Low-clearance Wrist Orthosis for Improving Wrist Motion in Children with Cerebral Palsy

Children with Cerebral Palsy (CP) often exhibit impairments in the coordination of the grip and lift phases of arm movements that directly impact their ability to perform activities of daily living (ADLs). The application of assistive robotic therapy to children with spastic hemiplegic CP has shown that augmented movement training can lead to improved functional outcomes and improved arm kinematics. Assistive robotic therapy of the wrist has been shown to help improve motor skills in stroke patients, but the devices employed are often large and obtrusive, focusing on a repeated motion rather than a task-based itinerary. Here, we propose a lightweight low clearance wrist orthosis for use in children with Cerebral Palsy that actuates pronation/supination and flexion/extension of the wrist

Reaction-Diffusion Degradation Model for Delayed Erosion of Cross-Linked Polyanhydride Biomaterials

We develop a theoretical model to explain the long induction interval of water intake that precedes the onset of erosion due to degradation caused by hydrolysis in the recently synthesized and studied cross-linked polyanhydrides. Various kinetic mechanisms are incorporated in the model in an attempt to explain the experimental data for the mass loss profile. Our key finding is that the observed long induction interval is attributable to the nonlinear dependence of the degradation rate constants on the local water concentration, which essentially amounts to the breakdown of the standard rate-equation approach, potential causes for which are then discussed. Our theoretical results offer physical insights into which microscopic studies will be required to supplement the presently available macroscopic mass-loss data in order to fully understand the origin of the observed behavior

Local agency, development assistance and the legacies of rebellion in Burundi and Rwanda

Rwanda and Burundi have both emerged from civil wars over the past 20 years and foreign donors have provided significant contributions to post-conflict reconstruction and development in the two countries. Yet although Rwanda and Burundi share several important characteristics, the social, political and economic trajectories of the two countries have been different. The paper argues that the nature of the ruling parties in Rwanda and Burundi is key to understanding the countries' relationships with donors. Rather than seeing aid as an exogenous factor causing particular development outcomes, the paper shows how local party elites exert considerable agency over the aid relationship. Their agency, however, is influenced and constrained by a number of different local contextual factors, including pre-civil war structures. Thus, the paper provides an analysis of how local context matters in understanding donorrecipient aid relationships, and how the ruling party in Rwanda (the RPF) and in Burundi (the CNDD-FDD) emerged from their respective conflicts with different relationships with international donors

What's the Risk? Older Women Report Fewer Symptoms for Suspected Acute Coronary Syndrome than Younger Women.

The purpose of the study was to determine whether older (≥65 years) and younger (<65 years) women presenting to the emergency department (ED) with symptoms suggestive of acute coronary syndrome (ACS) varied on risk factors, comorbid conditions, functional status, and symptoms that have implications for emergent cardiac care. Women admitted to five EDs were enrolled. The ACS Symptom Checklist was used to measure symptoms. Comorbid conditions and functional status were measured with the Charlson Comorbidity Index and Duke Activity Status Index. Logistic regression models were used to evaluate symptom differences in older and younger women adjusting for ACS diagnosis, functional status, body mass index (BMI), and comorbid conditions. Analyses were stratified by age, and interaction of symptom by age was tested. Four hundred women were enrolled. Mean age was 61.3 years (range 21-98). Older women (n = 163) were more likely to have hypertension, hypercholesterolemia, never smoked, lower BMI, more comorbid conditions, and lower functional status. Younger women (n = 237) were more likely to be members of minority groups, be college-educated, and have a non-ACS discharge diagnosis. Younger women had higher odds of experiencing chest discomfort, chest pain, chest pressure, shortness of breath, nausea, sweating, and palpitations. Lack of chest symptoms and shortness of breath (key symptoms triggering a decision to seek emergency care) may cause older women to delay seeking treatment, placing them at risk for poorer outcomes. Younger African American women may require more comprehensive risk reduction strategies and symptom management

Sensitivity, specificity, and sex differences in symptoms reported on the 13-item acute coronary syndrome checklist.

BackgroundClinical symptoms are part of the risk stratification approaches used in the emergency department (ED) to evaluate patients with suspected acute coronary syndromes (ACS). The objective of this study was to determine the sensitivity, specificity, and predictive value of 13 symptoms for a discharge diagnosis of ACS in women and men.Methods and resultsThe sample included 736 patients admitted to 4 EDs with symptoms suggestive of ACS. Symptoms were assessed with the 13-item validated ACS Symptom Checklist. Mixed-effects logistic regression models were used to estimate sensitivity, specificity, and predictive value of each symptom for a diagnosis of ACS, adjusting for age, obesity, diabetes, and functional status. Patients were predominantly male (63%) and Caucasian (70.5%), with a mean age of 59.7±14.2 years. Chest pressure, chest discomfort, and chest pain demonstrated the highest sensitivity for ACS in both women (66%, 66%, and 67%) and men (63%, 69%, and 72%). Six symptoms were specific for a non-ACS diagnosis in both women and men. The predictive value of shoulder (odds ratio [OR]=2.53; 95% CI=1.29 to 4.96) and arm pain (OR 2.15; 95% CI=1.10 to 4.20) in women was nearly twice that of men (OR=1.11; 95% CI=0.67 to 1.85 and OR=1.21; 95% CI=0.74 to 1.99). Shortness of breath (OR=0.49; 95% CI=0.30 to 0.79) predicted a non-ACS diagnosis in men.ConclusionsThere were more similarities than differences in symptom predictors of ACS for women and men

The Strategic Distribution Management Initiative and its effects on inventory levels and readiness

Until just a few years ago, no organization was tasked with measuring overall effectiveness, design, or optimization of DOD's global supply chain management system. As a result, the Strategic Distribution Management Initiative (SDMI) was created as a joint venture between Defense Logistics Agency (DLA) and the United States Transportation Command (USTRANSCOM) charged with enterprise level redesign, streamlining, and optimization of the DOD global supply chain. This thesis examines the affects of the SDMI implementation on the Army's two maneuver divisions stationed in the Europe. Specifically, it analyzes affects of SDMI implementation on the eight supply support activities located within the two maneuver divisions in USAREUR. This thesis studies SDMI impacts on inventory levels; inventory turbulence in the SSAs during SDMI implementation; SDMI improvements with respect to readiness; and existing barriers to improving velocity. The research indicates that: (1) expected inventory reductions were not realized following SDMI implementation, (2) inventory turbulence consumes limited resources and is a lucrative target for further improvement, (3) there is no evidence that SDMI increased fleet readiness, and (4) backorder rates and time, along with sub-optimization of pieces of the DOD supply chain, are significant barriers to velocity that still must be broken through.http://archive.org/details/thestrategicdist109455797Approved for public release; distribution is unlimited