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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]

OBJECTIVE: To evaluate modern surgical outcomes in patients with stable heart failure undergoing elective major noncardiac surgery and to compare the experience of patients with heart failure who have reduced [...]

A systematic review of relevant data was performed to assess the prevalence of deficits in communication and information transfer between hospital-based and primary care physicians at hospital discharge. It was concluded that such deficits are common and might adversely affect patient care, while interventions like computer-generated summaries and standardized formats might rectify the defect.

The comprehensive discharge planning with post-discharge support for older patients with congestive heart failure (CHF) significantly leads to the reduction of readmission rates. It also improves the quality of life without increasing the costs.

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]

Antibodies were patterned onto flexible plastic filmsusing theflexographic printing process. An ink formulation was developed usinghigh molecular weight polyvinyl alcohol in carbonate–bicarbonatebuffer. In order to aid both antibody adhesion and the quality ofdefinition in the printed features, a nitrocellulose coating was developedthat was capable of being discretely patterned, thus increasing thesignal-to-noise ratio of an antibody array. Printing antibody featuressuch as dots, squares, text, and fine lines were reproduced effectively.Furthermore, this process could be easily adapted for printing ofother biological materials, including, but not limited to, enzymes,DNA, proteins, aptamers, and cells. [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]

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.

OBJECTIVE: To evaluate modern surgical outcomes in patients with stable heart failure undergoing elective major noncardiac surgery and to compare the experience of patients with heart failure who have reduced vs preserved left ventricular ejection fraction (EF). PATIENTS AND METHODS: We retrospectively studied 557 consecutive patients with heart failure (192 EF £40% and 365 EF >40%) and 10,583 controls who underwent systematic evaluation by hospitalists in a preoperative clinic before having major elective noncardiac surgery between January 1, 2003, and March 31, 2006. We examined outcomes in the entire cohort and in propensity-matched case-control groups. RESULTS: Unadjusted 1-month postoperative mortality in patients with both types of heart failure vs controls was 1.3% vs 0.4% (P=.009), but this difference was not significant in propensity-matched groups (P=.09). Unadjusted differences in mean hospital length of stay among heart failure patients vs controls (5.7 vs 4.3 days; P<.001) and 1-month readmission (17.8% vs 8.5%; P<.001) were also markedly attenuated in propensity-matched groups. Crude 1-year hazard ratios for mortality were 1.71 (95% confidence interval [CI], 1.5-2.0) for both types of heart failure, 2.1 (95% CI, 1.7-2.6) in patients with heart failure who had EF £40%, and 1.4 (95% CI, 1.2-1.8) in those who had EF >40% (P<.01 for all 3 comparisons); however, the differences were not significant in propensity-matched groups (P=.43). CONCLUSION: Patients with clinically stable heart failure did not have high perioperative mortality rates in association with elective major noncardiac surgery, but they were more likely than patients without heart failure to have longer hospital stays, were more likely to require hospital readmission, and had a substantial long-term mortality rate. [ABSTRACT FROM AUTHOR]

Background: Discharge planning is a routine feature of health systems in many countries. The aim of discharge planning is to reduce hospital length of stay and unplanned readmission to hospital, and improve the co-ordination of services following discharge from hospital., Objectives: To determine the effectiveness of planning the discharge of patients moving from hospital., Search Strategy: We updated the review using the Cochrane EPOC Group Trials Register, MEDLINE, EMBASE and the Social Science Citation Index (last searched in March 2009)., Selection Criteria: Randomised controlled trials (RCTs) that compared an individualised discharge plan with routine discharge care that was not tailored to the individual patient. Participants were hospital inpatients., Data Collection and Analysis: Two authors independently undertook data analysis and quality assessment using a predesigned data extraction sheet. Studies are grouped according to patient group (elderly medical patients, surgical patients and those with a mix of conditions) and by outcome., Main Results: Twenty-one RCTs (7234 patients) are included; ten of these were identified in this update. Fourteen trials recruited patients with a medical condition (4509 patients), four recruited patients with a mix of medical and surgical conditions (2225 patients), one recruited patients from a psychiatric hospital (343 patients), one from both a psychiatric hospital and from a general hospital (97 patients), and the final trial recruited patients admitted to hospital following a fall (60 patients). Hospital length of stay and readmissions to hospital were significantly reduced for patients allocated to discharge planning (mean difference length of stay -0.91, 95% CI -1.55 to -0.27, 10 trials; readmission rates RR 0.85, 95% CI 0.74 to 0.97, 11 trials). For elderly patients with a medical condition (usually heart failure) there was insufficient evidence for a difference in mortality (RR 1.04, 95% CI 0.74 to 1.46, four trials) or being discharged from hospital to home (RR 1.03, 95% CI 0.93 to 1.14, two trials). This was also the case for trials recruiting patients recovering from surgery and a mix of medical and surgical conditions. In three trials patients allocated to discharge planning reported increased satisfaction. There was little evidence on overall healthcare costs., Authors' Conclusions: The evidence suggests that a structured discharge plan tailored to the individual patient probably brings about small reductions in hospital length of stay and readmission rates for older people admitted to hospital with a medical condition. The impact of discharge planning on mortality, health outcomes and cost remains uncertain.

