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Manganese(III/IV) oxide is a promising pseudocapacitive material for supercapacitor electrodes due to favorable attributes such as its chemical resilience, high earth abundance and low specific cost. Herein, the morphological, compositional and electrochemical characteristics of co‐precipitated manganese(III/IV) oxide products, each described by the general formula NaxKyMnOz, are investigated to establish how these properties are influenced by synthesis conditions. NaxKyMnOz growths in low‐temperature (<100 °C) basic and acidic environments are shown to promote the formation of turbostratic birnessite and cryptomelane phases, respectively, with the latter polymorph containing a relatively low concentration of interstitial Na+ and K+ cations. It is demonstrated that K+ pre‐insertion during synthesis yields lower initial charge‐transfer resistances than equivalent Na+ intercalation, and that this parameter correlates strongly with storage performance. Accordingly, Na‐mediated storage initially delivers inferior specific capacitances and Coulombic efficiencies than K‐based mechanisms, but K+ intercalation/deintercalation causes faster capacitance decay during prolonged galvanostatic cycling. Furthermore, whilst crystallographic phase is shown to have a weaker effect on NaxKyMnOz storage properties than the choice of intercalating guest cations, cryptomelane electrodes are more susceptible to cycling‐induced capacitance and efficiency losses than their birnessite counterparts. In combination, these insights provide an instructive foundation for the optimization of NaxKyMnOz in high‐power storage applications. [ABSTRACT FROM AUTHOR]

This article presents a novel method for accelerated wear of squeegees used in screen printing and describes the development of mechanical tests which allow more in-depth measurement of squeegee properties. In this study, squeegees were abraded on the screen press so that they could be used for subsequent print tests to evaluate the effect of wear on the printed product. Squeegee wear was found to vary between different squeegee types and caused increases in ink transfer and wider printed features. In production this will lead to greater ink consumption, cost per unit and a likelihood of product failure. This also has consequences for the production of functional layers, etc., used in the construction of printed electronics. While more wear generally gave greater increases in ink deposition, the effect of wear differed, depending on the squeegee. There was a correlation between the angle of the squeegee wear and ink film thickness from a worn squeegee. An ability to resist flexing gave a high wear angle and presented a sharper edge at the squeegee/screen interface thus mitigating the effect of wear. There was also a good correlation between resistance to flexing and ink film thickness for unworn squeegees, which was more effective than a comparison based on Shore A hardness. Squeegee indentation at different force levels gave more information than a standard Shore A hardness test and the apparatus used was able to reliably measure reductions in surface hardness due to solvent absorption. Increases in ink deposition gave lower resistance in printed silver lines; however, the correlation between the amount of ink deposited and the resistance, remained the same for all levels of wear, suggesting that the wear regime designed for this study did not induce detrimental print defects such as line breakages. [ABSTRACT FROM AUTHOR]

Racial and ethnic minorities often receive lower-quality health care than white patients, even when socioeconomic status, education, access, and other factors are used as controls. To address these pervasive disparities, health care professionals should learn more about them and the roles they can play in eliminating them, but few curricula are focused on understanding and addressing racial and ethnic health disparities, and well-accepted guidelines on what and how to teach in this complex area are lacking. The Society of General Internal Medicine Health Disparities Task Force used a review and consensus process to develop specific recommendations and guidelines for curricula focusing on health disparities. Learning objectives, content, methods for teaching, and useful resources are provided. Although the guidelines were developed primarily for teaching medical students, residents, and practitioners in primary care, the Task Force's general recommendations can apply to learners in any specialty. The Task Force recommends that a curricula address 3 areas of racial and ethnic health disparities and focus on the following specific learning objectives: 1) examining and understanding attitudes, such as mistrust, subconscious bias, and stereotyping, which practitioners and patients may bring to clinical encounters; 2) gaining knowledge of the existence and magnitude of health disparities, including the multifactorial causes of health disparities and the many solutions required to diminish or eliminate them; and 3) acquiring the skills to effectively communicate and negotiate across cultures, languages, and literacy levels, including the use of key tools to improve communication. The broad goal of a curriculum on disparities should be for learners to develop a commitment to eliminating inequities in health care quality by understanding and assuming their professional role in addressing this pressing health care crisis. [ABSTRACT FROM AUTHOR]

