Development and validation of a casemix classification to predict costs of specialist palliative care provision across inpatient hospice, hospital and community settings in the UK: a study protocol

Introduction Provision of palliative care is inequitable with wide variations across conditions and settings in the UK. Lack of a standard way to classify by case complexity is one of the principle obstacles to addressing this. We aim to develop and validate a casemix classification to support the prediction of costs of specialist palliative care provision.Methods and analysis Phase I: A cohort study to determine the variables and potential classes to be included in a casemix classification. Data are collected from clinicians in palliative care services across inpatient hospice, hospital and community settings on: patient demographics, potential complexity/casemix criteria and patient-level resource use. Cost predictors are derived using multivariate regression and then incorporated into a classification using classification and regression trees. Internal validation will be conducted by bootstrapping to quantify any optimism in the predictive performance (calibration and discrimination) of the developed classification. Phase II: A mixed-methods cohort study across settings for external validation of the classification developed in phase I. Patient and family caregiver data will be collected longitudinally on demographics, potential complexity/casemix criteria and patient-level resource use. This will be triangulated with data collected from clinicians on potential complexity/casemix criteria and patient-level resource use, and with qualitative interviews with patients and caregivers about care provision across difference settings. The classification will be refined on the basis of its performance in the validation data set.Ethics and dissemination The study has been approved by the National Health Service Health Research Authority Research Ethics Committee. The results are expected to be disseminated in 2018 through papers for publication in major palliative care journals; policy briefs for clinicians, commissioning leads and policy makers; and lay summaries for patients and public

d dimensional SO(d)-Higgs Models with Instanton and Sphaleron: d=2,3

The Abelian Higgs model and the Georgi-Glashow model in 2 and 3 Euclidean dimensions respectively, support both finite size instantons and sphalerons. The instantons are the familiar Nielsen-Oleson vortices and the 't Hooft-Polyakov monopole solutions respectively. We have constructed the sphaleron solutions and calculated the Chern-Simons charges N_cs for sphalerons of both models and have constructed two types of noncontractible loops between topologically distinct vacuua. In the 3 dimensional model, the sphaleron and the vacuua have zero magnetic and electric flux while the configurations on the loops have non vanishing magnetic flux.Comment: 24 pages, 3 figures, LaTe

A novel genetic variant of Streptococcus pneumoniae serotype 11A discovered in Fiji.

OBJECTIVES: As part of annual cross-sectional Streptococcus pneumoniae carriage surveys in Fiji (2012-2015), we detected pneumococci in over 100 nasopharyngeal swabs that serotyped as '11F-like' by microarray. We examined the genetic basis of this divergence in the 11F-like capsular polysaccharide (cps) locus compared to the reference 11F cps sequence. The impact of this diversity on capsule phenotype, and serotype results using genetic and serologic methods were determined. METHODS: Genomic DNA from representative 11F-like S. pneumoniae isolates obtained from the nasopharynx of Fijian children was extracted and subject to whole genome sequencing. Genetic and phylogenetic analyses were used to identify genetic changes in the cps locus. Capsular phenotypes were evaluated using the Quellung reaction and latex agglutination. RESULTS: Compared to published 11F sequences, the wcwC and wcrL genes of the 11F-like cps locus are phylogenetically divergent, and the gct gene contains a single nucleotide insertion within a homopolymeric region. These changes within the DNA sequence of the 11F-like cps locus have modified the antigenic properties of the capsule, such that 11F-like isolates serotype as 11A by Quellung reaction and latex agglutination. CONCLUSIONS: This study demonstrates the ability of molecular serotyping by microarray to identify genetic variants of S. pneumoniae and highlights the potential for discrepant results between phenotypic and genotypic serotyping methods. We propose that 11F-like isolates are not a new serotype but rather are a novel genetic variant of serotype 11A. These findings have implications for invasive pneumococcal disease surveillance as well as studies investigating vaccine impact

A systematic review of the effects of exercise interventions on body composition in HIV+ adults

Over the years, physical activity and exercise have been used to positively impact the health and quality of life of persons infected with HIV and, more recently, has been associated with a spectrum of body composition changes. The aim of this review was to examine the effects of various exercise interventions on body composition in HIV positive adults, using a search strategy of randomized, controlled trials (RCTs). A systematic review was performed by five independent reviewers using a predetermined protocol adapted from previous research for assessing the articles for inclusion, the extracted data, and methodological quality. Eight RCTs involving 430 (26% female) HIV positive adults performing exercise a minimum of thrice weekly for at least six weeks were finally selected: Four were progressive resistance training (PRT) studies, three were aerobic training (AT) studies, and one involved yoga. In the PRT studies, there were significant increases in three anthropometric measures, namely, body mass, sum of skinfolds and sum of limb girths. In the AT studies, significant decreases were found in seven anthropometric measures, namely, body mass index, waist-hip ratio, body mass, triceps skinfold, waist circumference and sum of skinfolds. With yoga, the changes were nonsignificant. Exercise contributes to improved body composition and, when applied safely, appears to be beneficial for adults living with HIV/AIDS. However, these findings should be interpreted cautiously due to the relatively few RCTs published to date. Future studies would benefit from increased attention to sample size, female participants, participant follow-up, complete statistical analysis and intention-to-treat analysis.Scopu

