Evaluation and establishment of a ward-based geriatric liaison service for older urological surgical patients: Proactive care of Older People undergoing Surgery (POPS)-Urology.

OBJECTIVE: To assess the impact of introducing and embedding a structured geriatric liaison service, Proactive care of Older People undergoing Surgery (POPS)-Urology, using comprehensive geriatric assessment methodology, on an inpatient urology ward. PATIENTS AND METHODS: A phased quality improvement project was undertaken using stepwise interventions. Phase 1 was a before-and-after study with initiation of a daily board round, weekly multidisciplinary meeting, and targeted geriatrician-led ward rounds for elective and emergency urology patients aged ≥65 years admitted over two 1-month periods. Outcomes were recorded from medical records and discharge documentation, including length of inpatient stay, medical and surgical complications, and 30-day readmission and mortality rates. Phase 2 was a quality improvement project involving Plan-Do-Study-Act cycles and qualitative staff surveys in order to create a Geriatric Surgical Checklist (GSCL) to standardize the intervention in Phase 1, improve equity of care by extending it to all ages, improve team-working and streamline handovers for multidisciplinary staff. RESULTS: Phase 1 included 112 patients in the control month and 130 in the intervention month. The length of inpatient stay was reduced by 19% (mean 4.9 vs 4.0 days; P = 0.01), total postoperative complications were lower (risk ratio 0.24 [95% confidence interval 0.10, 0.54]; P = 0.001). A non-significant trend was seen towards fewer cancellations of surgery (10 vs 5%; P = 0.12) and 30-day readmissions (8 vs 3%; P = 0.07). In Phase 2, the GSCL was created and incrementally improved. Questionnaires repeated at intervals showed that the GSCL helped staff to understand their role better in multidisciplinary meetings, improved their confidence to raise issues, reduced duplication of handovers and standardized identification of geriatric issues. Equity of care was improved by providing the intervention to patients of all ages, despite which the time taken for the daily board round did not lengthen. CONCLUSION: This is the first known paper describing the benefits of daily proactive geriatric intervention in elective and emergency urological surgery. The results suggest that using a multidisciplinary team board round helps to facilitate collaborative working between surgical and geriatric medicine teams. The GSCL enables systematic identification of patients who require a focused comprehensive geriatric assessment. There is potential to transfer the GSCL package to other surgical specialties and hospitals to improve postoperative outcomes

Towards a sustainable Dunaliella salina microalgal biorefinery for 9-cis β-carotene production

Valorisation of the efficacy of 9-cis beta-carotene in treating atherosclerosis, psoriasis, and inhibiting atherogenesis and retinitis pigmentosa is becoming increasingly urgent, but supplies of 9-cis beta-carotene are scarce and this compound is difficult to synthesise chemically, unlike the much more common all-trans form. Innovative products, processes and services in an algal biorefinery that rely on renewable biological resources instead of fossil fuel alternatives offer the potential to lower the energy costs of traditional chemical processes and reduce carbon emissions, water usage and waste. In 2013, the European Commission supported development of 4 microalgal biorefinery projects to assess the potential for innovative approaches to tackle the major challenges intrinsic to the development of the algae biorefineries. One of these was the D-Factory (KBBE.2013.3.2-02) which sought to evaluate requirements for sustainable, industrial-scale production of Dunaliella salina and extraction of its carotenoids, especially 9-cis beta-carotene in a CO2 microalgae biorefinery. Here we present findings of the D-Factory project and propose a way forward for industrial-scale production of 9-cis beta-carotene using biotechnology based on Dunaliella salina biomass. Cultivation improvements are able to deliver more than double the current levels of productivity, with increased sustainability, whilst the use of natural hyper-accumulating carotenogenic strains combined with the use of red light to boost production of the beta-carotene pathway, will increase the relative concentration of 9-cis beta-carotene in extracts of carotenoids with consequent improvements in downstream processing. These developments pave the way for acquiring data for a Medicine Licence and prepare the market for entry of novel 9-cis beta-carotene products

Lepton Mass Matrix Models

The smallness and hierarchy in fermion parameters could be the result of selection rules due to an Abelian horizontal symmetry broken by a small parameter. When applied to the lepton sector, then for a large class of models, a number of interesting order of magnitude relations arise: with $i<j$, $m(\nu_i)/m(\nu_j)\sim\sin^2\theta_{ij}$; m(\ell^-_i)/m(\ell^-_j)\lsim\sin\theta_{ij}; m(\nu_i)/m(\nu_j)\gsim m^2(\ell^-_i)/m^2(\ell^-_j); m(\nu_e)\lsim m(\nu_\mu)\lsim m(\nu_\tau). The relations between neutrino masses and mixings may become exact if the horizontal symmetry together with holomorphy induce certain zero entries in the lepton mass matrices. A full high energy theory is likely to include scalars with flavor changing couplings and heavy leptons in vector representations; however, the masses of these particles are too heavy to be directly observed in experiment. Indirect evidence for the horizontal symmetry may arise from other sectors of the theory: non-degenerate sleptons are allowed as the symmetry aligns lepton and slepton mass matrices; light leptoquarks are allowed as the symmetry can make their couplings diagonal and chiral.Comment: 25 pages, uses harvmac; no figure

Tuberculosis diagnostics and biomarkers: needs, challenges, recent advances, and opportunities

