Use of hospital services by age and comorbidity after an index heart failure admission in England: an observational study

© Published by the BMJ Publishing Group Limited.Objectives To describe hospital inpatient, emergency department (ED) and outpatient department (OPD) activity for patients in the year following their first emergency admission for heart failure (HF). To assess the proportion receiving specialist assessment within 2â €...weeks of hospital discharge, as now recommended by guidelines. Design Observational study of national administrative data. Setting All acute NHS hospitals in England. Participants 82â €...241 patients with an index emergency admission between April 2009 and March 2011 with a primary diagnosis of HF. Main outcome measures Cardiology OPD appointment within 2â €...weeks and within a year of discharge from the index admission; emergency department (ED) and inpatient use within a year. Results 15.1% died during the admission. Of the 69â €...848 survivors, 19.7% were readmitted within 30â €...days and half within a year, the majority for non-HF diagnoses. 6.7% returned to the ED within a week of discharge, of whom the majority (77.6%) were admitted. The two most common OPD specialties during the year were cardiology (24.7% of the total appointments) and anticoagulant services (12.5%). Although half of all patients had a cardiology appointment within a year, the proportion within the recommended 2â €...weeks of discharge was just 6.8% overall and varied by age, from 2.4% in those aged 90+ to 19.6% in those aged 18-45 (p<0.0001); appointments in other specialties made up only some of the shortfall. More comorbidity at any age was associated with higher rates of cardiology OPD follow-up. Conclusions Patients with HF are high users of hospital services. Postdischarge cardiology OPD follow-up rates fell well below current National Institute for Health and Care Excellence guidelines, particularly for the elderly and those with less comorbidity

Star Formation History since z = 1.5 as Inferred from Rest-Frame Ultaviolet Luminosity Density Evolution

We investigate the evolution of the universal rest-frame ultraviolet luminosity density from z = 1.5 to the present. We analyze an extensive sample of multicolor data (U', B, V = 24.5) plus spectroscopic redshifts from the Hawaii Survey Fields and the Hubble Deep Field. Our multicolor data allow us to select our sample in the rest-frame ultraviolet (2500 angstrom) over the entire redshift range to z = 1.5. We conclude that the evolution in the luminosity density is a function of the form (1+z)^{1.7\pm1.0} for a flat lambda cosmology and (1+z)^{2.4\pm1.0} for an Einstein-de Sitter cosmology.Comment: 12 pages, 7 figs, 5 tables, submitted to A

Detection of Massive Forming Galaxies at Redshifts Greater than One

The complex problem of when and how galaxies formed has not until recently been susceptible of direct attack. It has been known for some time that the excessive number of blue galaxies counted at faint magnitudes implies that a considerable fraction of the massive star formation in the universe occurred at z < 3, but, surprisingly, spectroscopic studies of galaxies down to a B magnitude of 24 found little sign of the expected high-z progenitors of current massive galaxies, but rather, in large part, small blue galaxies at modest redshifts z \sim 0.3. This unexpected population has diverted attention from the possibility that early massive star-forming galaxies might also be found in the faint blue excess. From KECK spectroscopic observations deep enough to encompass a large population of z > 1 field galaxies, we can now show directly that in fact these forming galaxies are present in substantial numbers at B \sim 24, and that the era from redshifts 1 to 2 was clearly a major period of galaxy formation. These z > 1 galaxies have very unusual morphologies as seen in deep HST WFPC2 images.Comment: 10 pages LaTeX + 5 PostScript figures in uuencoded gzipped tar file; aasms4.sty, flushrt.sty, overcite.sty (the two aastex4.0 and overcite.sty macros are available from xxx.lanl.gov) Also available (along with style files) via anonymous ftp to ftp://hubble.ifa.hawaii.edu/pub/preprints . E-print version of paper adds citation cross-references to other archived e-prints, where available. To appear in Nature October 19, 199

The development of multisensory body representation and awareness continues to 10 years of age: evidence from the rubber hand illusion

Recent research using the “rubber hand illusion” shows that the multisensory processes underlying body representations are markedly different in children of 4 to 9 years and adults. In representing the position of their own hand in external space, children of this age rely more on the sight of the hand, and less on its proprioceptively felt position, than adults do. The current study investigated when during later childhood the balance between visual and proprioceptive inputs reaches an adult-like weighting. After inducing the rubber hand illusion in 10- to 13-year-olds, we asked participants to point, with eyes closed, to the perceived position of their hand. We found that pointing responses reached adult levels at 10 to 11 years, showing that at this age children perceive hand location using an adult-like balance of sensory cues. We conclude that the multisensory foundations of the bodily self undergo a protracted period of development through early and mid-childhood, reaching an adult state by 10 to 11 years

Visual control of action in step descent

Visual guidance of forwards, sideways, and upwards stepping has been investigated, but there is little knowledge about the visuomotor processes underlying stepping down actions. In this study we investigated the visual control of a single vertical step. We measured which aspects of the stepping down movement scaled with visual information about step height, and how this visual control varied with binocular versus monocular vision. Subjects stepped down a single step of variable and unpredictable height. Several kinematic measures were extracted including a new measure, “kneedrop”. This describes a transition in the movement of the lower leg, which occurs at a point proportional to step height. In a within-subjects design, measurements were made with either full vision, monocular vision, or no vision. Subjects scaled kneedrop relative to step height with vision, but this scaling was significantly impaired in monocular and no vision conditions. The study establishes a kinematic marker of visually controlled scaling in single-step locomotion which will allow further study of the visuomotor control processes involved in stepping dow

Visually guided step descent in children with Williams Syndrome

Individuals with Williams syndrome (WS) have impairments in visuospatial tasks and in manual visuomotor control, consistent with parietal and cerebellar abnormalities. Here we examined whether individuals with WS also have difficulties in visually controlling whole-body movements. We investigated visual control of stepping down at a change of level in children with WS (5–16-year-olds), who descended a single step while their movement was kinematically recorded. On each trial step height was set unpredictably, so that visual information was necessary to perceive the step depth and position the legs appropriately before landing. Kinematic measures established that children with WS did not use visual information to slow the leg at an appropriate point during the step. This pattern contrasts with that observed in typically developing 3- and 4-year-old children, implying severe impairment in whole-body visuomotor control in WS. For children with WS, performance was not significantly predicted by low-level visual or balance problems, but improved significantly with verbal age. The results suggest some plasticity and development in WS whole-body control. These data clearly show that visuospatial and visuomotor deficits in WS extend to the locomotor domain. Taken together with evidence for parietal and cerebellar abnormalities in WS, these results also provide new evidence for the role of these circuits in the visual control of whole-body movement

Progress towards omnidirectional transformation optics with lenses

We study, theoretically, omni-directional Euclidean transformation-optics (TO) devices comprising planar, light-ray-direction changing, imaging, interfaces. We initially studied such devices in the case when the interfaces are homogeneous, showing that very general transformations between physical and electromagnetic space are possible. We are now studying the case of inhomogeneous interfaces. This case is more complex to analyse, but the inhomogeneous interfaces include ideal thin lenses, which gives rise to the hope that it might be possible to construct practical omni-directional TO devices from lenses alone. Here we report on our progress in this direction