A Systems Thinking Approach to Redesigning the Patient Experience to Reduce 30 Day Hospital Readmission

INTRODUCTION The cost of medical care is spiraling out of control, and one of the many reasons is lack of preventative care, poor communication to the patient and primary caregiver(s) both in an inpatient and outpatient setting. There are potentially many reasons for this cost escalation, one of the drivers of this cost is 30 day readmission after a hospitalization and this is what was examined in this analysis. The purpose of this paper in particular is to share what has been learned using a systems thinking approach to hospital readmissions and the patient experience. It is critical to understand the problems that occurred in the past. In addition, we will explain the methodology utilized and bring awareness to the iterative process. We will also demonstrate a suggested redesigned model

Diffusion of e-health innovations in 'post-conflict' settings: a qualitative study on the personal experiences of health workers.

BACKGROUND: Technological innovations have the potential to strengthen human resources for health and improve access and quality of care in challenging 'post-conflict' contexts. However, analyses on the adoption of technology for health (that is, 'e-health') and whether and how e-health can strengthen a health workforce in these settings have been limited so far. This study explores the personal experiences of health workers using e-health innovations in selected post-conflict situations. METHODS: This study had a cross-sectional qualitative design. Telephone interviews were conducted with 12 health workers, from a variety of cadres and stages in their careers, from four post-conflict settings (Liberia, West Bank and Gaza, Sierra Leone and Somaliland) in 2012. Everett Roger's diffusion of innovation-decision model (that is, knowledge, persuasion, decision, implementation, contemplation) guided the thematic analysis. RESULTS: All health workers interviewed held positive perceptions of e-health, related to their beliefs that e-health can help them to access information and communicate with other health workers. However, understanding of the scope of e-health was generally limited, and often based on innovations that health workers have been introduced through by their international partners. Health workers reported a range of engagement with e-health innovations, mostly for communication (for example, email) and educational purposes (for example, online learning platforms). Poor, unreliable and unaffordable Internet was a commonly mentioned barrier to e-health use. Scaling-up existing e-health partnerships and innovations were suggested starting points to increase e-health innovation dissemination. CONCLUSIONS: Results from this study showed ICT based e-health innovations can relieve information and communication needs of health workers in post-conflict settings. However, more efforts and investments, preferably driven by healthcare workers within the post-conflict context, are needed to make e-health more widespread and sustainable. Increased awareness is necessary among health professionals, even among current e-health users, and physical and financial access barriers need to be addressed. Future e-health initiatives are likely to increase their impact if based on perceived health information needs of intended users

Gipc3 mutations associated with audiogenic seizures and sensorineural hearing loss in mouse and human

Sensorineural hearing loss affects the quality of life and communication of millions of people, but the underlying molecular mechanisms remain elusive. Here, we identify mutations in Gipc3 underlying progressive sensorineural hearing loss (age-related hearing loss 5, ahl5) and audiogenic seizures (juvenile audiogenic monogenic seizure 1, jams1) in mice and autosomal recessive deafness DFNB15 and DFNB95 in humans. Gipc3 localizes to inner ear sensory hair cells and spiral ganglion. A missense mutation in the PDZ domain has an attenuating effect on mechanotransduction and the acquisition of mature inner hair cell potassium currents. Magnitude and temporal progression of wave I amplitude of afferent neurons correlate with susceptibility and resistance to audiogenic seizures. The Gipc3343A allele disrupts the structure of the stereocilia bundle and affects long-term function of auditory hair cells and spiral ganglion neurons. Our study suggests a pivotal role of Gipc3 in acoustic signal acquisition and propagation in cochlear hair cells

Thermally stable single atom Pt/m-Al2O3 for selective hydrogenation and CO oxidation

