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In 1975-76 a one-year longitudinal study of the delivery of primary care services was carried out at all ambulatory institutional facilities in Durham County, North Carolina and in 47 of 50 community private practices covering the broad fields of surgery (including urology and orthopedics), medicine, pediatrics, and ob/gyn. The present paper focuses on the private and public clinics of Duke University Medical Center. Data were analyzed to document differentials in sociodemographic characteristics of patients attending these two systems of care. Results showed that patients attending the private clinics are predominantly white and covered by private insurance, while patients attending the public clinics are predominantly black and heavily dependent on Medicaid coverage. The potentially detrimental effects of a two-class system of care on the health of patients, as well as on the education of students, is discussed in the context of a scant medical literature on this subject. [ABSTRACT FROM AUTHOR]

Post-traumatic parotid sialocoele is a subcutaneous extravasation of saliva from the parotid gland secondary to traumatic disruption of its duct or parenchyma. Currently, there is no consensus regarding the best therapy for parotid sialocoele, as it is resistant to conservative management. The present paper puts forward a relatively simple, safe and effective technique for the treatment of parotid sialocoele, specifically a peroral drainage technique. The results justify our recommendation to use this approach for the treatment of sialocoele. [ABSTRACT FROM AUTHOR]

In this paper, daylight availability depending on building orientation in a typical educational classroom was investigated. Measurements of daylight illuminance distributions in the room depth for different illuminance outside the building allowed to determine the conditions when the luminaires in a classroom could be turned off, turned on, or dimmed. The outdoor daylight illuminance on the south-east and north façade of the building was recorded and the numbers of hours per year of university activity during which the lighting had to be switched on (up to 100% or brightened) were determined. Based on these numbers and luminaires powers the electricity consumption for lighting was estimated. It was proven that by using dimming control depending on daylight distribution in a room, comparable energy savings could be achieved for different building orientations. These savings of over 30% were greater than through the implementation of on/off control which, for a south-east oriented classroom reached about 28% and for a north-oriented one they were two times lower. Economic analysis showed payback time for dimming control around two years, which was longer than for on/off control. The electricity consumption estimated experimentally was also compared with the lighting energy numerical indicator (LENI) calculated according the standard EN 15193 1: 2017. [ABSTRACT FROM AUTHOR]

In medicine, the challenges faced by female faculty members who are attempting to achieve academic advancement have been well described. Various strategies have been proposed to increase academic productivity to aid the promotion of women in medicine. We propose an innovative collaboration strategy that encourages completion of an academic writing project. This strategy acknowledges the challenges inherent in achieving work-life balance and utilizes a collaborative work style with a group of peer physicians. The model is designed to encourage the completion and collation of independently prepared sections of an academic paper within a setting that emphasizes social networking and collaboration. This approach has many similarities to the construction of a quilt during a "quilting bee." [ABSTRACT FROM AUTHOR]

Background: Internationally there is an increasing concern about the quality of end-of-life care (EoLC) provided in acute hospitals. More people are cared for at end of life and die in acute hospitals than in any other healthcare setting. This paper reports the views of bereaved relatives on the experience of care they and the person that died received during their last admission in two university adult acute tertiary hospitals. Methods: Relatives of patients who died were invited to participate in a post-bereavement postal survey. An adapted version of VOICES (Views of Informal Carers - Evaluation of Services) questionnaire was used. VOICES MaJam has 36 closed questions and four open-ended questions. Data were gathered in three waves and analysed using SPSS and NVivo. 356 respondents completed the survey (46% response rate). Results: The majority of respondents (87%: n = 303) rated the quality of care as outstanding, excellent or good during the last admission to hospital. The quality of care by nurses, doctors and other staff was highly rated. Overall, care needs were well met; however, findings identified areas of care which could be improved, including communication and the provision of emotional and spiritual support. In addition, relatives strongly endorsed the provision of EoLC in single occupancy rooms, the availability of family rooms on acute hospital wards and the provision of bereavement support. Conclusions: This research provides a powerful snapshot in time into what works well and what could be improved in EoLC in acute hospitals. Findings are reported under several themes, including the overall quality of care, meeting care needs, communication, the hospital environment and support for relatives. Results indicate that improvements can be made that build on existing good practice that will enhance the experience of care for dying persons and their relatives. The study adds insights in relation to relative's priorities for EoLC in acute hospitals and can advance care providers', policy makers' and educationalists' priorities for service improvement. [ABSTRACT FROM AUTHOR]

