Equity of access to adult hospice inpatient care within north-west England.

There is a growing debate about the question of equity of access to hospice and palliative care services. Even countries with relatively well developed palliative care systems are considered to have problems of access and inequity of provision. Despite these concerns, we still lack a relevant evidence base to serve as a guide to action. We present an analysis of access to adult hospice inpatient provision in the north-west region of England that employs Geographical Information Systems (GIS). Measures of the possible demand for, and supply of, hospice inpatient services are used to determine the potential accessibility of cancer patients, assessed at the level of small areas (electoral wards). Further, the use of deprivation scores permits an analysis of the equity of access to adult inpatient hospice care, leading to the identification of areas where additional service provision may be warranted. Our research is subject to a number of caveats�it is limited to inpatient hospice provision and does not include other kinds of inpatient and community-based palliative care services. Likewise, we recognise that not everyone with cancer will require palliative care and also that palliative care needs exist among those with nonmalignant conditions. Nevertheless, our methodology is one that can also be applied more generally

Laser anemometer measurements in a transonic axial-flow fan rotor

Laser anemometer surveys were made of the 3-D flow field in NASA rotor 67, a low aspect ratio transonic axial-flow fan rotor. The test rotor has a tip relative Mach number of 1.38. The flowfield was surveyed at design speed at near peak efficiency and near stall operating conditions. Data is presented in the form of relative Mach number and relative flow angle distributions on surfaces of revolution at nine spanwise locations evenly spaced from hub to tip. At each spanwise location, data was acquired upstream, within, and downstream of the rotor. Aerodynamic performance measurements and detailed rotor blade and annulus geometry are also presented so that the experimental results can be used as a test case for 3-D turbomachinery flow analysis codes

Inpatient urine cultures are frequently performed without urinalysis or microscopy: Findings from a large academic medical center

OBJECTIVETo describe the frequency of urine cultures performed in inpatients without additional testing for pyuriaDESIGNRetrospective cohort studySETTINGA 1,250-bed academic tertiary referral centerPATIENTSHospitalized adultsMETHODSThis study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital’s medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as “isolated.” The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures.RESULTSDuring the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11–1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89–2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47–2.00; surgical ICU aOR, 1.82; 95% CI, 1.51–2.19), and obtaining the urine culture ≥1 calendar day after admission (1–7 days aOR, 1.91; 95% CI. 1.71–2.12; &gt;7 days after admission aOR, 2.81; 95% CI, 2.37–3.34).CONCLUSIONSIsolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections.Infect Control Hosp Epidemiol2017;38:455–460</jats:sec

Combinatorial mappings of exclusion processes

We review various combinatorial interpretations and mappings of stationary-state probabilities of the totally asymmetric, partially asymmetric and symmetric simple exclusion processes (TASEP, PASEP, SSEP respectively). In these steady states, the statistical weight of a configuration is determined from a matrix product, which can be written explicitly in terms of generalised ladder operators. This lends a natural association to the enumeration of random walks with certain properties. Specifically, there is a one-to-many mapping of steady-state configurations to a larger state space of discrete paths, which themselves map to an even larger state space of number permutations. It is often the case that the configuration weights in the extended space are of a relatively simple form (e.g., a Boltzmann-like distribution). Meanwhile, various physical properties of the nonequilibrium steady state - such as the entropy - can be interpreted in terms of how this larger state space has been partitioned. These mappings sometimes allow physical results to be derived very simply, and conversely the physical approach allows some new combinatorial problems to be solved. This work brings together results and observations scattered in the combinatorics and statistical physics literature, and also presents new results. The review is pitched at statistical physicists who, though not professional combinatorialists, are competent and enthusiastic amateurs.Comment: 56 pages, 21 figure

Resistance to Wheat streak mosaic virus generated by expression of an artificial polycistronic microRNA in wheat

