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London Archaeologist, 13 (5), 133-139

Background— Accumulated data suggest that low-dose aspirin after myocardial infarction (MI) may offer similar efficacy to higher dose aspirin with reduced risk of bleeding. Few data are available on contemporary aspirin dosing patterns after MI in the United States Methods and Results— Aspirin dosing from 221 199 patients with MI (40.2% ST-segment–elevation MI) from 525 US hospitals enrolled in the National Cardiovascular Data Registry’s (NCDR’s) Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines were described, overall and in clinically relevant subgroups. High-dose aspirin was defined as 325 mg and low dose as 81 mg. Between January 2007 and March 2011, 60.9% of patients with acute MI were discharged on high-dose aspirin, 35.6% on low-dose aspirin, and 3.5% on other doses. High-dose aspirin was prescribed at discharge to 73.0% of patients treated with percutaneous coronary intervention and 44.6% of patients managed medically. Among 9075 patients discharged on aspirin, thienopyridine, and warfarin, 44.0% were prescribed high-dose aspirin. Patients with an in-hospital major bleeding event were also frequently discharged on high-dose aspirin (56.7%). A 25-fold variation in the proportion prescribed high-dose aspirin at discharge was observed across participating centers. Conclusions— Most US patients with MI continue to be discharged on high-dose aspirin. Although aspirin dosing after percutaneous coronary intervention largely reflected prevailing guidelines before 2012, high-dose aspirin was prescribed with similar frequency in medically managed patients and to those in categories expected to be at high risk for bleeding. Wide variability in the proportional use of high-dose aspirin across centers suggests significant influence from local practice habits and uncertainty about appropriate aspirin dosing.

A cryogenically pumped, windowless gas target has been used to study the radiative alpha-capture reaction on 16O and 12C targets, giving information on the electromagnetic decay properties of various unbound states in 20Ne and 16O. Several states in 20Ne have been observed in this reaction for the first time. The first five unit-isospin, natural parity states in 20Ne have been observed. The isospin assignment of the 11.27 MeV (1-)) state has been made definite by the observation of a strong Ml decay to the 8.85 MeV (1-)state, and the analogue of the 1.97 MeV state in 20F has been identified with the 20Ne state at 12.25 MeV. Angular distribution measurements have shown the spin of this state to be 3-), and the total width has been shown to be less than 1 keV, contradicting previous reports. The 12.22 MeV (2+)state has been resolved clearly as an individual resonance for the first time. The electromagnetic transition rates for the lower T=l states in 20Ne are compared with shell model calculations. Five zero-isospin capture resonances in 20Ne have been studied, the gamma-decay of the 8.70 MeV (1-), 9.11 MeV (3-) and 11.92 MeV (4+) states being observed for the first time. A remeasurement has been made of the enhanced E2 decay strength of the 8+ member of the ground state rotational band, giving ω=l31 ±18 meV, in agreement with a previous less accurate value. This result is compared with shell model calculations. A study of the capture reaction on 12C has been performed in the beam energy range 5.22 MeV < Eα < 9.53 MeV. No new capture resonances have been found but the known inelastic resonances have been seen. The 11.10 MeV (4+) state has been studied and the strength for the decay to the 6.13 MeV (3-) state has been shown to be only half of a previous result. The 12.05 MeV (0+) state has not been observed, but a limit has been placed on its strength.