Background: Working with patients and health care providers to co-design health interventions is gaining global prominence. While co-design of interventions is important for all patients, it is particularly important for older adults who often experience multiple and complex chronic conditions. Persona-scenarios have been used by designers of technology applications. The purpose of this paper is to explore how a modified approach to the persona-scenario method was used to co-design a complex primary health care intervention (Health TAPESTRY) by and for older adults and providers and the value added of this approach. Methods: The persona-scenario method involved patient and clinician participants from two academically-linked primary care practices. Local prospective volunteers and community service providers (e.g., home care services, support services) were also recruited. Persona-scenario workshops were facilitated by researchers experienced in qualitative methods. Working mostly in homogenous pairs, participants created a fictitious but authentic persona that represented people like themselves. Core components of the Health TAPESTRY intervention were described. Then, participants created a story (scenario) involving their persona and an aspect of the proposed Health TAPESTRY program (e.g., volunteer roles). Two stages of analysis involved descriptive identification of themes, followed by an interpretive phase to extract possible actions and products related to ideas in each theme. Results: Fourteen persona-scenario workshops were held involving patients (n = 15), healthcare providers/community care providers (n = 29), community service providers (n = 12), and volunteers (n = 14). Fifty themes emerged under four Health TAPESTRY components and a fifth category - patient. Eight cross cutting themes highlighted areas integral to the intervention. In total, 414 actions were identified and 406 products were extracted under the themes, of which 44.8% of the products (n = 182) were novel. The remaining 224 had been considered by the research team. Conclusions: The persona-scenario method drew out feasible novel ideas from stakeholders, which expanded on the research team's original ideas and highlighted interactions among components and stakeholder groups. Many ideas were integrated into the Health TAPESTRY program's design and implementation. Persona-scenario method added significant value worthy of the added time it required. This method presents a promising alternative to active engagement of multiple stakeholders in the co-design of complex interventions. [ABSTRACT FROM AUTHOR]

The article presents the authors' reply to a letter from D. Meyre regarding their systematic review and meta-analysis on the associations of variants of proprotein convertase subtilisine/kexin type I gene (PCSKI) with obesity. The reply addresses Meyre's criticisms of what he perceives as errors in the paper including an assertion that meta-analysis included 2 overlapping cohorts and suggestion that the analysis was underpowered to find significant association of rs632 with body mass index.