The article discusses the adverse effect of combination angiotensin II receptor blockers (ARBs) plus angiotension-converting enzyme (ACE) inhibitors in symptomatic left ventricular dysfunction. Eligible randomized controlled trials (RCTs) from MEDLINE and Web sites for the National Institute of Health Clinical Trials and the Food and Drug Administration were selected. Results from the four qualified studies showed that combination ARBs plus ACE inhibitors was associated with significant increases in medication discontinuations due to its adverse effects in patients with chronic heart failure and acute myocardial infarctions with symptomatic left ventricular dysfunction. Moreover, it also worsens renal function, hyperkalemia and symptomatic hypotension.

Context: Delayed or inaccurate communication between hospital-based and primary care physicians at hospital discharge may negatively affect continuity of care and contribute to adverse events.Objectives: To characterize the prevalence of deficits in communication and information transfer at hospital discharge and to identify interventions to improve this process.Data Sources: MEDLINE (through November 2006), Cochrane Database of Systematic Reviews, and hand search of article bibliographies.Study Selection: Observational studies investigating communication and information transfer at hospital discharge (n = 55) and controlled studies evaluating the efficacy of interventions to improve information transfer (n = 18).Data Extraction: Data from observational studies were extracted on the availability, timeliness, content, and format of discharge communications, as well as primary care physician satisfaction. Results of interventions were summarized by their effect on timeliness, accuracy, completeness, and overall quality of the information transfer.Data Synthesis: Direct communication between hospital physicians and primary care physicians occurred infrequently (3%-20%). The availability of a discharge summary at the first postdischarge visit was low (12%-34%) and remained poor at 4 weeks (51%-77%), affecting the quality of care in approximately 25% of follow-up visits and contributing to primary care physician dissatisfaction. Discharge summaries often lacked important information such as diagnostic test results (missing from 33%-63%), treatment or hospital course (7%-22%), discharge medications (2%-40%), test results pending at discharge (65%), patient or family counseling (90%-92%), and follow-up plans (2%-43%). Several interventions, including computer-generated discharge summaries and using patients as couriers, shortened the delivery time of discharge communications. Use of standardized formats to highlight the most pertinent information improved the perceived quality of documents.Conclusions: Deficits in communication and information transfer at hospital discharge are common and may adversely affect patient care. Interventions such as computer-generated summaries and standardized formats may facilitate more timely transfer of pertinent patient information to primary care physicians and make discharge summaries more consistently available during follow-up care. [ABSTRACT FROM AUTHOR]

The article presents research findings and recommendations for the hand-off of discharged patient data from hospital-based physicians to primary care physicians. Common deficits in communication and information transfer included the availability, timeliness, content, and format of discharge communications, as well as primary care physician satisfaction. Measures of these deficits showed the communication problems to be common and with adverse effects on patient care. Recommendations include provision of computer-generated summaries of pertinent patient data and use of standardized formats for data presentation to primary care physicians.