Introduction: The United Kingdom (U.K.) is working to develop the world’s leading sports coaching system. However, women currently make up only 28% of the profession and very few reach senior levels. Little is known about why career pathways are gendered or how women coaches’ occupational experiences affect their health and well-being. Therefore, the aim of this study was to further understanding of the occupational health and well-being of female sports coaches and to investigate the facilitators of and barriers to their careers and life transitions.\ud Method: Following institutional ethical approval, women coaches (n = 162) based in the U.K. volunteered to take part. Each coach completed an online version of the Shortened Stress Evaluation Tool (ASSET; Cartwright & Cooper, 2002). This questionnaire is a valid and reliable measure of job characteristics, organisational commitment, health, and psychological well-being. Descriptive statistics were computed using a Statistical Package for the Social Sciences to provide a broad overview of the data.\ud Results: 97% of the sample categorised themselves as ‘White’, ‘White Irish’, or ‘White Other;’ that the number of respondents over the age of 55 (n = 6) was dramatically lower than the number of responses from younger coaches (n = 156); and that 67% of the sample was educated to undergraduate degree level or higher. Over half of the sample (53%) was employed as a head coach at the time of completion and 56% of these head coaches were employed on a part-time basis. When compared to the normative data for ASSET, our sample reported above average psychological well-being (M = 27.75, SD = 4.87), sense of purpose (M = 18.72, SD = 4.01), and engagement (M = 19.18, SD = 3.78), and reported less strain on their psychological health (M = 21.06, SD = 6.91). However, the results also demonstrate that the coaches experience poorer work-life balance (M = 13.33, SD = 5.35), job security (M = 14.20, SD = 5.39), and work relationships (M = 18.02, SD = 7.88) than the normative sample.\ud Conclusions: The findings suggest that, on average, our sample of women coaches are highly engaged with their role, feel a sense of purpose during their coaching practice, and are psychologically well. The results do, however, suggest that women coaches require better work-life balance, more job security, and more meaningful relationships with their colleagues. These findings provide insight to potential facilitators of and barriers to career progression for women coaches and offer interesting applied implications for national governing bodies (NGBs). In particular, NGBs should pay acute attention to interventions that support women coaches to connect with other coaches and effectively balance their personal and occupational commitments.

The QBC Star haematology system includes the QBC Star centrifugal analytical analyser and the QBC Star tube system. Together, they are capable of producing a haematology profile on venous or capillary whole blood. The aim of this study is to compare full blood count (FBC) including differential white cell count performance between the QBC Star analyser and a gold standard Sysmex XE-2100 haematology analyser. The FBC performance was evaluated according to the National Committee for Clinical Laboratory Standards (NCCLS) document H20-A. Imprecision, correlation and linearity studies all showed excellent results. Overall, the haemoglobin, haematocrit, white cell count (WCC) and platelet count parameters showed excellent correlation. Mean corpuscular haemoglobin concentration (MCHC) results showed poor comparability. The white cell differential parameters showed good correlation within certain clinically significant limits. Imprecision for haemoglobin, haematocrit, WCC, MCHC and platelet count was considered acceptable. The re-read function was found to be stable over the five-hour testing period under the authors' laboratory environmental conditions. The subjective assessment by biomedical scientist staff demonstrated that the system was user friendly, required little maintenance, and no user calibration was required. Staff considered the user manual to be excellent. Overall, the QBC Star appears to be an excellent point-of-care (POC) dry haematology analyser that delivers clinically significant nine-parameter complete blood count and will make a good POC analyser for use in field hospitals, research, screening programmes, GP surgeries as well as in emergency and intensive care units. It is a health and safety-friendly analyser considering the fact that it uses dry haematology reagents instead of the bulky wet reagents that are often associated with liquid biohazard waste.

The global prevalence of diabetes mellitus (DM) continues to climb, and is accompanied by an increase in DM associated complications, most often manifesting as coronary heart disease. Platelet dysfunction has been implicated as a central contributor to the increased risk of coronary artery disease in patients with DM, and it is not surprising that the anti-platelet agent, clopidogrel, has been shown to have efficacy in both short and long term outcomes in patients with acute coronary syndrome and those undergoing percutaneous coronary intervention. However, accumulating data suggest a clinically relevant sub-optimal clopidogrel response in some patients with DM. The exact mechanism of these observations is not yet fully understood, but appears to be related to reduced concentrations of circulating clopidogrel active metabolite, with less variability in pharmacodynamic and clinical response suggested by the evaluation of newer P2Y12 antagonists, such as prasugrel and ticagrelor. More research is needed to better understand both the pharmacology and clinical consequences of these observations.