Single-atom metal catalysts offer a promising way to utilize precious noble metal elements more effectively, provided that they are catalytically active and sufficiently stable. Herein, we report a synthetic strategy for Pt single-atom catalysts with outstanding stability in several reactions under demanding conditions. The Pt atoms are firmly anchored in the internal surface of mesoporous Al2O3, likely stabilized by coordinatively unsaturated pentahedral Al3+ centres. The catalyst keeps its structural integrity and excellent performance for the selective hydrogenation of 1,3-butadiene after exposure to a reductive atmosphere at 200 °C for 24 h. Compared to commercial Pt nanoparticle catalyst on Al2O3 and control samples, this system exhibits significantly enhanced stability and performance for n-hexane hydro-reforming at 550 °C for 48 h, although agglomeration of Pt single-atoms into clusters is observed after reaction. In CO oxidation, the Pt single-atom identity was fully maintained after 60 cycles between 100 and 400 °C over a one-month period

Generation of subnanometric platinum with high stability during transformation of a 2D zeolite into 3D

[EN] Single metal atoms and metal clusters have attracted much attention thanks to their advantageous capabilities as heterogeneous catalysts. However, the generation of stable single atoms and clusters on a solid support is still challenging. Herein, we report a new strategy for the generation of single Pt atoms and Pt clusters with exceptionally high thermal stability, formed within purely siliceous MCM-22 during the growth of a two-dimensional zeolite into three dimensions. These subnanometric Pt species are stabilized by MCM-22, even after treatment in air up to 540 degrees C. Furthermore, these stable Pt species confined within internal framework cavities show size-selective catalysis for the hydrogenation of alkenes. High-temperature oxidation-reduction treatments result in the growth of encapsulated Pt species to small nanoparticles in the approximate size range of 1 to 2 nm. The stability and catalytic activity of encapsulated Pt species is also reflected in the dehydrogenation of propane to propylene.This work was funded by the Spanish Government (Consolider Ingenio 2010-MULTICAT (CSD2009-00050) and MAT2014-52085-C2-1-P) and by the Generalitat Valenciana (Prometeo). The Severo Ochoa Program (SEV-2012-0267) is gratefully acknowledged. L.L. thanks ITQ for a contract. The authors also thank the Microscopy Service of UPV for the TEM and STEM measurements. The HAADF-HRSTEM works were conducted in the Laboratorio de Microscopias Avanzadas (LMA) at the Instituto de Nanociencia de Aragon (INA)-Universidad de Zaragoza (Spain), a Spanish ICTS National Facility. Some of the research leading to these results has received funding from the European Union Seventh Framework Program under Grant Agreement 312483-ESTEEM2 (Integrated Infrastructure Initiative-I3). R.A. also acknowledges funding from the Spanish Ministerio de Economia y Competitividad (FIS2013-46159-C3-3-P) and the European Union Horizon 2020 research and innovation programme under the Marie Sldodowska-Curie grant agreement No. 642742.Liu, L.; Díaz Morales, UM.; Arenal, R.; Agostini, G.; Concepción Heydorn, P.; Corma Canós, A. (2017). Generation of subnanometric platinum with high stability during transformation of a 2D zeolite into 3D. Nature Materials. 