Browsing by Subject "circulation"

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    Design and Rationale of the Fontan Udenafil Exercise Longitudinal (FUEL) Trial
    (Elsevier, 2018) Goldberg, David J.; Zak, Victor; Goldstein, Bryan H.; McCrindle, Brian W.; Menon, Shaji C.; Schumacher, Kurt R.; Payne, R. Mark; Rhodes, Jonathan; McHugh, Kimberly E.; Penny, Daniel J.; Trachtenberg, Felicia; Hamstra, Michelle S.; Richmond, Marc E.; Frommelt, Peter C.; Files, Matthew D.; Yeager, James L.; Pemberton, Victoria L.; Stylianou, Mario P.; Pearson, Gail D.; Paridon, Stephen M.; Pediatrics, School of Medicine
    The Fontan operation creates a circulation characterized by elevated central venous pressure and low cardiac output. Over time, these characteristics result in a predictable and persistent decline in exercise performance that is associated with an increase in morbidity and mortality. A medical therapy that targets the abnormalities of the Fontan circulation might, therefore, be associated with improved outcomes. Udenafil, a phosphodiesterase type 5 inhibitor, has undergone phase I/II testing in adolescents who have had the Fontan operation and has been shown to be safe and well tolerated in the short-term. However, there are no data regarding the long-term efficacy of udenafil in this population. The Fontan Udenafil Exercise Longitudinal (FUEL) Trial is a randomized, double blind, placebo controlled phase III clinical trial being conducted by the Pediatric Heart Network in collaboration with Mezzion Pharma Co., Ltd. This trial is designed to test the hypothesis that treatment with udenafil will lead to an improvement in exercise capacity in adolescents who have undergone the Fontan operation. A safety extension trial, the FUEL Open-Label Extension Trial (FUEL OLE), offers the opportunity for all FUEL subjects to obtain open-label udenafil for an additional 12 months following completion of FUEL, and evaluates the long-term safety and tolerability of this medication. This manuscript describes the rationale and study design for FUEL and FUEL OLE. Together, these trials provide an opportunity to better understand the role of medical management in the care of those who have undergone the Fontan operation.
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    Managing Employees in Interlibrary Loan, Circulation and Reserves: Supervision in a Production Environment
    (Haworth Press, 2007) Janke, Karen L.; Weible, Cherie' L.
    In a production environment, strategies for dealing with personnel problems are critical. Two of the most challenging staff problems that an interlibrary loan manager can confront are: (1) How to keep up with work when employees are absent and (2) Employee productivity problems. Interlibrary loan departments face the unique paradox of a workplace that is constantly changing and becoming more efficient due to the influence of technology on daily processes, yet still relies heavily on the daily labor and productivity of the staff. Additionally, interlibrary loan departments face almost constant time pressures, both from internal and external customers. The challenge is magnified when personnel issues arise, and the time needed to problem solve seems nonexistent. In particular, absenteeism and worker productivity can have disastrous results on interlibrary loan service quality, as well as a negative effect on departmental morale.