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Aim: The purpose of this study is to develop a tool and assess patient satisfaction with inpatient Nurse Practitioner (NP) care.Design: A 10 item questionnaire was administered to hospital inpatients cared for directly by one of two NP’s.Methods: Patients were given a point of care tablet to answer the survey questions with yes or no. The primary outcomes measured were satisfaction with the hospital NP in quality of care, effective communication, and discharge planning.Results: A total of 19 patients participated in this study. 100% of patients felt that nurse practitioners communicated the plan of care effectively, clearly communicated medication information, answered all questions effectively, and knew what to expect when they went home. Between 80-89.5% of patients understood their discharge goals, what they may need after discharge, and understood what signs and symptoms to look for after discharge. Only 36% reported that they had a primary care provider appointment upon discharge.Conclusions: Results of the questionnaire showed a high level of satisfaction with NP care and identified specific discharge barriers among these hospitalized patients. Determining patient satisfaction with NP care can help direct important performance and improvement activities for healthcare institutions.

SummaryThe serial use of non-invasive tests has been shown to be a safe method of managing outpatients who are suspected of having lower limb deep venous thrombosis (DVT). Objective testing has shown that the majority of these outpatients do not have venous thrombosis. A rapid test to exclude DVT in these patients, without the need for expensive and inconvenient serial non-invasive vascular testing, would have practical and economic advantages.Studies measuring the fibrin degradation product D-dimer using enzyme-linked immunoassays (EIA) in patients with veno-graphically proven DVT suggest that it should be possible to exclude this condition by the use of one of the rapid latex bead D-dimer tests.We have examined 190 patients with suspected DVT using both a latex and an EIA D-dimer assay. The latex D-dimer test used in this study was negative in 7 of the 36 proven cases of DVT. This sensitivity of only 80% is not sufficient to allow this type of assay, in its current form, to be used as an exclusion test for DVT. The same plasma samples were tested with an EIA assay. This information was used to mathematically model the effects of selecting a range of D-dimer discriminant cut off points for the diagnosis of DVT. These results indicate that 62% of suspected clinically significant DVT could have this diagnosis excluded, with a 98% sensitivity, if the rapid latex or equivalent D-dimer test could be reformulated to measure less than 185 ng/ml of D-dimer.

The Mexican axolotl (Ambystoma mexicanum) provides an excellent model for studying heart development since it carries a cardiac lethal mutation in gene c that results in failure of contraction of mutant embryonic myocardium. In cardiac mutant axolotls (c/c) the hearts do not beat, apparently because of an absence of organized myofibrils. To date, there has been no way to analyze the genotypes of embryos from heterozygous spawnings (+/c x +/c) until stage 35 when the normal (+/c or +/+) embryos first begin to have beating hearts; mutant (c/c) embryos fail to develop normal heartbeats. In the present study, we created chimeric axolotls by using microsurgical techniques. The general approach was to transect tailbud embryos and join the anterior and posterior halves of two different individuals. The chimeric axolotl is composed of a normal head and heart region (+/+), permitting survival and a mutant body containing mutant gonads (c/c) that permits the production of c/c mutant offspring: 100% c/c offspring were obtained by mating c/c chimeras (c/c x c/c). The mutant phenotypes were confirmed by the absence of beating hearts and death at stage 41 in 100% of the embryos. Examination of the mutant hearts with electron microscopy and comfocal microscopy after immunofluorescent staining for tropomyosin showed identical images to those described previously in naturally-occurring c/c mutant axolotls (i.e., lacking organized sarcomeric myofibrils). These "c/c chimeric" axolotls provide a useful and unique way to investigate early embryonic heart development in cardiac mutant Mexican axolotls.

The production of ferrochrome alloy from chromium bearing chromite ores is conducted at high temperature under highly reducing conditions. However, albeit completely unintended, it is impossible to completely exclude oxygen from all high temperature process steps, with the corresponding possibility arising for the generation of small amounts of Cr(VI) species. Certain Cr(VI) species are regarded as a carcinogenic, with specifically airborne exposure to these Cr(VI) species being associated with cancer of the respiratory system. With approximately three-quarters of the world's viable chromite ore reserves located in South Africa, and annual ferrochrome production approaching almost half of total annual global output, aspects of Cr(VI) generation and control are of particular relevance and importance to the local industry, and naturally to the global industry at large. This paper seeks to examine theoretical and practical aspects associated with Cr(VI) generation (based largely on experience within the local South African industry, but considered to be generally encountered in the broader global industry context), together with mitigating measures that can be applied within the context of the production processes. From the discussions it is clear that significant improvements in various Cr(VI)-related aspects have been made by the South African ferrochrome industry. However, it is also evident that several areas of uncertainty still exist, which require further research in order to better quantify risks and enhance the efficacy of mitigating steps.