The non-adoption of supply chain management

This is an Accepted Manuscript of an article published by Taylor & Francis in Construction Management and Economics on 10th October 2013, available online: http://wwww.tandfonline.com/10.1080/01446193.2013.830186.Largely taken for granted within the UK construction sector has been a view that supply chain management theory is robust, relevant and reliable. As such it has formed a substantial aspect of previous and contemporary policy and government funded research. Despite this, the general view of its development and diffusion over the last 15 years within the construction industry has been problematic. Coincidentally, prevailing debates within the supply chain management academic community point to the lack of unified theory, models of diffusion and strong connections to organization theory. Using Straussian grounded theory, iterations between data and organization theory provided a fresh perspective on the development and diffusion of supply chain management in construction. This inductive research provided contextually rich explanations for development and diffusion that explicitly connected with and drew upon robust, relevant and reliable theories of institutions, innovation diffusion, triads, quasifirms and mechanisms of organizational governance. These explanations challenge the simplistic assumption that chains and networks of organizations are holistically managed and controlled by any single organization or institution in the construction industry. The debate therefore shifts away from proselytizing supply chain management towards research that explores the rigour, relevance and reliability of supply chain management assumptions in construction. The gap between industry practice and policy is exposed and the question is posed: to what extent policy and practice do, or should, constitute a recursive relationship.© 2013 Taylor & Francis

Measurements of differential production cross sections for a Z boson in association with jets in pp collisions at root s=8 TeV

Peer reviewe

A search for prompt lepton-jets in pp collisions at root s=8 TeV with the ATLAS detector

A search is presented for a new, light boson with a mass of about 1 GeV and decaying promptly to jets of collimated electrons and/or muons (lepton-jets). The analysis is performed with 20.3 fb−1 of data collected by the ATLAS detector at the Large Hadron Collider in proton-proton collisions at a centre-of-mass energy of 8 TeV. Events are required to contain at least two lepton-jets. This study finds no statistically significant deviation from predictions of the Standard Model and places 95% confidence-level upper limits on the contribution of new phenomena beyond the SM, incuding SUSY-portal and Higgs-portal models, on the number of events with lepton-jets.We acknowledge the support of ANPCyT, Argentina; YerPhI, Armenia; ARC, Australia; BMWFW and FWF, Austria; ANAS, Azerbaijan; SSTC, Belarus; CNPq and FAPESP, Brazil; NSERC, NRC and CFI, Canada; CERN; CONICYT, Chile; CAS, MOST and NSFC, China; COLCIENCIAS, Colombia; MSMT CR, MPO CR and VSC CR, Czech Republic; DNRF, DNSRC and Lundbeck Foundation, Denmark; IN2P3-CNRS, CEADSM/IRFU, France; GNSF, Georgia; BMBF, HGF, and MPG, Germany; GSRT, Greece; RGC, Hong Kong SAR, China; ISF, I-CORE and Benoziyo Center, Israel; INFN, Italy; MEXT and JSPS, Japan; CNRST, Morocco; FOM and NWO, Netherlands; RCN, Norway; MNiSW and NCN, Poland; FCT, Portugal; MNE/IFA, Romania; MES of Russia and NRC KI, Russian Federation; JINR; MESTD, Serbia; MSSR, Slovakia; ARRS and MIZ. S, Slovenia; DST/NRF, South Africa; MINECO, Spain; SRC and Wallenberg Foundation, Sweden; SERI, SNSF and Cantons of Bern and Geneva, Switzerland; MOST, Taiwan; TAEK, Turkey; STFC, United Kingdom; DOE and NSF, United States of America. In addition, individual groups and members have received support from BCKDF, the Canada Council, CANARIE, CRC, Compute Canada, FQRNT, and the Ontario Innovation Trust, Canada; EPLANET, ERC, FP7, Horizon 2020 and Marie Sklodowska-Curie Actions, European Union; Investissements d'Avenir Labex and Idex, ANR, Region Auvergne and Fondation Partager le Savoir, France; DFG and AvH Foundation, Germany; Herakleitos, Thales and Aristeia programmes co-financed by EU-ESF and the Greek NSRF; BSF, GIF and Minerva, Israel; BRF, Norway; the Royal Society and Leverhulme Trust, United Kingdom

Search for the production of single vector-like and excited quarks in the Wt final state in pp collisions at √s=8 TeV with the ATLAS detector

A search for vector-like quarks and excited quarks in events containing a top quark and a W boson in the final state is reported here. The search is based on 20.3 fb−1 of proton-proton collision data taken at the LHC at a centre-of-mass energy of 8 TeV recorded by the ATLAS detector. Events with one or two leptons, and one, two or three jets are selected with the additional requirement that at least one jet contains a b-quark. Single-lepton events are also required to contain at least one large-radius jet from the hadronic decay of a high-pTW boson or a top quark. No significant excess over the expected background is observed and upper limits on the cross-section times branching ratio for different vector-like quark and excited-quark model masses are derived. For the excited-quark production and decay to Wt with unit couplings, quarks with masses below 1500 GeV are excluded and coupling-dependent limits are set

Integrating social–ecological vulnerability assessments with climate forecasts to improve local climate adaptation planning for coral reef fisheries in Papua New Guinea

A major gap exists in integrating climate projections and social–ecological vulnerability analyses at scales that matter, which has affected local-scale adaptation planning and actions to date. We address this gap by providing a novel methodology that integrates information on: (i) the expected future climate, including climate-related extreme events, at the village level; (ii) an ecological assessment of the impacts of these climate forecasts on coral reefs; and (iii) the social adaptive capacity of the artisanal fishers, to create an integrated vulnerability assessment on coastal communities in five villages in Papua New Guinea. We show that, despite relatively proximate geographies, there are substantial differences in both the predicted extreme rainfall and temperature events and the social adaptive capacity among the five fishing-dependent communities, meaning that they have likely different vulnerabilities to future climate change. Our methodology shows that it is possible to capture social information and integrate this with climate and ecological modeling in ways that are best suited to address the impacts of climate-mediated environmental changes currently underway across different scales