A 65-year-old female with a history of bicuspid aortic valve s/p AVR with a Medtronic Hall mechanical valve presented with chest pain. Her recent history was notable for one week of intermittent substernal chest pain present when lying in the left lateral position. Initial ECG, obtained during an episode of chest pain, revealed 2 mm ST segment depression in the anterolateral leads and ST segment elevation in lead aVR. The ECG changes normalized with cessation of her chest pain. Laboratory evaluation showed an INR of 3.5 (on warfarin), and normal cardiac biomarkers. Chest imaging, including CT angiography, was unremarkable. Physical examination demonstrated a normal jugular venous pressure, a mechanical second heart sound, and a II/VI crescendo-decrescendo systolic murmur at the right upper sternal border. Transthoracic echocardiography (TTE) revealed normal biventricular systolic function and a mechanical valve in the aortic position, associated with mild aortic regurgitation. Valve fluoroscopy revealed an aortic monoleaflet mechanical prosthesis with normal opening and closing angles in the supine position, but with closing restriction when in the left lateral decubitus position (closing angle 46 degrees, associated with recurrent chest pain and ischemic ECG changes). Transesophageal echocardiography (TEE) showed moderate aortic stenosis, mild aortic regurgitation, and multiple linear echodensities on the aortic prosthesis. These echogenicities were felt to represent thrombi, and the patient was treated with 5 doses of tPA and intravenous heparin. Subsequent TEE and valve fluoroscopy revealed improved prosthetic leaflet motion in supine and lateral decubitus positions. This case describes an unusual presentation of mechanical aortic valve thrombosis. The contiguous association of the mechanical valve with the coronary ostia can contribute to ischemic complications, in this case positionally induced. It also highlights the value of timely valve fluoroscopy and the consideration of patient maneuvers to delineate valve function. Current guidelines support the use of thrombolytic therapy for small, left-sided thrombi, with recent literature suggesting that slowly infused low-dose tPA provides the optimal risk-benefit profile.

Importance The US Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program penalizes hospitals with higher-than-expected risk-adjusted 30-day readmission rates (excess readmission ratio [ERR] > 1) after acute myocardial infarction (MI). However, the association of ERR with MI care processes and outcomes are not well established. Objective To evaluate the association between ERR for MI with in-hospital process of care measures and 1-year clinical outcomes. Design, Setting, and Participants Observational analysis of hospitalized patients with MI from National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines centers subject to the first cycle of the Hospital Readmissions Reduction Program between July 1, 2008, and June 30, 2011. Exposures The ERR for MI (MI-ERR) in 2011. Main Outcomes and Measures Adherence to process of care measures during index hospitalization in the overall study population and risk of the composite outcome of mortality or all-cause readmission within 1 year of discharge and its individual components among participants with available Centers for Medicare and Medicaid Services–linked data. Results The median ages of patients in the MI-ERR greater than 1 and tertiles 1, 2, and 3 of the MI-ERR greater than 1 groups were 64, 63, 64, and 63 years, respectively. Among 380 hospitals that treated a total of 176 644 patients with MI during the study period, 43% had MI-ERR greater than 1. The proportions of patients of black race, those with heart failure signs at admission, and bleeding complications increased with higher MI-ERR. There was no significant association between adherence to MI performance measures and MI-ERR (adjusted odds ratio, 0.94; 95% CI, 0.81-1.08, per 0.1-unit increase in MI-ERR for overall defect-free care). Among the 51 453 patients with 1-year outcomes data available, higher MI-ERR was associated with higher adjusted risk of the composite outcome and all-cause readmission within 1 year of discharge. This association was largely driven by readmissions early after discharge and was not significant in landmark analyses beginning 30 days after discharge. The MI-ERR was not associated with risk for mortality within 1 year of discharge in the overall and 30-day landmark analyses. Conclusions and Relevance During the first cycle of the Hospital Readmissions Reduction Program, participating hospitals’ risk-adjusted 30-day readmission rates following MI were not associated with in-hospital quality of MI care or clinical outcomes occurring after the first 30 days after discharge.