Tuberculosis is unique among the major infectious diseases in that it lacks accurate rapid point-of-care diagnostic tests. Failure to control the spread of tuberculosis is largely due to our inability to detect and treat all infectious cases of pulmonary tuberculosis in a timely fashion, allowing continued Mycobacterium tuberculosis transmission within communities. Currently recommended gold-standard diagnostic tests for tuberculosis are laboratory based, and multiple investigations may be necessary over a period of weeks or months before a diagnosis is made. Several new diagnostic tests have recently become available for detecting active tuberculosis disease, screening for latent M. tuberculosis infection, and identifying drug-resistant strains of M. tuberculosis. However, progress toward a robust point-of-care test has been limited, and novel biomarker discovery remains challenging. In the absence of effective prevention strategies, high rates of early case detection and subsequent cure are required for global tuberculosis control. Early case detection is dependent on test accuracy, accessibility, cost, and complexity, but also depends on the political will and funder investment to deliver optimal, sustainable care to those worst affected by the tuberculosis and human immunodeficiency virus epidemics. This review highlights unanswered questions, challenges, recent advances, unresolved operational and technical issues, needs, and opportunities related to tuberculosis diagnostics

Transplanckian axions !?

We discuss quantum gravitational effects in Einstein theory coupled to periodic axion scalars to analyze the viability of several proposals to achieve superplanckian axion periods (aka decay constants) and their possible application to large field inflation models. The effects we study correspond to the nucleation of euclidean gravitational instantons charged under the axion, and our results are essentially compatible with (but independent of) the Weak Gravity Conjecture, as follows: Single axion theories with superplanckian periods contain gravitational instantons inducing sizable higher harmonics in the axion potential, which spoil superplanckian inflaton field range. A similar result holds for multi-axion models with lattice alignment (like the Kim-Nilles-Peloso model). Finally, theories with $N$ axions can still achieve a moderately superplanckian periodicity (by a $\sqrt{N}$ factor) with no higher harmonics in the axion potential. The Weak Gravity Conjecture fails to hold in this case due to the absence of some instantons, which are forbidden by a discrete $\mathbf{Z}_N$ gauge symmetry. Finally we discuss the realization of these instantons as euclidean D-branes in string compactifications.Comment: 46 pages, 6 figures. Added references, clarifications, and missing factor of 1/2 to instanton action. Conclusions unchange

Dynamics of a global string with large Higgs boson mass

We consider a self-gravitating string generated by a global vortex solution in general relativity. We investigate the Einstein and field equations of a global vortex in the region of its central line and at a distance from the centre of the order of the inverse of its Higgs boson mass. By combining the two we establish by a limiting process of large Higgs mass the dynamics of a self-gravitating global string. Under our assumptions the presence of gravitation restricts the world sheet of the global string to be totally geodesic.Comment: 23 pages, LaTeX, one figure, to be published in Phys.Rev.D 15th of March issu

Tuberculosis Diagnostics and Biomarkers: Needs, Challenges, Recent Advances, and Opportunities

Tuberculosis is unique among the major infectious diseases in that it lacks accurate rapid point-of-care diagnostic tests. Failure to control the spread of tuberculosis is largely due to our inability to detect and treat all infectious cases of pulmonary tuberculosis in a timely fashion, allowing continued Mycobacterium tuberculosis transmission within communities. Currently recommended gold-standard diagnostic tests for tuberculosis are laboratory based, and multiple investigations may be necessary over a period of weeks or months before a diagnosis is made. Several new diagnostic tests have recently become available for detecting active tuberculosis disease, screening for latent M. tuberculosis infection, and identifying drug-resistant strains of M. tuberculosis. However, progress toward a robust point-of-care test has been limited, and novel biomarker discovery remains challenging. In the absence of effective prevention strategies, high rates of early case detection and subsequent cure are required for global tuberculosis control. Early case detection is dependent on test accuracy, accessibility, cost, and complexity, but also depends on the political will and funder investment to deliver optimal, sustainable care to those worst affected by the tuberculosis and human immunodeficiency virus epidemics. This review highlights unanswered questions, challenges, recent advances, unresolved operational and technical issues, needs, and opportunities related to tuberculosis diagnostic

Unobtrusive monitoring of behavior and movement patterns to detect clinical depression severity level via smartphone

The number of individuals with mental disorders is increasing and they are commonly found among individuals who avoid social interaction and like to live alone. Amongst such mental health disorders is depression which is both common and serious. The present paper introduces a method to assess the depression level of an individual using a smartphone by monitoring their daily activities. The time domain characteristics from a smartphone acceleration sensor were used alongside a vector machine algorithm to classify physical activities. Additionally, the geographical location information was clustered using a smartphone GPS sensor to simplify movement patterns. A total of 12 features were extracted from individuals’ physical activity and movement patterns and were analyzed alongside their weekly depression scores using the nine-item Patient Health Questionnaire. Using a wrapper feature selection method, a subset of features was selected and applied to a linear regression model to estimate the depression score. The support vector machine algorithm was then used to classify the depression severity level among individuals (absence, moderate, severe) and had an accuracy of 87.2% in severe depression cases which outperformed other classification models including the k-nearest neighbor and artificial neural network. This method of identifying depression is a cost-effective solution for long-term use and can monitor individuals for depression without invading their personal space or creating other day-to-day disturbances