Collaborative working within UK NHS secondary care and across sectors for COPD and the impact of peer review : qualitative findings from the UK National COPD Resources and Outcomes Project

Introduction: We investigated the effects on collaborative work within the UK National Health Service (NHS) of an intervention for service quality improvement: informal, structured, reciprocated, multidisciplinary peer review with feedback and action plans. The setting was care for chronic obstructive pulmonary disease (COPD). Theory and methods: We analysed semi-structured interviews with 43 hospital respiratory consultants, nurses and general managers at 24 intervention and 11 control sites, as part of a UK randomised controlled study, the National COPD Resources and Outcomes Project (NCROP), using Scott’s conceptual framework for action (inter-organisational, intra-organisational, inter-professional and inter-individual). Three areas of care targeted by NCROP involved collaboration across primary and secondary care. Results: Hospital respiratory department collaborations with commissioners and hospital managers varied. Analysis suggested that this is related to team responses to barriers. Clinicians in unsuccessful collaborations told ‘atrocity stories’ of organisational, structural and professional barriers to service improvement. The others removed barriers by working with government and commissioner agendas to ensure continued involvement in patients’ care. Multidisciplinary peer review facilitated collaboration between participants, enabling them to meet, reconcile differences and exchange ideas across boundaries. Conclusions: The data come from the first randomised controlled trial of organisational peer review, adding to research into UK health service collaborative work, which has had a more restricted focus on inter-professional relations. NCROP peer review may only modestly improve collaboration but these data suggest it might be more effective than top-down exhortations to change when collaboration both across and within organisations is required

Discrimination of prostate cancer cells and non-malignant cells using secondary ion mass spectrometry

This communication utilises Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS) combined with multivariate analysis to obtain spectra from the surfaces of three closely related cell lines allowing their discrimination based upon mass spectral ions

The potential role of creatine in vascular health

Creatine is an organic compound, consumed exogenously in the diet and synthesized endogenously via an intricate inter-organ process. Functioning in conjunction with creatine kinase, creatine has long been known for its pivotal role in cellular energy provision and energy shuttling. In addition to the abundance of evidence supporting the ergogenic benefits of creatine supplementation, recent evidence suggests a far broader application for creatine within various myopathies, neurodegenerative diseases, and other pathologies. Furthermore, creatine has been found to exhibit non-energy related properties, contributing as a possible direct and in-direct antioxidant and eliciting anti-inflammatory effects. In spite of the new clinical success of supplemental creatine, there is little scientific insight into the potential effects of creatine on cardiovascular disease (CVD), the leading cause of mortality. Taking into consideration the non-energy related actions of creatine, highlighted in this review, it can be speculated that creatine supplementation may serve as an adjuvant therapy for the management of vascular health in at-risk populations. This review, therefore, not only aims to summarize the current literature surrounding creatine and vascular health, but to also shed light onto the potential mechanisms in which creatine may be able to serve as a beneficial supplement capable of imparting vascular-protective properties and promoting vascular health

Evolution of Subglacial Overdeepenings in Response to Sediment Redistribution and Glaciohydraulic Supercooling

Glaciers erode bedrock rapidly, but evacuation of sediments requires efficient subglacial drainage networks. If glaciers erode more rapidly than evacuation proceeds, a protective subglacial till layer can form to armor the bed. Where glaciers cross overdeepenings, local closed depressions, the bed slope opposes the ice surface and lowers the hydraulic potential gradient that drives water flow. Here, we present results of a dynamic, distributed model of coupled basal water flow and sediment transport to show how overdeepenings evolve over the course of a melt season. We use steady-state calculations as well as numerical simulations to understand how alluvial bed erosion alters overdeepenings. Numerical results from a modified form of the Spring-Hutter equations show behaviors that cannot be inferred from either local or steady-state calculations. In general, opposition of surface and bed slopes lessens sediment transport regardless of ice accretion from glaciohydraulic supercooling. Drainage efficiency strongly affects erosion and deposition rates. Results show characteristic behaviors of flow through overdeepenings such as overpressured water systems and accretion rates compatible with field measurements. Simulations that start with overdeepened glacier configurations progress out of a freezing regime where glaciohydraulic supercooling occurs. This progression indicates that glacier hydrology is more strongly affected by erosion and deposition than by freezing from glaciohydraulic supercooling. We discuss how this outcome affects glacier erosion and sediment transport under modern and past ice sheets