Roeland Huijgen, MD,* S. Matthijs Boekholdt, MD, PhD,*† Benoit J. Arsenault, PhD,* Weihang Bao, PhD,‡ Jean-Michel Davaine, MD,§ Fatiha Tabet, PhD,‖ Francine Petrides, BSC,‖ Kerry-Anne Rye, PhD, ‖¶ David A. DeMicco, PharmD,‡ Philip J. Barter, MD, PhD,‖¶ John J. P. Kastelein, MD, PhD,* Gilles Lambert, PhD§‖ From the *Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands; †Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands; ‡Pfizer Inc., New York, New York; §Laboratoire Inserm U957, Faculté de Médecine, Université de Nantes, Nantes, France; ‖The Heart Research Institute, Sydney, New South Wales, Australia; and the ¶Faculty of Medicine, University of Sydney, New South Wales, Australia This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the author. The main findings of the TNT Trial were published in 2005 (1). Since that time, members of the Steering Committee and other investigators have published 32 papers based upon additional analyses of TNT. The data for these papers were derived from analyses of the TNT clinical database, managed by Pfizer. The clinical database has been crosschecked many times and the data in it is valid. During the trial, blood samples were drawn from the patients at regular intervals for subsequent analysis. We performed a nested case-control study that included 507 patients who experienced a CV event and 1,020 control patients in the main biomarker analysis, and 496 patients who experienced a CV event and 1,117 control patients in the PCSK9 analysis. The biomarker database was sesimple-parate from the clinical database. An anonymization code was run in 2007 to link patients from one database to the other. In late 2012, the TNT frozen blood samples were integrated into a large automated biobank that includes samples from other Pfizer trials. At that time discrepancies were noted among the samples, indicating that an error had occurred when the samples were anonymized in 2007. Further investigation revealed that the code created to manually anonymize the data was accidentally run twice. During the first run, anonymized subject identifiers were successfully assigned to both biosamples and clinical data. However, after this first run had passed quality control checks, the anonymization code was re-run inadvertently, replacing the first correct set of identifiers with a random and incorrect set. We do not understand how or why the code was re-run. The study team, who were blinded as to patient identity, thus reported on mismatched clinical and biomarker data. The investigators of the biomarkers study were puzzled that none of the 18 biomarkers were predictive of cardiovascular events. However we were reassured because on-treatment LDL-cholesterol, HDL-cholesterol and triglyceride levels were all strongly predictive of events, and we reported this in the paper. These lipid levels were part of the clinical database, and thus were not subject to the error that occurred with the biomarkers. In the PCSK9 analysis, PCSK9 levels were predictive of events in the atorvastatin 10-mg group (p 0.039) but not in the 80-mg group. This finding, which we now realize is totally spurious, was not unexpected and raised no red flags. Similarly, the failure of vitamin D levels to predict events, as reported in the AHJ paper, was not surprising. Since the error was discovered, we have created a new anonymized clinical and biomarker database by restoring the original set of anonymized identifiers. We are currently reanalyzing the data according to our original study plans. However, the nested case-control feature of the original study design has been lost because the patient selection for biomarker sampling was random. Only approximately one tenth of patients now had an event, compared to one third in the original study design. Thus, the power to detect a difference in the level of a biomarker between patients with and without events has been attenuated. All authors of these manuscripts are anguished to have made this mistake and publishing incorrect information. [Copyright &y& Elsevier]

Benoit J. Arsenault, PhD,* Philip Barter, MD, PhD,† David A. DeMicco, PharmD,‡ Weihang Bao, PhD,‡ Gregory M. Preston, PhD,‡ John C. LaRosa, MD,§ Scott M. Grundy, MD, PhD,‖ Prakash Deedwania, MD, PhD,¶ Heiner Greten, MD,# Nanette K. Wenger, MD,** James Shepherd, MD,†† David D. Waters, MD,‡‡ John J. P. Kastelein, MD, PhD,* for the TNT Study Investigators From the *Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; †The Heart Research Institute, Sydney, Australia; ‡Pfizer, Inc., New York, New York; §State University of New York Health Science Center, Brooklyn, New York; ‖University of Texas Southwestern Medical Center, Dallas, Texas; ¶Veterans Affairs Central California Healthcare System and University of California San Francisco School of Medicine, San Francisco, California; #Universitätsklinikum, Eppendorf, Germany; **Emory University School of Medicine, Atlanta, Georgia; ††University of Glasgow, Glasgow, United Kingdom; and the ‡‡San Francisco General Hospital, San Francisco, California This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the author. The main findings of the TNT Trial were published in 2005 (1). Since that time, members of the Steering Committee and other investigators have published 32 papers based upon additional analyses of TNT. The data for these papers were derived from analyses of the TNT clinical database, managed by Pfizer. The clinical database has been crosschecked many times and the data in it is valid. During the trial, blood samples were drawn from the patients at regular intervals for subsequent analysis. We performed a nested case-control study that included 507 patients who experienced a CV event and 1,020 control patients in the main biomarker analysis, and 496 patients who experienced a CV event and 1,117 control patients in the PCSK9 analysis. The biomarker database was separate from the clinical database. An anonymization code was run in 2007 to link patients from one database to the other. In late 2012, the TNT frozen blood samples were integrated into a large automated biobank that includes samples from other Pfizer trials. At that time discrepancies were noted among the samples, indicating that an error had occurred when the samples were anonymized in 2007. Further investigation revealed that the code created to manually anonymize the data was accidentally run twice. During the first run, anonymized subject identifiers were successfully assigned to both biosamples and clinical data. However, after this first run had passed quality control checks, the anonymization code was re-run inadvertently, replacing the first correct set of identifiers with a random and incorrect set. We do not understand how or why the code was re-run. The study team, who were blinded as to patient identity, thus reported on mismatched clinical and biomarker data. The investigators of the biomarkers study were puzzled that none of the 18 biomarkers were predictive of cardiovascular events. However we were reassured because on-treatment LDL-cholesterol, HDL-cholesterol and triglyceride levels were all strongly predictive of events, and we reported this in the paper. These lipid levels were part of the clinical database, and thus were not subject to the error that occurred with the biomarkers. In the PCSK9 analysis, PCSK9 levels were predictive of events in the atorvastatin 10-mg group (p = 0.039) but not in the 80-mg group. This finding, which we now realize is totally spurious, was not unexpected and raised no red flags. Similarly, the failure of vitamin D levels to predict events, as reported in the AHJ paper, was not surprising. Since the error was discovered, we have created a new anonymized clinical and biomarker database by restoring the original set of anonymized identifiers. We are currently reanalyzing the data according to our original study plans. However, the nested case-control feature of the original study design has been lost because the patient selection for biomarker sampling was random. Only approximately one tenth of patients now had an event, compared to one third in the original study design. Thus, the power to detect a difference in the level of a biomarker between patients with and without events has been attenuated. All authors of these manuscripts are anguished to have made this mistake and publishing incorrect information. [Copyright &y& Elsevier]

