PACE-IT study protocol: a stepped wedge cluster randomised controlled trial evaluating the implementation of telehealth visual assessment in emergency care for people living in residential aged-care facilities.

BACKGROUND:Transfer of residential aged-care facility (RACF) residents to Emergency Departments (ED) is common, risky and expensive. RACF residents who present to ED are more likely to have hospital readmissions, longer stays and face major risks related to hospital acquired complications. Aged Care Emergency services (ACE) is a nurse led, protocol- guided, telephone RACF/ED outreach model that has been shown to be effective in reducing hospitalisation and length of hospital stay for RACF residents in the Hunter New England Local Health District, New South Wales (NSW). The Partnerships in Aged-Care Emergency services using Interactive Telehealth (PACE-IT) project enhances ACE by incorporating interactive video assessment and consultation. The PACE-IT project's primary aim is to assess whether augmentation of ACE services through the addition of protocol-guided interactive Visual Telehealth Consultation (VTC) for clinical decision-making, plus telephone follow-up, reduces RACF resident transfers to ED. METHODS:A stepped-wedge cluster randomised controlled trial will be conducted. The intervention will be delivered sequentially to 8 clusters; each cluster comprises one ED and two RACFs in NSW, Australia. The 16 RACFs in the study will be selected for order of implementation using a computer-generated randomisation sequence. A 2-step randomisation process will be undertaken, randomising the hospital EDs first and then randomising the RACFs aligned with each hospital. The PACE-IT intervention comprises: an initial phone call by RACFs to the ACE service in the ED; the ACE service in ED responds with a protocol-guided VTC, a management plan agreed between all participants; an automated consultation summary letter to the General Practitioner and the RACF; a post VTC 24 h follow-up phone call to the RACF. DISCUSSION:If shown to be effective, the intervention has the potential to improve the clinical care and quality of life for residents. Findings will provide high level evidence that will inform sustainable change and broad translation into practice across NSW. It will show how the change has been achieved and highlight success factors for scalability and sustainability. It will inform review of processes, the development of policy and guidelines that will integrate PACE-IT into existing service models in NSW. TRIAL REGISTRATION:The trial is registered with the Australian New Zealand Clinical Trials Registry (Trial ID ACTR N12619001692123 ) 02/12/2020.)

Complete genome sequence of the Medicago microsymbiont Ensifer (Sinorhizobium) medicae strain WSM419

Ensifer (Sinorhizobium) medicae is an effective nitrogen fixing microsymbiont of a diverse range of annual Medicago (medic) species. Strain WSM419 is an aerobic, motile, non-spore forming, Gram-negative rod isolated from a M. murex root nodule collected in Sardinia, Italy in 1981. WSM419 was manufactured commercially in Australia as an inoculant for annual medics during 1985 to 1993 due to its nitrogen fixation, saprophytic competence and acid tolerance properties. Here we describe the basic features of this organism, together with the complete genome sequence, and annotation. This is the first report of a complete genome se-quence for a microsymbiont of the group of annual medic species adapted to acid soils. We reveal that its genome size is 6,817,576 bp encoding 6,518 protein-coding genes and 81 RNA only encoding genes. The genome contains a chromosome of size 3,781,904 bp and 3 plasmids of size 1,570,951 bp, 1,245,408 bp and 219,313 bp. The smallest plasmid is a fea-ture unique to this medic microsymbiont

Blurred Boundaries: Gender and Work-Family Interference in Cross-National Context

Although well theorized at the individual level, previous research has neglected the role of national context in shaping overall levels of nonwork-work and work-nonwork interference. This study fills this gap by examining how a national context of gender empowerment affects the likelihood of experiencing nonwork-work and work-nonwork interference at the individual and national levels. Controlling for individual-level differences in the distribution of job demands and resources, results from our multilevel models indicate that women's empowerment has significant net gender and parenthood effects on nonwork-work interference. By contrast, gender empowerment equally structures work-nonwork interference for these groups. Our results highlight the need to investigate interference bidirectionally and in a multilevel context. © The Author(s) 2013