Restructuring and Serving Web-Accessible Streamflow Data From the NOAA National Water Model Historic Simulations

In 2016, the National Oceanic and Atmospheric Administration deployed the first iteration of an operational National Water Model (NWM) to forecast the water cycle in the continental United States. With many versions, an hourly, multi-decadal historic simulation is made available to the public. In all released to date, the files containing simulated streamflow contain a snapshot of model conditions across the entire domain for a single timestep which makes accessing time series a technical and resource-intensive challenge. In the most recent release, extracting a complete streamflow time series for a single location requires managing 367,920 files (~16.2 TB). In this work we describe a reproducable process for restructuring a sequential set of NWM steamflow files for efficient time series access and provide restructured datasets for versions 1.2 (1993-2018), 2.0 (1993-2020), and 2.1 (1979-2022). These datasets have been made accessible via an OPeNDAP enabled THREDDS data server for public use and a brief analysis highlights the latest version of the model should not be assumed best for all locations. Laslty, we describe an R package that expedites data retrieval with examples for multiple use-cases

Anatomy of Malicious Singularities

As well known, the b-boundaries of the closed Friedman world model and of Schwarzschild solution consist of a single point. We study this phenomenon in a broader context of differential and structured spaces. We show that it is an equivalence relation $\rho$, defined on the Cauchy completed total space $\bar{E}$ of the frame bundle over a given space-time, that is responsible for this pathology. A singularity is called malicious if the equivalence class $[p_0]$ related to the singularity remains in close contact with all other equivalence classes, i.e., if $p_0 \in \mathrm{cl}[p]$ for every $p \in E$. We formulate conditions for which such a situation occurs. The differential structure of any space-time with malicious singularities consists only of constant functions which means that, from the topological point of view, everything collapses to a single point. It was noncommutative geometry that was especially devised to deal with such situations. A noncommutative algebra on $\bar{E}$, which turns out to be a von Neumann algebra of random operators, allows us to study probabilistic properties (in a generalized sense) of malicious singularities. Our main result is that, in the noncommutative regime, even the strongest singularities are probabilistically irrelevant.Comment: 16 pages in LaTe

The Critical Power Model as a Potential Tool for Anti-Doping

Existing doping detection strategies rely on direct and indirect biochemical measurement methods focused on detecting banned substances, their metabolites, or biomarkers related to their use. However, the goal of doping is to improve performance, and yet evidence from performance data is not considered by these strategies. The emergence of portable sensors for measuring exercise intensities and of player tracking technologies may enable the widespread collection of performance data. How these data should be used for doping detection is an open question. Herein, we review the basis by which performance models could be used for doping detection, followed by critically reviewing the potential of the critical power (CP) model as a prototypical performance model that could be used in this regard. Performance models are mathematical representations of performance data specific to the athlete. Some models feature parameters with physiological interpretations, changes to which may provide clues regarding the specific doping method. The CP model is a simple model of the power-duration curve and features two physiologically interpretable parameters, CP and W0 . We argue that the CP model could be useful for doping detection mainly based on the predictable sensitivities of its parameters to ergogenic aids and other performance-enhancing interventions. However, our argument is counterbalanced by the existence of important limitations and unresolved questions that need to be addressed before the model is used for doping detection. We conclude by providing a simple worked example showing how it could be used and propose recommendations for its implementation

Exploring multiple factors affecting participation outcomes for children with communication aids

Many factors affect how much communication aids support and promote children’s participation in everyday settings. However, little research has explored which combinations of environmental, child and communication aid factors appear most influential. This paper will present preliminary findings from a pilot study of outcomes of communication aid provision to children. The main aims were to: (1) develop a self-report questionnaire for the parents and carers; (2) conduct a descriptive analysis of parents’ and carers’ perspectives. It is hoped that this presentation will stimulate discussion on issues such as identifying key influential factors in the take-up and use of communication aids and measuring children’s participation