Purpose:Over the past two decades, attempts have been made to describe the nurse’s role and functions in the inpatient stroke rehabilitation; however, the nursing contribution is neither clear nor well-defined. Previous studies have highlighted the need for research aimed at developing interventions in the neuro-nursing area. The objective of this paper was to describe the development of a nursing intervention aimed at optimising the inpatient rehabilitation of stroke patients by strengthening the role and functions of nursing staff. Method:A systematic approach was used, consistent with the framework for developing and evaluating complex interventions by the UK’s Medical Research Council (MRC). Based on qualitative methods and using the Behaviour Change Wheel’s (BCW) stepwise approach, we sought behaviours related to nursing staffs’ roles and functions. Results:We conducted a behavioural analysis to explain why nursing staff were or were not engaged in these behaviours. The nursing staff’s Capability, Opportunity and Motivation were analysed with regard to working systematically with a rehabilitative approach and working deliberately and systematically with the patient’s goals. Conclusion:We developed the educational intervention Rehabilitation 24/7. Following the MRC and the BCW frameworks is resource-consuming, but offers a way of developing a practical, well-structured intervention that is theory- and evidence based. [ABSTRACT FROM PUBLISHER]

An introduction is presented in which the editors discuss various research papers within the issue on topics including management and control of hypertension, presence of cerebral white matter lesions in high blood pressure patients, and hypertension with periodontitis in nonsmoking African women.

An introduction is presented in which the editors discuss various papers within the issue on topics related to target-organ damage in hypertension including T-regulatory lymphocytes' positive effects on vascular disease, role of magnesium in pathogenesis, and erectile dysfunction in hypertension.

An introduction is presented in which the editors discuss various research papers within the issue on topics including prevention and treatment of hypertension, biobehavioral factors affected by increases in blood pressure, and impact of sleep and anxiety on blood pressure.