16(1):132-138. https://doi.org/10.1038/NMAT4757S132138161Boronat, M., Leyva-Perez, A. & Corma, A. Theoretical and experimental insights into the origin of the catalytic activity of subnanometric gold clusters: attempts to predict reactivity with clusters and nanoparticles of gold. Acc. Chem. Res. 47, 834–844 (2014).Flytzani-Stephanopoulos, M. & Gates, B. C. Atomically dispersed supported metal catalysts. Ann. Rev. Chem. Bio. Eng. 3, 545–574 (2012).Gates, B. C. Supported metal clusters: synthesis, structure, and catalysis. Chem. Rev. 95, 511–522 (1995).Corma, A. et al. Exceptional oxidation activity with size-controlled supported gold clusters of low atomicity. Nat. Chem. 5, 775–781 (2013).Yang, M. et al. Catalytically active Au-O(OH)x-species stabilized by alkali ions on zeolites and mesoporous oxides. Science 346, 1498–1501 (2014).Rivallan, M. et al. Platinum sintering on H-ZSM-5 followed by chemometrics of CO adsorption and 2D pressure-jump IR spectroscopy of adsorbed species. Angew. Chem. Int. Ed. 49, 785–789 (2010).Zecevic, J., van der Eerden, A. M., Friedrich, H., de Jongh, P. E. & de Jong, K. P. Heterogeneities of the nanostructure of platinum/zeolite Y catalysts revealed by electron tomography. ACS Nano 7, 3698–3705 (2013).Philippaerts, A. et al. Unprecedented shape selectivity in hydrogenation of triacylglycerol molecules with Pt/ZSM-5 zeolite. Angew. Chem. Int. Ed. 50, 3947–3949 (2011).Kim, J., Kim, W., Seo, Y., Kim, J.-C. & Ryoo, R. n-Heptane hydroisomerization over Pt/MFI zeolite nanosheets: effects of zeolite crystal thickness and platinum location. J. Catalys. 301, 187–197 (2013).Goel, S., Wu, Z., Zones, S. I. & Iglesia, E. Synthesis and catalytic properties of metal clusters encapsulated within small-pore (SOD, GIS, ANA) zeolites. J. Am. Chem. Soc. 134, 17688–17695 (2012).Choi, M., Wu, Z. & Iglesia, E. Mercaptosilane-assisted synthesis of metal clusters within zeolites and catalytic consequences of encapsulation. J. Am. Chem. Soc. 132, 9129–9137 (2010).Choi, M., Yook, S. & Kim, H. Hydrogen spillover in encapsulated metal catalysts: new opportunities for designing advanced hydroprocessing catalysts. ChemCatChem 7, 1048–1057 (2015).Kulkarni, A., Lobo-Lapidus, R. J. & Gates, B. C. Metal clusters on supports: synthesis, structure, reactivity, and catalytic properties. Chem. Commun. 46, 5997–6015 (2010).Guzman, J. & Gates, B. C. Supported molecular catalysts: metal complexes and clusters on oxides and zeolites. Dalton Trans. 1, 3303–3318 (2003).Leonowicz, M. E., Lawton, J. A., Lawton, S. L. & Rubin, M. K. MCM-22: a molecular sieve with two independent multidimensional channel systems. Science 264, 1910–1913 (1994).Camblor, M. A. et al. A new microporous polymorph of silica isomorphous to zeolite MCM-22. Chem. Mater. 8, 2415–2417 (1996).Hyotanishi, M., Isomura, Y., Yamamoto, H., Kawasaki, H. & Obora, Y. Surfactant-free synthesis of palladium nanoclusters for their use in catalytic cross-coupling reactions. Chem. Commun. 47, 5750–5752 (2011).Duchesne, P. N. & Zhang, P. Local structure of fluorescent platinum nanoclusters. Nanoscale 4, 4199–4205 (2012).Lu, J., Aydin, C., Browning, N. D. & Gates, B. C. Imaging isolated gold atom catalytic sites in zeolite NaY. Angew. Chem. Int. Ed. 51, 5842–5846 (2012).Yacamán, M. J., Santiago, U. & Mejía-Rosales, S. in Advanced Transmission Electron Microscopy: Applications to Nanomaterials (eds Francis, L., Mayoral, A. & Arenal, R.) 1–29 (Springer, 2015).Jena, P., Khanna, S. N. & Rao, B. K. Physics and Chemistry of Finite Systems: From Clusters to Crystals (Springer, 1992).Yamasaki, J. et al. Ultramicroscopy 151, 224–231 (2015).Sohlberg, K., Pennycook, T. J., Zhoud, W. & Pennycook, S. J. Insights into the physical chemistry of materials from advances in HAADF-STEM. Phys. Chem. Chem. Phys. 17, 3982–4006 (2015).Aydin, C., Lu, J., Browning, N. D. & Gates, B. C. A ‘smart’ catalyst: sinter-resistant supported iridium clusters visualized with electron microscopy. Angew. Chem. Int. Ed. 51, 5929–5934 (2012).Wei, H. et al. FeOx-supported platinum single-atom and pseudo-single-atom catalysts for chemoselective hydrogenation of functionalized nitroarenes. Nat. Commun. 