Evaluating tools to support a new practical classification of diabetes: excellent control may represent misdiagnosis and omission from disease registers is associated with worse control.

To conduct a service evaluation of usability and utility on-line clinical audit tools developed as part of a UK Classification of Diabetes project to improve the categorisation and ultimately management of diabetes

Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network.

BACKGROUND: Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. METHOD: We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. RESULTS: We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR - Patients at risk of readmission and ACG - Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. CONCLUSIONS: Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don't change

Influence Of HF2V Damping Devices On The Performance Of The SAC3 Building Subjected To The SAC Ground Motion Suites

Recent advances in energy dissipation for structural systems can create structural connections that undergo zero sacrificial energy absorbing damage, even at extreme story drifts. However, questions exist around the ability of such structures to re-center after a major event. In this paper, the seismic performance of the as-designed SAC LA3 seismic frame with rigid moment connections at the beam ends is compared with the same frame using semi-rigid connections with high force-to-volume (HF2V) lead dissipators. Non-linear dynamic analysis is preformed using Abaqus™. With respect to re-centering, the presence of the gravity frames in the model is also considered. It was found that the placement of dissipators, ignoring the effect of gravity frames, caused a 12% increase in period due to the decreased stiffness of the connections. During design level ground shaking the semi-rigid connections with HF2V dissipators have slightly lower accelerations, up to an 80% increase in peak drift, and a 200% increase in the permanent displacement compared to the as-designed case, but no structural damage is expected. When gravity frames are considered, the floor accelerations decrease further, the peak displacements do not significantly change, but the residual storey drift ratios reduce to approximately 0.17%. This result is less than one half that of the as-designed frame, where typically gravity frame effects are not considered. The addition of braces with a stiffness 20% of the pushover stiffness ensures that the structures can re-center after any given event to within construction error. The realistic non-linear dynamic analyses combining HF2V lead dissipators with gravity frames and well-designed non-structural elements creates a system with almost no structural damage and low residual displacements

Association of anaemia in primary care patients with chronic kidney disease: cross sectional study of quality improvement in chronic kidney disease (QICKD) trial data.

BACKGROUND: Anaemia is a known risk factor for cardiovascular disease and treating anaemia in chronic kidney disease (CKD) may improve outcomes. However, little is known about the scope to improve primary care management of anaemia in CKD. METHODS: An observational study (N = 1,099,292) with a nationally representative sample using anonymised routine primary care data from 127 Quality Improvement in CKD trial practices (ISRCTN5631023731). We explored variables associated with anaemia in CKD: eGFR, haemoglobin (Hb), mean corpuscular volume (MCV), iron status, cardiovascular comorbidities, and use of therapy which associated with gastrointestinal bleeding, oral iron and deprivation score. We developed a linear regression model to identify variables amenable to improved primary care management. RESULTS: The prevalence of Stage 3-5 CKD was 6.76%. Hb was lower in CKD (13.2 g/dl) than without (13.7 g/dl). 22.2% of people with CKD had World Health Organization defined anaemia; 8.6% had Hb ≤ 11 g/dl; 3% Hb ≤ 10 g/dl; and 1% Hb ≤ 9 g/dl. Normocytic anaemia was present in 80.5% with Hb ≤ 11; 72.7% with Hb ≤ 10 g/dl; and 67.6% with Hb ≤ 9 g/dl; microcytic anaemia in 13.4% with Hb ≤ 11 g/dl; 20.8% with Hb ≤ 10 g/dl; and 24.9% where Hb ≤ 9 g/dl. 82.7% of people with microcytic and 58.8% with normocytic anaemia (Hb ≤ 11 g/dl) had a low ferritin (<100 ug/mL). Hypertension (67.2% vs. 54%) and diabetes (30.7% vs. 15.4%) were more prevalent in CKD and anaemia; 61% had been prescribed aspirin; 73% non-steroidal anti-inflammatory drugs (NSAIDs); 14.1% warfarin 12.4% clopidogrel; and 53.1% aspirin and NSAID. 56.3% of people with CKD and anaemia had been prescribed oral iron. The main limitations of the study are that routine data are inevitably incomplete and definitions of anaemia have not been standardised. CONCLUSIONS: Medication review is needed in people with CKD and anaemia prior to considering erythropoietin or parenteral iron. Iron stores may be depleted in over >60% of people with normocytic anaemia. Prescribing oral iron has not corrected anaemia

Bromine-80m-labeled estrogens: Auger-electron emitting, estrogen receptor-directed ligands with potential for therapy of estrogen receptor positive cancers

A triphenylbromoethylene, 1,1-bis(p-hydroxyphenyl)-2-bromo-2-phenylethylene, Br-BHPE, and a bromosteroidal estrogen, 17..cap alpha..- bromovinylestradiol, BrVE/sub 2/, were labeled with the Auger electron emitting nuclide bromine-80m, prepared by the (p,n) reaction with /sup 80/Se. To assess their potential as estrogen receptor (ER) directed therapeutic substrates the bromine-80m labeled estrogens were injected into immature female rats and the tissue distribution studied at 0.5 and 2 hours. Both radiobromoestrogens showed substantial diethylstilbesterol (DES)-inhibitable localization in the ER rich tissues, uterus, pituitary, ovary and vagina at both time points. While the percent dose per gram tissue was higher for the Br-BHPE, the BrVE/sub 2/ showed higher tissue to blood ratios, especially at 2 hr, reflecting the lower blood concentrations of radiobromine following administration of the steroidal bromoestrogen. Comparing intraperitoneal, intravenous and subcutaneous routes of administration for the radiobromine labeled Br-BHPE, the intraperitoneal route was particularly advantageous to provide maximum, DES-inhibitable concentrations in the peritoneal, ER-rich target organs, the uterus, ovary and vagina. While uterine concentrations after BrBHPE were from 10--48% dose/g and after BrVE/sub 2/ were 15--25% dose/g, similar treatment with /sup 80m/Br as sodium bromide showed uniform low concentrations in all tissues at about the levels seen in blood. The effective specific activity of (/sup 80m/Br)BrBHPE, assayed by specific binding to ER in rat uterine cytosol, was 8700 Ci/mmole. 23 refs., 9 figs., 2 tabs