The author reviews the history of the Tulane School of Public Health and Tropical Medicine. In 1912, Dr. Creighton Wellman published a groundbreaking paper entitled “The New Orleans School of Tropical Medicine and Hygiene,” outlining a clear plan for a new independent school of public health. He became the founding dean of the Tulane School of Hygiene and Tropical Medicine. Dr. Wellman had spent 9 years practicing medicine in Angola and graduated from the London School of Tropical Medicine before launching a career in tropical medicine in the United States. Tulane already had a formal course of hygiene established as early as 1881. The founding of Tulane School of Hygiene and Tropical Medicine was made possible by a gift from Samuel Zemurray, who would become the president of the United Fruit Company. In January of 1914, Dr. Wellman abruptly left New Orleans to live in Brazil. The school lost its independence in 1919 and again became part of the School of Medicine until 1967. The school initiated by Dr. Wellman is the foundation on which today's Tulane School of Public Health and Tropical Medicine is built. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: The purpose of this paper is to demonstrate how current visual representations of organizational and technological processes do not fully account for the variability present in everyday practices. We further demonstrate how narrative networks can augment these representations to indicate potential areas for successful or problematic adoption of new technologies and potential needs for additional training. Methods: We conducted a qualitative study of the processes and routines at a major academic medical center slated to be supported by the development and installation of a new comprehensive HIT system. We used qualitative data collection techniques including observations of the activities to be supported by the new system and interviews with department heads, researchers, and both clinical and non-clinical staff. We conducted a narrative network analysis of these data by choosing exemplar processes to be modeled, selecting and analyzing narrative fragments, and developing visual representations of the interconnection of these narratives. Results: Narrative networks enable us to view the variety of ways work has been and can be performed in practice, influencing our ability to design for innovation in use. Discussion: Narrative networks are a means for analyzing and visualizing organizational routines in concert with more traditional requirements engineering, workflow modeling, and quality improvement outcome measurement. This type of analysis can support a deeper and more nuanced understanding of how and why certain routines continue to exist, change, or stop entirely. At the same time, it can illuminate areas in which adoption may be slow, more training or communication may be needed, and routines preferred by the leadership are subverted by routines preferred by the staff. [Copyright &y& Elsevier]

Abstract: Objective: To investigate the human, social and organizational issues surrounding a Computerized Physician Order Entry system for Laboratory ordering (CPOE-L) implementation process and to analyze their interrelated effects on the system implementation failure in an academic medical setting. Second, to provide lessons learned and recommendations on to how to manage challenges of human, social and organizational nature surrounding CPOE-L implementations. Methods: The themes surrounding CPOE introduction were identified by a heuristic analysis of literature on CPOE implementations. The resulting set of themes was applied as a reference model for 20 semi-structured interviews conducted during the CPOE-L implementation process with 11 persons involved in the CPOE-L project and in reviewing all CPOE-L related project documentation. Data was additionally gathered by user questionnaires, by user discussion rounds and through an ethnographical study performed at the involved clinical and laboratory departments. In analyzing the interview transcripts, project documentation and data from user questionnaires and discussion rounds a grounded theory approach was applied by the evaluation team to identify problem areas or issues deserving further analysis. Results: Outlined central problem areas concerning the CPOE-L implementation and their mutual relations were depicted in a conceptual interpretative model. Understanding of clinical workflow was identified as a key theme pressured by organizational, human and social issues ultimately influencing the entire implementation process in a negative way. Vast delays in CPOE introduction, system immaturity and under-functionality could all be directly attributed to a superficial understanding of workflow. Consequently, final CPOE integration into clinical and laboratory workflows was inhibited by both end-users as well as department managers and withdrawal of the CPOE-L system became inevitable. Conclusion: This case study demonstrates which human, social and organizational issues relevant to CPOE implementation cumulatively led to a failure outcome of the CPOE-L pilot introduction. The experiences and considerations described in this paper show important issues for CPOE systems to be successfully introduced and to be taken into account in future CPOE implementations. Understanding and consideration of (clinical) workflow aspects by project managers and the involved clinical organization is of extreme importance from the very start of a CPOE implementation process. [Copyright &y& Elsevier]

This article focuses on a study related to epidemiology. Mankind may be worried about a worldwide outbreak of influenza, but man's best friend is already in the midst of one. A dangerous flu virus originating in horses is spreading fast among U.S. dogs and may circle the globe, researchers say. With very few exceptions, dogs seemed resistant to influenza, says Edward Kilbourne, a retired flu researcher at New York Medical College in New York City, who published rare evidence of a human flu strain infecting six dogs in New York in 1975. The current outbreak, described in a paper published online by Science this week, came to light after 22 greyhounds developed a respiratory disease, and eight died, at a Florida racetrack in January 2004. The researchers found that it belongs to the H3N8 strain, which causes influenza in horses worldwide. Its sequence is 96% identical to that of other circulating H3N8 strains, suggesting that the entire virus jumped the species barrier, without reassorting with another strain first.