Convexity in partial cubes: the hull number

We prove that the combinatorial optimization problem of determining the hull number of a partial cube is NP-complete. This makes partial cubes the minimal graph class for which NP-completeness of this problem is known and improves some earlier results in the literature. On the other hand we provide a polynomial-time algorithm to determine the hull number of planar partial cube quadrangulations. Instances of the hull number problem for partial cubes described include poset dimension and hitting sets for interiors of curves in the plane. To obtain the above results, we investigate convexity in partial cubes and characterize these graphs in terms of their lattice of convex subgraphs, improving a theorem of Handa. Furthermore we provide a topological representation theorem for planar partial cubes, generalizing a result of Fukuda and Handa about rank three oriented matroids.Comment: 19 pages, 4 figure

CD-independent subsets in meet-distributive lattices

A subset $X$ of a finite lattice $L$ is CD-independent if the meet of any two incomparable elements of $X$ equals 0. In 2009, Cz\'edli, Hartmann and Schmidt proved that any two maximal CD-independent subsets of a finite distributive lattice have the same number of elements. In this paper, we prove that if $L$ is a finite meet-distributive lattice, then the size of every CD-independent subset of $L$ is at most the number of atoms of $L$ plus the length of $L$. If, in addition, there is no three-element antichain of meet-irreducible elements, then we give a recursive description of maximal CD-independent subsets. Finally, to give an application of CD-independent subsets, we give a new approach to count islands on a rectangular board.Comment: 14 pages, 4 figure

Viral population estimation using pyrosequencing

The diversity of virus populations within single infected hosts presents a major difficulty for the natural immune response as well as for vaccine design and antiviral drug therapy. Recently developed pyrophosphate based sequencing technologies (pyrosequencing) can be used for quantifying this diversity by ultra-deep sequencing of virus samples. We present computational methods for the analysis of such sequence data and apply these techniques to pyrosequencing data obtained from HIV populations within patients harboring drug resistant virus strains. Our main result is the estimation of the population structure of the sample from the pyrosequencing reads. This inference is based on a statistical approach to error correction, followed by a combinatorial algorithm for constructing a minimal set of haplotypes that explain the data. Using this set of explaining haplotypes, we apply a statistical model to infer the frequencies of the haplotypes in the population via an EM algorithm. We demonstrate that pyrosequencing reads allow for effective population reconstruction by extensive simulations and by comparison to 165 sequences obtained directly from clonal sequencing of four independent, diverse HIV populations. Thus, pyrosequencing can be used for cost-effective estimation of the structure of virus populations, promising new insights into viral evolutionary dynamics and disease control strategies.Comment: 23 pages, 13 figure

kk-Critical Graphs in P5P_5-Free Graphs

Given two graphs $H_1$ and $H_2$, a graph $G$ is $(H_1,H_2)$-free if it contains no induced subgraph isomorphic to $H_1$ or $H_2$. Let $P_t$ be the path on $t$ vertices. A graph $G$ is $k$-vertex-critical if $G$ has chromatic number $k$ but every proper induced subgraph of $G$ has chromatic number less than $k$. The study of $k$-vertex-critical graphs for graph classes is an important topic in algorithmic graph theory because if the number of such graphs that are in a given hereditary graph class is finite, then there is a polynomial-time algorithm to decide if a graph in the class is $(k-1)$-colorable. In this paper, we initiate a systematic study of the finiteness of $k$-vertex-critical graphs in subclasses of $P_5$-free graphs. Our main result is a complete classification of the finiteness of $k$-vertex-critical graphs in the class of $(P_5,H)$-free graphs for all graphs $H$ on 4 vertices. To obtain the complete dichotomy, we prove the finiteness for four new graphs $H$ using various techniques -- such as Ramsey-type arguments and the dual of Dilworth's Theorem -- that may be of independent interest.Comment: 18 page