Wheat streak mosaic virus (WSMV) is a persistent threat to wheat production, necessitating novel approaches for protection. We developed an artificial miRNA strategy against WSMV, incorporating five amiRNAs within one polycistronic amiRNA precursor. Using miRNA sequence and folding rules, we chose five amiRNAs targeting conserved regions of WSMV but avoiding off-targets in wheat. These replaced the natural miRNA in each of five arms of the polycistronic rice miR395, producing amiRNA precursor, FanGuard (FGmiR395), which was transformed into wheat behind a constitutive promoter. Splinted ligation detected all five amiRNAs being processed in transgenic leaves. Resistance was assessed over two generations. Three types of response were observed in T 1 plants of different transgenic families: completely immune; initially resistant with resistance breaking down over time; and initially susceptible followed by plant recovery. Deep sequencing of small RNAs from inoculated leaves allowed the virus sequence to be assembled from an immune transgenic, susceptible transgenic, and susceptible non-transgenic plant; the amiRNA targets were fully conserved in all three isolates, indicating virus replication on some transgenics was not a result of mutational escape by the virus. For resistant families, the resistance segregated with the transgene. Analysis in the T 2 generation confirmed the inheritance of immunity and gave further insights into the other phenotypes. Stable resistant lines developed no symptoms and no virus by ELISA; this resistance was classified as immunity when extracts failed to transmit from inoculated leaves to test plants. This study demonstrates the utility of a polycistronic amiRNA strategy in wheat against WSMV

Modelling plausible scenarios for the Omicron SARS-CoV-2 variant from early-stage surveillance

In this paper we used an adapted version of an existing simulation model of SARS-CoV-2 transmission in Scotland to investigate the rise of the Omicron variant of concern, in order to evaluate plausible scenarios for transmission advantage and vaccine immune escape relative to the Delta variant. We also explored possible outcomes of different levels of imposed non-pharmaceutical intervention. The initial results of these scenarios were used to inform the Scottish Government in the early outbreak stages of the Omicron variant. We use an explicitly spatial agent-based simulation model combined with spatially fine-grained COVID-19 observation data from Public Health Scotland. Using the model with parameters fit over the Delta variant epidemic, some initial assumptions about Omicron transmission advantage and vaccine escape, and a simple growth rate fitting procedure, we were able to capture the initial outbreak dynamics for Omicron. We also find the modelled dynamics hold up to retrospective scrutiny. We found that the modelled imposition of extra non-pharmaceutical interventions planned by the Scottish Government at the time would likely have little effect in light of the transmission advantage held by the Omicron variant and the fact that the planned interventions would have occurred too late in the outbreak's trajectory. Finally, we found that any assumptions made about the projected distribution of vaccines in the model population had little bearing on the outcome, in terms of outbreak size and timing, rather that the detailed landscape of immunity prior to the outbreak was of far greater importance

Vertical movements of shortfin mako sharks Isurus oxyrinchus in the western North Atlantic Ocean are strongly influenced by temperature

Although shortfin mako sharks Isurus oxyrinchus are regularly encountered in pelagic fisheries, limited information is available on their vertical distribution and is primarily restricted to cooler areas of their geographic range. We investigated the vertical movements of mako sharks across differing temperature regimes within the western North Atlantic by tagging 8 individuals with pop-up satellite archival tags off the northeastern United States and the Yucatan Peninsula, Mexico. Depth and temperature records across 587 d showed vertical movements strongly associated with ocean temperature. Temperatures150 m compared to only 1% in the coldest water columns. The sharks showed diel diving behavior, with deeper dives occurring primarily during the daytime (maximum depth: 866 m). Overall, sharks experienced temperatures between 5.2 and 31.1°C. When the opportunity was available, sharks spent considerable time in waters ranging from 22 to 27°C, indicating underestimation of the previously reported upper limit of the mako sharks’ preferred temperature. The preference for higher temperatures does not support endothermy as an adaption for niche expansion in mako sharks. The strong influence of thermal habitat on movement behavior suggests potentially strong impacts of rising ocean temperatures on the ecology of this highly migratory top predator

Experimental and computational investigation of the NASA low-speed centrifugal compressor flow field

An experimental and computational investigation of the NASA Lewis Research Center's low-speed centrifugal compressor (LSCC) flow field was conducted using laser anemometry and Dawes' three-dimensional viscous code. The experimental configuration consisted of a backswept impeller followed by a vaneless diffuser. Measurements of the three-dimensional velocity field were acquired at several measurement planes through the compressor. The measurements describe both the throughflow and secondary velocity field along each measurement plane. In several cases the measurements provide details of the flow within the blade boundary layers. Insight into the complex flow physics within centrifugal compressors is provided by the computational fluid dynamics analysis (CFD), and assessment of the CFD predictions is provided by comparison with the measurements. Five-hole probe and hot-wire surveys at the inlet and exit to the impeller as well as surface flow visualization along the impeller blade surfaces provided independent confirmation of the laser measurement technique. The results clearly document the development of the throughflow velocity wake that is characteristic of unshrouded centrifugal compressors