Background: Although statins reduce the risk of cardiovascular events, concerns about adverse effects may deter physicians from prescribing these agents. We performed a systematic overview of randomized statin trials to quantify the risks of musculoskeletal, renal, and hepatic complications associated with therapy., Methods and Results: Major statin trials were identified by electronic search of the MEDLINE database from 1966 to December 2005. We included English language reports of adults with documented hyperlipidemia; double-blind, random allocation of > or = 100 patients to statin monotherapy versus placebo; and reports of myalgia, creatine kinase elevations, rhabdomyolysis, transaminase elevations, and discontinuation due to adverse events. Among 74,102 subjects enrolled in 35 trials (follow-up range, 1 to 65 months), statin therapy (excluding cerivastatin) did not result in significant absolute increases in risks of myalgias (risk difference/1000 patients [RD], 2.7; 95% CI, -3.2 to 8.7), creatine kinase elevations (RD, 0.2; 95% CI, -0.6 to 0.9), rhabdomyolysis (RD, 0.4; 95% CI, -0.1 to 0.9), or discontinuation due to any adverse event (RD, -0.5; 95% CI, -4.3 to 3.3). The absolute risk of transaminase elevations was significantly higher with statin therapy (RD, 4.2; 95% CI, 1.5 to 6.9)., Conclusions: On the basis of data available from published clinical trials, statin therapy is associated with a small excess risk of transaminase elevations, but not of myalgias, creatine kinase elevations, rhabdomyolysis, or withdrawal of therapy compared with placebo. Further study is necessary to determine whether the results from these published clinical trials are similar to what occurs in routine practice, particularly among patients who are older, have more severe comorbid conditions, or receive higher statin doses than most patients in these clinical trials.

Background: Disease management has shown great promise as a means of reorganizing chronic care and optimizing patient outcomes. Nevertheless, disease management programs are widely heterogeneous and lack a shared definition of disease management, which limits our ability to compare and evaluate different programs. To address this problem, the American Heart Association's Disease Management Taxonomy Writing Group developed a system of classification that can be used both to categorize and compare disease management programs and to inform efforts to identify specific factors associated with effectiveness., Methods: The AHA Writing Group began with a conceptual model of disease management and its components and subsequently validated this model over a wide range of disease management programs. A systematic MEDLINE search was performed on the terms heart failure, diabetes, and depression, together with disease management, case management, and care management. The search encompassed articles published in English between 1987 and 2005. We then selected studies that incorporated (1) interventions designed to improve outcomes and/or reduce medical resource utilization in patients with heart failure, diabetes, or depression and (2) clearly defined protocols with at least 2 prespecified components traditionally associated with disease management. We analyzed the study protocols and used qualitative research methods to develop a disease management taxonomy with our conceptual model as the organizing framework., Results: The final taxonomy includes the following 8 domains: (1) Patient population is characterized by risk status, demographic profile, and level of comorbidity. (2) Intervention recipient describes the primary targets of disease management intervention and includes patients and caregivers, physicians and allied healthcare providers, and healthcare delivery systems. (3) Intervention content delineates individual components, such as patient education, medication management, peer support, or some form of postacute care, that are included in disease management. (4) Delivery personnel describes the network of healthcare providers involved in the delivery of disease management interventions, including nurses, case managers, physicians, pharmacists, case workers, dietitians, physical therapists, psychologists, and information systems specialists. (5) Method of communication identifies a broad range of disease management delivery systems that may include in-person visitation, audiovisual information packets, and some form of electronic or telecommunication technology. (6) Intensity and complexity distinguish between the frequency and duration of exposure, as well as the mix of program components, with respect to the target for disease management. (7) Environment defines the context in which disease management interventions are typically delivered and includes inpatient or hospital-affiliated outpatient programs, community or home-based programs, or some combination of these factors. (8) Clinical outcomes include traditional, frequently assessed primary and secondary outcomes, as well as patient-centered measures, such as adherence to medication, self-management, and caregiver burden., Conclusions: This statement presents a taxonomy for disease management that describes critical program attributes and allows for comparisons across interventions. Routine application of the taxonomy may facilitate better comparisons of structure, process, and outcome measures across a range of disease management programs and should promote uniformity in the design and conduct of studies that seek to validate disease management strategies.