REFERQUAL: A pilot study of a new service quality assessment instrument in the GP Exercise Referral scheme setting

Background The development of an instrument accurately assessing service quality in the GP Exercise Referral Scheme (ERS) industry could potentially inform scheme organisers of the factors that affect adherence rates leading to the implementation of strategic interventions aimed at reducing client drop-out. Methods A modified version of the SERVQUAL instrument was designed for use in the ERS setting and subsequently piloted amongst 27 ERS clients. Results Test re-test correlations were calculated via Pearson's 'r' or Spearman's 'rho', depending on whether the variables were Normally Distributed, to show a significant (mean r = 0.957, SD = 0.02, p < 0.05; mean rho = 0.934, SD = 0.03, p < 0.05) relationship between all items within the questionnaire. In addition, satisfactory internal consistency was demonstrated via Cronbach's 'α'. Furthermore, clients responded favourably towards the usability, wording and applicability of the instrument's items. Conclusion REFERQUAL is considered to represent promise as a suitable tool for future evaluation of service quality within the ERS community. Future research should further assess the validity and reliability of this instrument through the use of a confirmatory factor analysis to scrutinise the proposed dimensional structure

Analytical Investigation of the Effects of HF2V Damping Devices on the Seismic Performance of the SAC LA3 Building

In this paper, the seismic performance of a 3 storey seismic frame with rigid moment connections at the beam ends (commonly known as the SAC LA3 building) is compared with that of the same frame using semi-rigid connections with high force to volume (HF2V) lead dissipators. The presence of the gravity frames in the model is also considered. It was found that the use of semi-rigid connections with HF2V dissipators, ignoring the effect of the gravity frames, caused a 12% increase in period of the frame due to the decreased stiffness of the connections. Accelerations were slightly lower and there was up to an 80% increase in peak drift, and a 200% increase in the permanent displacement compared to the as-designed case, but no structural damage was expected. When gravity frames were considered, the floor accelerations decreased further, the peak displacements do not significantly change, but the residual storey drift ratios reduced to approximately 0.17%. This result is less than one half that of the as-designed frame, where typically gravity frame effects are not considered. The analyses show that combining HF2V lead dissipators with gravity frames and well-designed non-structural elements creates a system with almost no structural damage and low residual displacements

Influence Of HF2V Damping Devices On The Performance Of The SAC3 Building Subjected To The SAC Ground Motion Suites

Recent advances in energy dissipation for structural systems can create structural connections that undergo zero sacrificial energy absorbing damage, even at extreme story drifts. However, questions exist around the ability of such structures to re-center after a major event. In this paper, the seismic performance of the as-designed SAC LA3 seismic frame with rigid moment connections at the beam ends is compared with the same frame using semi-rigid connections with high force-to-volume (HF2V) lead dissipators. Non-linear dynamic analysis is preformed using Abaqus™. With respect to re-centering, the presence of the gravity frames in the model is also considered. It was found that the placement of dissipators, ignoring the effect of gravity frames, caused a 12% increase in period due to the decreased stiffness of the connections. During design level ground shaking the semi-rigid connections with HF2V dissipators have slightly lower accelerations, up to an 80% increase in peak drift, and a 200% increase in the permanent displacement compared to the as-designed case, but no structural damage is expected. When gravity frames are considered, the floor accelerations decrease further, the peak displacements do not significantly change, but the residual storey drift ratios reduce to approximately 0.17%. This result is less than one half that of the as-designed frame, where typically gravity frame effects are not considered. The addition of braces with a stiffness 20% of the pushover stiffness ensures that the structures can re-center after any given event to within construction error. The realistic non-linear dynamic analyses combining HF2V dissipators with gravity frames and well-designed non-structural elements creates a system with almost no structural damage and low residual displacements

HF2V dissipator effects on the performance of a 3 story moment frame

In this paper, the seismic performance of the as-designed SAC Los Angeles 3 storey seismic frame with rigid moment connections at the beam ends is compared with that of the same frame using semirigid connections with high force-to-volume (HF2V) lead dissipators. The presence of the gravity frames in the model is also considered. It was found that the placement of dissipators, ignoring the effect of the gravity frames, caused a 12% increase in period of the frame due to the decreased stiffness of the connections. During design level ground shaking the semi-rigid connections with HF2V dissipators have slightly lower accelerations, up to an 80% increase in peak drift, and a 200% increase in the permanent displacement compared to the as-designed case, but no structural damage is expected. When the gravity frames are considered, the floor accelerations decrease further, the peak displacements do not significantly change, but the residual storey dirft ratios reduce to approximately 0.17%. This result is less than one half that of the as-designed frame, where typically gravity frame effects are not considered. The realistic analyses combining HF2V lead dissipators with gravity frames and well-designed non-structural elements creates a system with almost no structural damage and low residual displacements