Use of cumulative mortality data in patients with acute myocardial infarction for early detection of variation in clinical practice: observational study

OBJECTIVES: Use of cumulative mortality adjusted for case mix in patients with acute myocardial infarction for early detection of variation in clinical practice. DESIGN: Observational study. SETTING: 20 hospitals across the former Yorkshire region. PARTICIPANTS: All 2153 consecutive patients with confirmed acute myocardial infarction identified during three months. MAIN OUTCOME MEASURES: Variable life­adjusted displays showing cumulative differences between observed and expected mortality of patients; expected mortality calculated from risk model based on admission characteristics of age, heart rate, and systolic blood pressure. RESULTS: The performance of two individual hospitals over three months was examined as an example. One, the smallest district hospital in the region, had a series of 30 consecutive patients but had five more deaths than predicted. The variable life­adjusted display showed minimal variation from that predicted for the first 15 patients followed by a run of unexpectedly high mortality. The second example was the main tertiary referral centre for the region, which admitted 188 consecutive patients. The display showed a period of apparently poor performance followed by substantial improvement, where the plot rose steadily from a cumulative net lives saved of - 4 to 7. These variations in patient outcome are unlikely to have been revealed during conventional audit practice. CONCLUSIONS: Variable life­adjusted display has been integrated into surgical care as a graphical display of risk­adjusted survival for individual surgeons or centres. In combination with a simple risk model, it may have a role in monitoring performance and outcome in patients with acute myocardial infarction

Diffusive limits on the Penrose tiling

In this paper random walks on the Penrose lattice are investigated. Heat kernel estimates and the invariance principle are shown

The use of admissions simulation to stabilize ancillary workloads

As part of the planning of a new hospital, an analysis was per formed to determine the number of procedures that would be performed in each of nineteen ancillary departments on a day of the week basis. Because the planned occupancy was not the maximum possible, attempts were made using simulation to smooth the daily ancillary loads by varying the admission day of elective, urgent inpatient and outpatient loads. The methodology, sample outputs, and main conclusions are presented.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69095/2/10.1177_003754978404300203.pd

An alternative approach to the construction of Schur-Weyl transform

We propose an alternative approach for the construction of the unitary matrix which performs generalized unitary rotations of the system consisting of independent identical subsystems (for example spin system). This matrix, when applied to the system, results in a change of degrees of freedom, uncovering the information hidden in non-local degrees of freedom. This information can be used, inter alia, to study the structure of entangled states, their classification and may be useful for construction of quantum algorithms.Comment: 6 page

The caloric and sugar content of beverages purchased at different store-types changed after the sugary drinks taxation in Mexico

Background: Following the 2014 sugary drinks tax implementation in Mexico, promising reduction in the volume of purchases of taxed beverages were observed overall and at different store-types. However, the tax's effects on purchasing patterns of calories and sugar remain unclear. Methods: Using longitudinal data from Mexican households (n = 7038), we examined changes in volume, calories and total sugar of packaged beverages purchased from 2012 to 2016 overall and by store-type. We used fixed effects models to estimate means for volume, calories, and sugar of households. To address the potential selectivity from households shopping at different stores, we calculated inverse probability weights to model the purchases changes over time by store-type. Results: For taxed beverages, the volume of purchases declined by-49 ml and-30 ml in the first year and second year post tax (2014 and 2015, respectively), while purchases leveled off in the third year of the tax (2016). Calories and sugar from taxed beverage purchases decreased over time, with the majority of the declines occurring in the first two years post-tax implementation. The volume of untaxed beverage purchases increased, whereas changes in calories and total sugar of untaxed beverages were minimal. Store level purchases of taxed beverages significantly decreased in the first two years post taxation (2014 and to 2015) only in supermarkets and traditional stores. The steepest declines in purchases of taxed beverages in 2014 were observed at supermarkets (-40 ml or-45%). The volume of purchases of untaxed beverages increased over time in almost all store-types, while calories and sugar minimally decreased over time. Conclusion: Although the Mexican tax on SSBs has lowered the purchases of sugary drinks 3 years after the tax implementation, the tax should be strengthened and store-specific interventions should be implemented to further reduce SSBs purchases in the Mexican population

Constraints on food choices of women in the UK with lower educational attainment

Constraints on food choices of women in the UK with lower educational attainmen

Photoionization of ultracold and Bose-Einstein condensed Rb atoms

Photoionization of a cold atomic sample offers intriguing possibilities to observe collective effects at extremely low temperatures. Irradiation of a rubidium condensate and of cold rubidium atoms within a magneto-optical trap with laser pulses ionizing through 1-photon and 2-photon absorption processes has been performed. Losses and modifications in the density profile of the remaining trapped cold cloud or the remaining condensate sample have been examined as function of the ionizing laser parameters. Ionization cross-sections were measured for atoms in a MOT, while in magnetic traps losses larger than those expected for ionization process were measured.Comment: 9 pages, 7 figure

The β3-integrin endothelial adhesome regulates microtubule-dependent cell migration

Integrin β3 is seen as a key anti-angiogenic target for cancer treatment due to its expression on neovasculature, but the role it plays in the process is complex; whether it is pro- or anti-angiogenic depends on the context in which it is expressed. To understand precisely β3's role in regulating integrin adhesion complexes in endothelial cells, we characterised, by mass spectrometry, the β3-dependent adhesome. We show that depletion of β3-integrin in this cell type leads to changes in microtubule behaviour that control cell migration. β3-integrin regulates microtubule stability in endothelial cells through Rcc2/Anxa2-driven control of active Rac1 localisation. Our findings reveal that angiogenic processes, both in vitro and in vivo, are more sensitive to microtubule targeting agents when β3-integrin levels are reduced

Standard reference sequences for submission of HLA genotyping for the 18th International HLA and Immunogenetics Workshop

The International human leukocyte antigen (HLA) and Immunogenetics Workshops (IHIWs) have fostered international collaborations of researchers and experts in the fields of HLA, histocompatibility and immunology. These IHIW collaborations have comprised many projects focused on achieving a variety of specific goals. The international and collaborative nature of these projects necessitates the collection and analysis of complex data generated in multiple laboratories, often using multiple methods of acquisition. Collection and storage of these data in a consistent way adds value to IHIW projects, which can be extended to future work. DNA-based genotyping data, especially HLA genotyping data, can be transmitted in the form of a Histoimmunogenetics Markup Language (HML) document. HML facilitates clear communication of a genotype and supporting metadata, such as, sequencing platform, laboratory assays, consensus sequence, and interpretation. Sequence information can be reported relative to known reference sequences, which add meaning and context to genotypes. Selecting the correct reference sequence for a given allele sequence is nuanced, and guidelines have emerged through collaborative community efforts such as Data Standards Hackathons. Here, we describe the guidelines established for the selection of reference sequences to be used in transmission of HLA (and MICA/MICB) genotyping data for the 18th IHIW.Transplantation and autoimmunit

Chaos in a double driven dissipative nonlinear oscillator

We propose an anharmonic oscillator driven by two periodic forces of different frequencies as a new time-dependent model for investigating quantum dissipative chaos. Our analysis is done in the frame of statistical ensemble of quantum trajectories in quantum state diffusion approach. Quantum dynamical manifestation of chaotic behavior, including the emergence of chaos, properties of strange attractors, and quantum entanglement are studied by numerical simulation of ensemble averaged Wigner function and von Neumann entropy.Comment: 9 pages, 18 figure