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This work discusses the capability of Raman spectroscopy in monitoring the cure reaction and conversion of methyl methacrylate (MMA) in comparison to the conventional differential scanning calorimetry (DSC). In this regard, isothermal DSC measurements have been carried out as standard and compared against in-situ Raman spectra with the same material composition. A novel sample holder has been designed and implemented within the heated Raman chamber to monitor the cure reaction of the highly volatile MMA. The resulting spectra were processed using a custom written Python script, to compare the most significant C=C and C=O peaks. The conversion of monomeric MMA to Poly(methyl methacrylate) (PMMA) was calculated via the relative peak intensity of C=O at 1725 cm-1 to C=C at 1640 cm-1. Small deviations between the different measurement techniques have been observed and discussed in detail. The fundamental principle of Raman based in-situ conversion monitoring is proposed for industrial manufacturing of PMMA. Since these Raman measurements are carried out between 2 transparent glass plates, that are unaffected by the laser used, a simple and analogous setup would suffice industrially for on-line quality control and process optimization.

Background We analyzed how a pain management program (PMP) in a cardiology department of a high-volume center was implemented into daily practice. The results provide some very valuable insights into the dynamics of complex professional behavioral changes, including the barriers to and facilitators of such changes. Methodology The behavioral dynamics during the implementation of the PMP were analyzed using normalization process theory (NPT) because NPT reflects both individual and collective contributions. NPT elements were then studied in their relation to social marketing tools, especially the Cochrane Effective Practice and Organization of Care (EPOC) taxonomy. Where the EPOC tools did not wholly reflect the scope of the PMP, further marketing concepts were introduced. Results The frameworks used provided a useful structure to analyze the behavior change intervention, yielding insights into significant aspects of the change process (such as barriers and facilitators) at the level of the individual, within groups, and across the organization. By also integrating EPOC with NPT, we show how improvements in PMP tangibility can aid communication between PMP leaders and project participants. We also show how value can be co-created between the two groups. Conclusion Hospitals represent complex environments where effective behavior modification requires changes at many different levels. Nevertheless, we demonstrated, using NPT and the incorporation and adaptation of social marketing/EPOC tools, that an intervention designed to change behavior could succeed even in such extreme conditions.

Aims Proper management of post-interventional pain relieves unwarranted patient distress and enhances patient satisfaction. There have been only a limited number of investigations into patient discomfort following electrophysiological interventions. This study aims to quantify pain after interventional procedures, including ablation of atrial fibrillation (AF) or ventricular tachycardia (VT), as well as implant or explant of pacemakers or implantable cardioverter defibrillators. Methods and results One-hundred and two consecutive patients (mean age 66 years, 70 men) were asked to quantify post-interventional pain on a numeric rating scale (NRS 0-10) every 2 h during a period of 24 h after their intervention (49 ablations in deep propofol sedation, 53 device surgeries in local anaesthesia with mepivacaine 1%) and to specify the type of pain. Pain was classified as moderate to severe in case of NRS > 3. Post-operative pain medication included non-opioid and opioid analgesics as per the treating physicians' discretion. Sixty-one patients (60%) suffered from moderate-to-severe pain within the first 24 h after the procedure, despite the use of analgesics in 47 patients (46%). Pain was present in an early period (0-6 h) in 54% and in a late period (8-24 h) in 40% of patients. Patients complained of back pain (44%), pain at the site of the device pocket (39%), pain at the groin after puncture (7%), and pericarditic pain (5%). Multivariate analysis identified female gender (P = 0.046) associated with early post-interventional pain while age, diabetes mellitus, body mass index, type of intervention, and procedure time were not related to early or late post-interventional pain. Conclusion The findings highlight the high prevalence and the poor predictability of moderate-to-severe post-interventional pain within the first 24 h after catheter ablation and cardiac device surgery procedures, despite the use of peri-interventional analgesics. These findings highlight the need for more careful pain assessment and management programmes. © 2014 Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Over 6 million people in Europe suffer from atrial fibrillation and this number is expected to double over the next 50 years. The main goal of atrial fibrillation therapy is the prophylaxis of thromboembolic complications. This is achieved by administering oral anticoagulation which is tailored to the patient’s individual risk profile (assessed with risk scores, such as the CHA2DS2-VASc score) and to the presence of comorbidities. Therapy is further tailored to the extent of patient symptoms. A frequency control of < 110 bpm seems to be sufficient. In highly symptomatic patients the current strategy for restoration of sinus rhythm is cardioversion, antiarrhythmic drug therapy and catheter ablation. Catheter ablation is increasingly being adopted as the first line therapy. Whether maintenance of the sinus rhythm can improve the prognosis of atrial fibrillation is currently the focus of atrial fibrillation research. © 2014, Springer-Verlag Berlin Heidelberg.