OBJECTIVE: The role of proton pump inhibitors (PPIs) in suspected GERD-related chronic laryngitis (CL) is controversial. Hence, we performed a meta-analysis of the existing randomized controlled trials (RCTs) to evaluate the efficacy of PPIs in this disorder. METHODS: Data extracted from MEDLINE (1966 to August 2005), Cochrane Controlled Trials Register (1997 to August 2005), EMBASE (1980 to August 2005), ClinicalTrials.gov website, and meetings presentations (1999–2005). Published and unpublished randomized placebo-controlled trials of PPIs in suspected GERD-related CL were selected by consensus. Random effects model was utilized with standard approaches to quality assessment, sensitivity analysis, and an exploration of heterogeneity and publication bias. The primary outcome measure was defined as the proportion of patients with ≥50% reduction in self-reported laryngeal symptoms. RESULTS: Pooled data from 8 studies (N = 344, PPI 195, placebo 149; mean age 51 yr; males 55%; study duration 8–16 wk) were analyzed. No significant quantitative heterogeneity was found among the studies (χ2= 11.22, P= 0.13). Overall, PPI therapy resulted in a nonsignificant symptom reduction compared to placebo (relative risk 1.28, 95% confidence interval 0.94–1.74). No clinical predictors of PPI response were identified on meta-regression analysis done at study level. CONCLUSIONS: PPI therapy may offer a modest, but nonsignificant, clinical benefit over placebo in suspected GERD-related CL. Validated diagnostic guidelines may facilitate the recognition of those patients most likely to respond favorably to PPI treatment. [ABSTRACT FROM AUTHOR]

This study examined how health services research connects with practice and policy, first by investigating whether successful research projects continued in their test settings and engendered replication and then by examining whether a coherent body of research helped shape public policy. Chronic heart failure (CHF) was studied because randomized, controlled trials of posthospital CHF disease management have repeatedly demonstrated patient benefits and reduced costs, yet this practice has not become standard in the United States. Literature review produced 30 randomized, controlled trials of multidisciplinary outpatient CHF management, generally yielding improved patient outcomes. An e-mail survey of first authors (97% response rate) showed that practices proven to be effective in U.S. studies generally did not continue or expand (13 of 15 studies), mostly attributed to financial constraints (11 of 13), whereas similar projects in other countries often became permanent (7 of 13). U.S. respondents generally rated current quality of clinical care as good, whereas those elsewhere mostly rated it as excellent. Recent Medicare reforms implemented a model of CHF management substantially different from those studied in health services research. The Congressional hearings leading to these Medicare reforms, and the statute itself, mostly evidence the model used by commercial disease-management firms. Policy-makers, health service researchers, and funding agencies could develop more-effective methods for translating proven models of healthcare delivery into routine practice. Reforms that might improve the effectiveness of the linkages between research, policy, and practice are suggested. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To determine whether a hierarchy of effectiveness exists with respect to complexity of published protocols of heart failure (HF) disease management (DM) incorporating specialist nurse-led HF clinics. Data sources and study selection: We searched MEDLINE (1966–November 2004), the Cochrane Library, article bibliographies, and contacted experts. Inclusion criteria were random allocation of at least 100 patients, specialist HF nurses, HF clinics, and readmission as an outcome measure. Data extraction: Paired reviewers conducted quality assessment, deconstructed and categorized protocols by complexity, and extracted results for readmission, mortality, the combined endpoint of mortality and hospitalization, HF readmission, and hospital days utilized. Data synthesis: Six trials were selected (N=949, mean age 73 years [range 62–79], men 58%, LVEF 34% [27–41], and average follow-up of 8.5 months [3–12]). Compared with usual care, the overall relative risk [95% confidence interval] for readmission with this strategy was 0.91 [0.72, 1.16], mortality was 0.80 [0.57, 1.06], and the combined endpoint of mortality and hospitalization was 0.88 [0.74, 1.04]. We observed better outcomes for programs with versus programs without hospital discharge planning and immediate post-discharge follow-up; readmission 0.30 [0.04, 2.60] vs. 1.00 [0.86, 1.17], mortality 0.96 [0.63, 1.47] vs. 0.75 [0.55, 1.03], the combined endpoint of mortality and hospitalization 0.61 [0.18, 2.02] vs. 0.91 [0.80, 1.03], HF readmission 0.09 [0.10, 0.65] vs. 0.65 [0.43, 1.00], and hospitalized days utilized per patient −0.26 [−0.49,−0.02] vs. 0.09 [−1.17, 1.34]. Conclusions: HF DM with specialist nurse-led HF clinics is a promising strategy or effective alternative whose benefit may be optimized by programs with a homogeneous structure and components that are delivered with consistency. [Copyright &y& Elsevier]