5, 5634 (2014).Addou, R. et al. Influence of hydroxyls on Pd atom mobility and clustering on rutile TiO2(011)-2 × 1. ACS Nano 8, 6321–6333 (2014).Jung, U. et al. Comparative in operando studies in heterogeneous catalysis: atomic and electronic structural features in the hydrogenation of ethylene over supported Pd and Pt catalysts. ACS Catal. 5, 1539–1551 (2015).Agostini, G. et al. Effect of different face centered cubic nanoparticle distributions on particle size and surface area determination: a theoretical study. J. Phys. Chem. C 118, 4085–4094 (2014).Alexeev, O. & Gates, B. C. EXAFS characterization of supported metal-complex and metal-cluster catalysts made from organometallic precursors. Top. Catal. 10, 273–293 (2000).Chakraborty, I., Bhuin, R. G., Bhat, S. & Pradeep, T. Blue emitting undecaplatinum clusters. Nanoscale 6, 8561–8564 (2014).Zheng, J., Nicovich, P. R. & Dickson, R. M. Highly fluorescent noble-metal quantum dots. Ann. Rev. Phys. Chem. 58, 409–431 (2007).Okrut, A. et al. Selective molecular recognition by nanoscale environments in a supported iridium cluster catalyst. Nat. Nanotech. 9, 459–465 (2014).Zhou, C. et al. On the sequential hydrogen dissociative chemisorption on small platinum clusters: a density functional theory study. J. Phys. Chem. C 111, 12773–12778 (2007).De La Cruz, C. & Sheppard, N. An exploration of the surfaces of some Pt/SiO2 catalysts using CO as an infrared spectroscopic probe. Spectrochim. Acta A 50, 271–285 (1994).Klünker, C., Balden, M., Lehwald, S. & Daum, W. CO stretching vibrations on Pt(111) and Pt(110) studied by sum frequency generation. Surf. Sci. 360, 104–111 (1996).Stakheev, A. Y., Shpiro, E. S., Jaeger, N. I. & Schulz-Ekloff, G. Electronic state and location of Pt metal clusters in KL zeolite: FTIR study of CO chemisorption. Catal. Lett. 32, 147–158 (1995).Heiz, U., Sanchez, A., Abbet, S. & Schneider, W. D. Catalytic oxidation of carbon monoxide on monodispersed platinum clusters: each atom counts. J. Am. Chem. Soc. 121, 3214–3217 (1999).Levitas, V. I. & Samani, K. Size and mechanics effects in surface-induced melting of nanoparticles. Nat. Commun. 2, 284 (2011).Jiang, H., Moon, K.-s., Dong, H., Hua, F. & Wong, C. P. Size-dependent melting properties of tin nanoparticles. Chem. Phys. Lett. 429, 492–496 (2006).Nanda, K. K., Kruis, F. E. & Fissan, H. Evaporation of free PbS nanoparticles: evidence of the Kelvin effect. Phys. Rev. Lett. 89, 256103 (2002).Vajda, S. et al. Subnanometre platinum clusters as highly active and selective catalysts for the oxidative dehydrogenation of propane. Nat. Mater. 8, 213–216 (2009).Ortalan, V., Uzun, A., Gates, B. C. & Browning, N. D. Direct imaging of single metal atoms and clusters in the pores of dealuminated HY zeolite. Nat. Nanotech. 5, 506–510 (2010).Koch, C. Determination of Core Structure Periodicity and Point Defect Density along Dislocations PhD thesis, Univ. Arizona (2002).Mathon, O. et al. The time-resolved and extreme conditions XAS (TEXAS) facility at the European Synchrotron Radiation Facility: the general-purpose EXAFS bending-magnet beamline BM23. J. Synchrotron Radiat. 22, 1548–1554 (2015).Newville, M. IFEFFIT: interactive XAFS analysis and FEFF fitting. J. Synchrotron Radiat. 8, 322–324 (2001)

