A paediatric telecardiology service for district hospitals in south-east England: an observational study.

The attached article is a Publisher version of the final published version which may be accessed at the link below. Copyright © 2010 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health. All rights reservedOBJECTIVES: To compare caseloads of new patients assessed by paediatric cardiologists face-to-face or during teleconferences, and assess NHS costs for the alternative referral arrangements. DESIGN: Prospective cohort study over 15 months. SETTING: Four district hospitals in south-east England and a London paediatric cardiology centre. PATIENTS: Babies and children. INTERVENTION: A telecardiology service introduced alongside outreach clinics. MEASUREMENTS: Clinical outcomes and mean NHS costs per patient. RESULTS: 266 new patients were studied: 75 had teleconsultations (19 of 42 newborns and 56 of 224 infants and children). Teleconsultation patients generally were younger (49% being under 1 year compared with 32% seen personally (p = 0.025)) and their symptoms were not as severe. A cardiac intervention was undertaken immediately or planned for five telemedicine patients (7%) and 30 conventional patients (16%). However, similar proportions of patients were discharged after being assessed (32% telemedicine and 39% conventional). During scheduled teleconferences the mean duration of time per patient in sessions involving real-time echocardiography was 14.4 min, and 8.5 min in sessions where pre-recorded videos were transmitted. Mean cost comparisons for telemedicine and face-to-face patients over 14-day and 6-month follow-up showed the telecardiology service to be cost-neutral for the three hospitals with infrequently-held outreach clinics (1519 UK pounds vs 1724 UK pounds respectively after 14 days). CONCLUSION: Paediatric cardiology centres with small cadres of specialists are under pressure to cope with ever-expanding caseloads of new patients with suspected anomalies. Innovative use of telecardiology alongside conventional outreach services should suitably, and economically, enhance access to these specialists.The Department of Health and the Charitable Funds Committee of the Royal Brompton and Harefield NHS Trust funded the project

Experiments and Simulations of short-pulse laser-pumped extreme ultraviolet lasers

Recent experimental work on the development of extreme ultraviolet lasers undertaken using as the pumping source the VULCAN laser at the Rutherford Appleton Laboratory is compared to detailed simulations. It is shown that short duration (similar topicosecond) pumping can produce X-ray laser pulses of a few picosecond duration and that measurement of the emission from the plasma can give an estimate of the duration of the gain coefficient. The Ehybrid fluid and atomic physics code developed at the University of York is used to simulate X-ray laser gain and plasma emission. Two postprocessors to the Ehybrid code are utilized: 1) to raytrace the X-ray laser beam amplification and refraction and 2) to calculate the radiation emission in the kiloelectronvolt photon energy range. The raytracing and spectral simulations are compared, respectively, to measured X-ray laser output and the output of two diagnostics recording transverse X-ray emission. The pumping laser energy absorbed in the plasma is examined by comparing the simulations to experimental results. It is shown that at high pumping irradiance (>10(15) Wcm(-2)), fast electrons are produced by parametric processes in the preformed long scale-length plasmas. These fast electrons do not pump the population inversion and so pumping efficiency is reduced at high irradiance

Current state of antimicrobial stewardship in children’s hospital emergency departments

BACKGROUND Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described. OBJECTIVE To determine current ED involvement in children's hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs. METHODS A cross-sectional survey of 37 children's hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution. Items assessed included beliefs regarding ED antibiotic prescribing, ED prescribing resources, ASP methods used in the ED such as clinical decision support and clinical care guidelines, ED participation in ASP activities, and preferred methods for ED-based ASP implementation. RESULTS A total of 36 ASP leaders (97.3%) and 32 ED directors (86.5%) responded; the overall response rate was 91.9%. Most ASP leaders (97.8%) and ED directors (93.7%) agreed that creation of ED-based ASPs was necessary. ED resources for antibiotic prescribing were obtained via the Internet or electronic health records (EHRs) for 29 hospitals (81.3%). The main ASP activities for the ED included production of antibiograms (77.8%) and creation of clinical care guidelines for pneumonia (83.3%). The ED was represented on 3 hospital ASP committees (8.3%). No hospital ASPs actively monitored outpatient ED prescribing. Most ASP leaders (77.8%) and ED directors (81.3%) preferred implementation of ED-based ASPs using clinical decision support integrated into the EHR. CONCLUSIONS Although ED involvement in ASPs is limited, both ASP and ED leaders believe that ED-based ASPs are necessary. Many children's hospitals have the capability to implement ED-based ASPs via the preferred method: EHR clinical decision support. Infect Control Hosp Epidemiol 2017;38:469-475

Optimization with gradient-boosted trees and risk control

Decision trees effectively represent the sparse, high dimensional and noisy nature of chemical data from experiments. Having learned a function from this data, we may want to thereafter optimize the function, e.g., picking the best chemical process catalyst. In this way, we may repurpose legacy predictive models. This work studies a large-scale, industrially-relevant mixed-integer quadratic optimization problem involving: (i) gradient-boosted pre-trained regression trees modeling catalyst behavior, (ii) penalty functions mitigating risk, and (iii) penalties enforcing composition constraints. We develop heuristic methods and an exact, branch-and-bound algorithm leveraging structural properties of gradient-boosted trees and penalty functions. We numerically test our methods on an industrial instance

Assessment of HRV After Maximal Exercise in Trained Postmenopausal Women

Increased parasympathetic tone achieved with endurance training may provide cardioprotection after menopause. To compare heart rate variability (HRV) from rest through maximal exercise and recovery in trained postmenopausal women. Thirtysix postmenopausal women who self-reported training at either moderate (MOD; 3-5.9 METS; 58.9±4.4 year) or vigorous (VIG; \u3e6 METS; 59.7±5.2 year) intensities participated. HRV was measured for 5 min in the supine position, in the last minute of the VO2max test and after 2 min of active recovery. HRV in MOD and VIG was compared using a factorial ANOVA with repeated measures on time. MOD and VIG responded similarly over the three time periods for root mean square of sequential deviations (rMSSD), and high (HF) and low frequency (LF) power (p\u3e0.05). Maximal exercise lowered rMSSD (3.3±0.08 vs. 1.2±0.06) and lnLF (4.1±0.05 vs. 3.3±0.13) and increased lnHF (3.3±0.14 vs. 4.0±0.10; p\u3c0.01) from resting. However, active recovery restored lnHF (3.3±0.11) and lnLF (4.1±0.08) from maximal values (p\u3c0.01). Our findings suggest that moderate and vigorous exercise training may enhance HRV recovery following one bout of maximal exercise in older women