Context: Comprehensive discharge planning plus postdischarge support may reduce readmission rates for older patients with congestive heart failure (CHF). Objective: To evaluate the effect of comprehensive discharge planning plus postdischarge support on the rate of readmission in patients with CHF, all-cause mortality, length of stay (LOS), quality of life (QOL), and medical costs. Data Sources: We searched MEDLINE (1966 to October 2003), the Cochrane Clinical Trials Register (all years), Social Science Citation Index (1992 to October 2003), and other databases for studies that described such an intervention and evaluated its effect in patients with CHF. Where possible we also contacted lead investigators and experts in the field. Study Selection: We selected English-language publications of randomized clinical trials that described interventions to modify hospital discharge for older patients with CHF (mean age ≥55 years), delineated clearly defined inpatient and outpatient components, compared efficacy with usual care, and reported readmission as the primary outcome. Data Extraction: Two authors independently reviewed each report, assigned quality scores, and extracted data for primary and secondary outcomes in an unblinded standardized manner. Data Synthesis: Eighteen studies representing data from 8 countries randomized 3304 older inpatients with CHF to comprehensive discharge planning plus postdischarge support or usual care. During a pooled mean observation period of 8 months (range, 3-12 months), fewer intervention patients were readmitted compared with controls (555/1590 vs 741/1714, number needed to treat = 12; relative risk [RR], 0.75; 95% confidence interval [CI], 0.64-0.88). Analysis of studies reporting secondary outcomes found a trend toward lower all-cause mortality for patients assigned to an intervention compared with usual care (RR, 0.87; 95% CI, 0.73-1.03; n = 14 studies), similar initial LOS (mean [SE]: 8.4 [2.5] vs 8.5 [2.2] days, P = .60; n = 10), greater percentage improvement in QOL scores compared with baseline scores (25.7% [95% CI, 11.0%-40.4%] vs 13.5% [95% CI, 5.1%-22.0%]; n = 6, P = .01), and similar or lower charges for medical care per patient per month for the initial hospital stay, administering the intervention, outpatient care, and readmission (-$359 [95% CI, -$763 to $45]; n = 4, P = .10 for non-US trials and -$536 [95% CI, -$956 to -$115]; n = 4, P = .03, for US trials). Conclusion: Comprehensive discharge planning plus postdischarge support for older patients with CHF significantly reduced readmission rates and may improve health outcomes such as survival and QOL without increasing costs. [ABSTRACT FROM AUTHOR]

In this article, the author discusses the study of F. A. McAlister and colleagues regarding the use of the combination of angiotensin-receptor blockers and converting-enzyme inhibitors in the treatment of patients with heart failure. He is critical to the strength of the study, which according to him, is its consistency in terms of adverse drug effects as reported in clinical trials. He also mentions several clinical trials that affirm that the combination lessens morbidity.

In this article, the authors discuss the Women's Antioxidant and Folic Acid Cardiovascular Study (WAFACS), carried out by W.G. Christen and colleagues. The authors remark the significance of the study on public health to prevent the early stage development of age-related macular degeneration (AMD). The authors relate the development of advanced treatments for AMD as a major program of the U.S. National Eye Institute. The authors believe that the need for AMD treatments must be recognized.

Presents a reply by Christopher Phillips and colleagues to letters to the editor about their article "Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis."

The article presents a meta-analysis of randomized controlled trials on the effectiveness of proton pump inhibitor (PPI) therapy for the treatment of suspected Gastroesophageal Reflux Disease (GERD)-Related Chronic Laryngitis (CL). The analysis used random effects model with standard approaches to quality assessment, sensitivity analysis and an exploration of heterogeneity and publication bias. PPI therapy offer a nonsignificant clinical benefit over placebo in patients with GERD-related CL.