Biosecurity and Vector Behaviour: Evaluating the Potential Threat Posed by Anglers and Canoeists as Pathways for the Spread of Invasive Non-Native Species and Pathogens

Invasive non-native species (INNS) endanger native biodiversity and are a major economic problem. The management of pathways to prevent their introduction and establishment is a key target in the Convention on Biological Diversity's Aichi biodiversity targets for 2020. Freshwater environments are particularly susceptible to invasions as they are exposed to multiple introduction pathways, including non-native fish stocking and the release of boat ballast water. Since many freshwater INNS and aquatic pathogens can survive for several days in damp environments, there is potential for transport between water catchments on the equipment used by recreational anglers and canoeists. To quantify this biosecurity risk, we conducted an online questionnaire with 960 anglers and 599 canoeists to investigate their locations of activity, equipment used, and how frequently equipment was cleaned and/or dried after use. Anglers were also asked about their use and disposal of live bait. Our results indicate that 64% of anglers and 78.5% of canoeists use their equipment/boat in more than one catchment within a fortnight, the survival time of many of the INNS and pathogens considered in this study and that 12% of anglers and 50% of canoeists do so without either cleaning or drying their kit between uses. Furthermore, 8% of anglers and 28% of canoeists had used their equipment overseas without cleaning or drying it after each use which could facilitate both the introduction and secondary spread of INNS in the UK. Our results provide a baseline against which to evaluate the effectiveness of future biosecurity awareness campaigns, and identify groups to target with biosecurity awareness information. Our results also indicate that the biosecurity practices of these groups must improve to reduce the likelihood of inadvertently spreading INNS and pathogens through these activities

Spectroscopic Observations and Analysis of the Peculiar SN 1999aa

We present an extensive new time-series of spectroscopic data of the peculiar SN 1999aa in NGC 2595. Our data set includes 25 optical spectra between -11 and +58 days with respect to B-band maximum light, providing an unusually complete time history. The early spectra resemble those of a SN 1991T-like object but with a relatively strong Ca H&K absorption feature. The first clear sign of Si II 6355, characteristic of Type Ia supernovae, is found at day -7 and its velocity remains constant up to at least the first month after B-band maximum light. The transition to normal-looking spectra is found to occur earlier than in SN 1991T suggesting SN 1999aa as a possible link between SN 1991T-like and Branch-normal supernovae. Comparing the observations with synthetic spectra, doubly ionized Fe, Si and Ni are identified at early epochs. These are characteristic of SN 1991T-like objects. Furthermore, in the day -11 spectrum, evidence is found for an absorption feature which could be identified as high velocity C II 6580 or H-alpha. At the same epoch C III 4648.8 at photospheric velocity is probably responsible for the absorption feature at 4500 A. High velocity Ca is found around maximum light together with Si II and Fe II confined in a narrow velocity window. Implied constraints on supernovae progenitor systems and explosion hydrodynamical models are briefly discussed.Comment: 46 pages including 23 figures. Accepted for publication by AJ. For full-resolution figures see http://www.physto.se/~gabri/sn99aa

Space Telescope and Optical Reverberation Mapping Project. VII. Understanding the Ultraviolet Anomaly in NGC 5548 with X-Ray Spectroscopy

During the Space Telescope and Optical Reverberation Mapping Project observations of NGC 5548, the continuum and emission-line variability became decorrelated during the second half of the six-month-long observing campaign. Here we present Swift and Chandra X-ray spectra of NGC 5548 obtained as part of the campaign. The Swift spectra show that excess flux (relative to a power-law continuum) in the soft X-ray band appears before the start of the anomalous emission-line behavior, peaks during the period of the anomaly, and then declines. This is a model-independent result suggesting that the soft excess is related to the anomaly. We divide the Swift data into on- and off-anomaly spectra to characterize the soft excess via spectral fitting. The cause of the spectral differences is likely due to a change in the intrinsic spectrum rather than to variable obscuration or partial covering. The Chandra spectra have lower signal-to-noise ratios, but are consistent with the Swift data. Our preferred model of the soft excess is emission from an optically thick, warm Comptonizing corona, the effective optical depth of which increases during the anomaly. This model simultaneously explains all three observations: the UV emission-line flux decrease, the soft-excess increase, and the emission-line anomaly