Threats to safe transitions from hospital to home: a consensus study in North West London primary care.

BACKGROUND: Transitions between healthcare settings are vulnerable points for patients. AIM: To identify key threats to safe patient transitions from hospital to primary care settings. DESIGN AND SETTING: Three-round web-based Delphi consensus process among clinical and non-clinical staff from 39 primary care practices in North West London, England. METHOD: Round 1 was a free-text idea-generating round. Rounds 2 and 3 were consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1-3: 'not important', 4-6: 'somewhat important', 7-9: 'very important'). Percentage of votes cast for each patient or medication group were recorded; consensus was defined as ≥75%. RESULTS: A total of 39 practices completed round 1, 36/39 (92%) completed round 2, and 30/36 (83%) completed round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision, and patients who were most at risk. 'Poor quality of handover instructions from secondary to primary care teams' achieved the highest rating (mean rating at round 3 = 8.43) and a 100% consensus that it was a 'very important' threat. Older individuals (97%) and patients with complex medical problems taking >5 medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients. CONCLUSION: This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work would need to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise

The factorisation of glue and mass terms in SU(N) gauge theories

In this paper we investigate the structure of the glue in Zwanziger's gauge invariant expansion for the A^2-type mass term in Yang-Mills theory. We show how to derive this expansion, in terms of the inverse covariant Laplacian, and extend it to higher orders. In particular, we give an explicit expression, for the first time, for the next to next to leading order term. We further show that the expansion is not unique and give examples of the resulting ambiguity.Comment: 22 page

Asymptotic Dynamics in Quantum Field Theory

A crucial element of scattering theory and the LSZ reduction formula is the assumption that the coupling vanishes at large times. This is known not to hold for the theories of the Standard Model and in general such asymptotic dynamics is not well understood. We give a description of asymptotic dynamics in field theories which incorporates the important features of weak convergence and physical boundary conditions. Applications to theories with three and four point interactions are presented and the results are shown to be completely consistent with the results of perturbation theory.Comment: 18 pages, 3 figure

Population dynamics and adaptive strategies of Martiodrilus carimaguensis (Oligochaeta, Glossoscolecidae), a native species from the well-drained savannas of Colombia

23 páginas, 5 figuras, 2 tablas.Martiodrilus carimaguensis (Oligochaeta, Glossoscolecidae) is a large, anecic native earthworm species which was found in natural and disturbed savannas in the Oxisols of the Colombian Llanos. Its population dynamics were studied in a native savanna, and in a 17 years old grazed grass-legume pasture where density and biomass were higher. Monthly cast deposition on the soil surface in the improved pasture was 38.4×103 fresh casts ha−1, eleven times more than in the native savanna. A strong relationship was found between numbers of M. carimaguensis and numbers of fresh surface casts. Different patterns of adaptation to the dry season were observed for adults and juveniles. Adults are active for eight months whereas juveniles enter diapause 3–4 months earlier. The vertical distribution pattern of the earthworm population also shows marked seasonal changes.This work is funded by a research grant from the Macrofauna project (STD3 EC Program) for which we are greatly indebted. We also wish to thank CIAT (International Center for Tropical Agriculture), especially the Tropical Lowlands Program for human and technical support, and for scientific discussions on this study. Our deepest gratitude is expressed to all the people at Carimagua station, and especially to field workers, for their invaluable help.Peer reviewe

Wilson Loop and the Treatment of Axial Gauge Poles

We consider the question of gauge invariance of the Wilson loop in the light of a new treatment of axial gauge propagator proposed recently based on a finite field-dependent BRS (FFBRS) transformation. We remark that as under the FFBRS transformation the vacuum expectation value of a gauge invariant observable remains unchanged, our prescription automatically satisfies the Wilson loop criterion. Further, we give an argument for {\it direct} verification of the invariance of Wilson loop to O(g^4) using the earlier work by Cheng and Tsai. We also note that our prescription preserves the thermal Wilson loop to O(g^2).Comment: 8 pages, LaTex; some typos related to equation (18) correcte

Symmetry breaking, conformal geometry and gauge invariance

When the electroweak action is rewritten in terms of SU(2) gauge invariant variables, the Higgs can be interpreted as a conformal metric factor. We show that asymptotic flatness of the metric is required to avoid a Gribov problem: without it, the new variables fail to be nonperturbatively gauge invariant. We also clarify the relations between this approach and unitary gauge fixing, and the existence of similar transformations in other gauge theories.Comment: 11 pages. Version 2: typos corrected, discussion of Elitzur's theorem added. Version to appear in J.Phys.

Charges in Gauge Theories

In this article we investigate charged particles in gauge theories. After reviewing the physical and theoretical problems, a method to construct charged particles is presented. Explicit solutions are found in the Abelian theory and a physical interpretation is given. These solutions and our interpretation of these variables as the true degrees of freedom for charged particles, are then tested in the perturbative domain and are demonstrated to yield infra-red finite, on-shell Green's functions at all orders of perturbation theory. The extension to collinear divergences is studied and it is shown that this method applies to the case of massless charged particles. The application of these constructions to the charged sectors of the standard model is reviewed and we conclude with a discussion of the successes achieved so far in this programme and a list of open questions.Comment: 47 pages, LaTeX, 14 figures, uses feynmp, necessary Metapost files included. Review to appear in Pramana, Journal of Physics. Minor LaTeX change to make page numbers visible on "Letter" paper forma

New Gauge Invariant Formulation of the Chern-Simons Gauge Theory

A new gauge invariant formulation of the relativistic scalar field interacting with Chern-Simons gauge fields is considered. This formulation is consistent with the gauge fixed formulation. Furthermore we find that canonical (Noether) Poincar\'e generators are not gauge invariant even on the constraints surface and do not satisfy the (classical) Poincar\'e algebra. It is the improved generators, constructed from the symmetric energy-momentum tensor, which are (manifestly) gauge invariant and obey the classical Poincar\'e algebra.Comment: Shortened, to appear as Papid Communication-PRD/Nov/9

Are lower rates of surgery amongst older women with breast cancer in the UK explained by co-morbidity?

Background: Around 60% of women greater than or equal to 80 years old, in the UK do not have surgery for their breast cancer (vs<10% of younger age groups). The extent to which this difference can be accounted for by co-morbidity has not been established. Methods: A Cancer Registry/Hospital Episode Statistics-linked data set identified women aged greater than or equal to 65 years diagnosed with invasive breast cancer (between 1 April 1997 and 31 March 2005) in two regions of the UK (n=23 038). Receipt of surgery by age was investigated using logistic regression, adjusting for co-morbidity and other patient, tumour and treatment factors. Results: Overall, 72% of older women received surgery, varying from 86% of 65–69-year olds to 34% of women aged greater than or equal to 85 years. The proportion receiving surgery fell with increasing co-morbidity (Charlson score 0=73%, score 1=66%, score 2+=49%). However, after adjustment for co-morbidity, older age still predicts lack of surgery. Compared with 65–69-year olds, the odds of surgery decreased from 0.74 (95% CI: 0.66–0.83) for 70–74-year olds to 0.13 (95% CI: 0.11–0.14) for women aged greater than or equal to 85 years. Conclusion: Although co-morbidity is associated with a reduced likelihood of surgery, it does not explain the shortfall in surgery amongst older women in the UK. Routine data on co-morbidity enables fairer comparison of treatment across population groups but needs to be more complete