All industrial processes are economically driven, resulting in the ever increasing need for process optimization in order to stay competitive and profitable. Numerous models has been published depicting the optimization of the raw material usage in an arc furnace, as well as the thermal and electrical efficiency; however, to obtain a holistic view of the cost-effectiveness of the process one needs to expand the model to include the cost of all the operational variables. This project therefore aimed to not only include the raw material feeds and power consumption as input variables, but also the labour, maintenance, and environmental costs to generate an all-inclusive financial balance. In the end, the model was able to mathematically optimize the ferrochrome (FeCr) production process through evaluating the effect of a specified combination of input parameters. It could therefore be used as a tool to aid in managerial decision-making; to appraise and correspondingly adjust certain operational variables in order to achieve a maximum return on investment. This paper fully describes the reasoning behind the choice of the essential model components, the assumptions made during the models development, the calculation approach, as well as the advantages, limitations, possible applications, and areas for expansion of the final model. Through running simulations with plant data, it was found that the accuracy of final model remained fairly constant when applied to stable furnace conditions, but was met with a number of limitations when applied to more complex situations. These limitations could, however, be overcome through further development and expansion of the existing model to include a larger number of process variables.

Background Patients with metastatic urothelial carcinoma have few treatment options after failure of platinum-based chemotherapy. In this trial, we assessed treatment with atezolizumab, an engineered humanised immunoglobulin G1 monoclonal antibody that binds selectively to programmed death ligand 1 (PD-L1), in this patient population. Methods For this multicentre, single-arm, two-cohort, phase 2 trial, patients (aged >= 18 years) with inoperable locally advanced or metastatic urothelial carcinoma whose disease had progressed after previous platinum-based chemotherapy were enrolled from 70 major academic medical centres and community oncology practices in Europe and North America. Key inclusion criteria for enrolment were Eastern Cooperative Oncology Group performance status of 0 or 1, measurable disease defined by Response Evaluation Criteria In Solid Tumors version 1.1 (RECIST v1.1), adequate haematological and end-organ function, and no autoimmune disease or active infections. Formalin-fixed paraffin-embedded tumour specimens with sufficient viable tumour content were needed from all patients before enrolment. Patients received treatment with intravenous atezolizumab (1200 mg, given every 3 weeks). PD-L1 expression on tumour-infiltrating immune cells (ICs) was assessed prospectively by immunohistochemistry. The co-primary endpoints were the independent review facility-assessed objective response rate according to RECIST v1.1 and the investigator-assessed objective response rate according to immune-modified RECIST, analysed by intention to treat. A hierarchical testing procedure was used to assess whether the objective response rate was significantly higher than the historical control rate of 10% at an a level of 0.05. This study is registered with ClinicalTrials.gov, number NCT02108652. Findings Between May 13, 2014, and Nov 19, 2014, 486 patients were screened and 315 patients were enrolled into the study. Of these patients, 310 received atezolizumab treatment (five enrolled patients later did not meet eligibility criteria and were not dosed with study drug). The PD-L1 expression status on infiltrating immune cells (ICs) in the tumour microenvironment was defined by the percentage of PD-L1-positive immune cells: IC0 (= 1% but < 5%), and IC2/3 (>= 5%). The primary analysis (data cutoff May 5, 2015) showed that compared with a historical control overall response rate of 10%, treatment with atezolizumab resulted in a significantly improved RECIST v1.1 objective response rate for each prespecified immune cell group (IC2/3: 27% [95% CI 19-37], p< 0.0001; IC1/2/3: 18% [13-24], p= 0.0004) and in all patients (15% [11-20], p= 0.0058). With longer follow-up (data cutoff Sept 14, 2015), by independent review, objective response rates were 26% (95% CI 18-36) in the IC2/3 group, 18% (13-24) in the IC1/2/3 group, and 15% (11-19) overall in all 310 patients. With a median follow-up of 11.7 months (95% CI 11.4-12.2), ongoing responses were recorded in 38 (84%) of 45 responders. Exploratory analyses showed The Cancer Genome Atlas (TCGA) subtypes and mutation load to be independently predictive for response to atezolizumab. Grade 3-4 treatment-related adverse events, of which fatigue was the most common (five patients [2%]), occurred in 50 (16%) of 310 treated patients. Grade 3-4 immune-mediated adverse events occurred in 15 (5%) of 310 treated patients, with pneumonitis, increased aspartate aminotransferase, increased alanine aminotransferase, rash, and dyspnoea being the most common. No treatment-related deaths occurred during the study. Interpretation Atezolizumab showed durable activity and good tolerability in this patient population. Increased levels of PD-L1 expression on immune cells were associated with increased response. This report is the first to show the association of TCGA subtypes with response to immune checkpoint inhibition and to show the importance of mutation load as a biomarker of response to this class of agents in advanced urothelial carcinoma.