Extent of use of electronic records in children's primary care and public health in Europe

EHRs are widely seen as a key resource in modern health care. For children not only is primary care vital, but also case-based public health systems can help ensure that all children receive immunisation and other preventive programmes. A European study showed that in 2016 in the 30 EU and EEA countries, 19 countries had widespread use of EHRs in children's primary care, while 20 countries had case-based child public health systems. However, the results show a bias of disadvantage for poorer or smaller countries. More study is needed in this area

Nurses\u27 Alumnae Association Bulletin - Volume 2 Number 2

Coming Events Come On, \u2732 Ballot for Officers Hospital News Legislation Scholarship Fund Notes Refresher Course Correspondence Use of Heparin in Modern Treatment The Jefferson Medical College Library Nursing School Education Action - Camera - Seniors Degrees Received Engagements Weddings Births Deaths Attention Alumnae Bulletin Progress Of Special Interest Army Assignments Organized Staff Meeting

Trends in healthcare use in children aged less than 15 years; a population-based cohort study in England from 2007 to 2017

Objective To describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017 Design Population-based retrospective cohort study. Methods We used linked data from the Clinical Practice Research Datalink to study children’s primary care consultations and use of hospital care including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists. Results Between 1 April 2007 and 31 March 2017, there were 7 604 024 general practitioner (GP) consultations, 981 684 ED visits, 287 719 emergency hospital admissions, 2 253 533 outpatient visits and 194 034 elective admissions among 1 484 455 children aged less than 15 years. Age-standardised GP consultation rates fell (−1.0%/year) to 1864 per 1000 child-years in 2017 in all age bands except infants rising by 1%/year to 6722 per 1000/child-years in 2017. ED visit rates increased by 1.6%/year to 369 per 1000 child-years in 2017, with steeper rises of 3.9%/year in infants (780 per 1000 child-years in 2017). Emergency hospital admission rates rose steadily by 3%/year to 86 per 1000 child-years and outpatient visit rates rose to 724 per 1000 child-years in 2017. Conclusions Over the past decade since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children’s use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children

Evaluation of the North West London Diabetes Foot Care Transformation Project: a mixed-methods evaluation

Introduction: Diabetes foot ulceration (DFU) presents an enormous burden to those living with diabetes and to the local health systems and economies. There is an increasing interest in implementing integrated care models to enhance the quality of care for people living with diabetes and related complications and the value of co-production approaches to achieve sustainable change. This paper aims to describe the evaluation methodology for the North West London (NWL) Diabetes Foot Care Transformation project. Description: A mixed methods design including: i) a quasi-experimental quantitative analysis assessing the impact of the implementation of the local secondary care multi-disciplinary diabetes foot team clinics on service utilisation and clinical outcomes (amputations and number of healed patients); ii) a phenomenological, qualitative study to explore patient and staff experience; and iii) a within-trial cost-effectiveness analysis (pre and post 2017) to evaluate the programme cost-effectiveness. Discussion and Conclusion: Demonstrating the impact of multidisciplinary, integrated care models and the value of co-production approaches is important for health providers and commissioners trying to improve health outcome. Evaluation is also needed to identify strategies to overcome barriers which might have reduced the impact of the programme and key elements for improvement

What’s Worth Talking About? Information Theory Reveals How Children Balance Informativeness and Ease of Production

Of all the things we could say, what determines what is worth saying? Greenfield’s principle of informativeness states that, right from the onset of language, humans selectively comment on whatever they find unexpected. We quantify this tendency using information theoretic measures, and test the counterintuitive prediction that children will produce words that are low frequency given the context because these will be most informative. Using corpora of child directed speech, we identified adjectives that varied in how informative (i.e., unexpected) they were given the noun they modified. Three-year-olds (N=31, replication N=13) heard an experimenter use these adjectives to describe pictures. The children’s task was then to describe the pictures to another person. As the information content of the experimenter’s adjective increased, so did children’s tendency to comment on the feature that adjective had encoded. Furthermore, our analyses suggest that children balance this informativeness with a competing drive to ease production

Exercise to preserve beta cell function in recent-onset type 1 diabetes mellitus (EXTOD) - a study protocol for a pilot randomized controlled trial

BACKGROUND: Exercise has a beta cell preserving effect in patients with type 2 diabetes. This benefit of exercise has not been examined in type 1 diabetes. Significant beta cell function is present at the time of diagnosis of type 1 diabetes and therefore studies of beta cell preservation are ideally conducted immediately after diagnosis.Many of the variables required to design and power such a study are currently unknown. The aim of EXTOD is to obtain the information required to design a formal study of exercise and beta cell preservation in newly diagnosed patients with type 1 diabetes. METHODS: Barriers to exercise will initially be assessed in a qualitative study of newly diagnosed patients. Then, sixty newly diagnosed adult type 1 diabetes patients will be randomized to either conventional treatment or exercise, stratified on beta cell function and fitness. The exercise group will be encouraged to increase their level of activity to a minimum of 150 minutes of moderate to vigorous intensity exercise per week, aiming for 240 minutes per week of exercise for 12 months. Beta cell function will be measured by meal-stimulated C peptide. Primary outcomes are recruitment, adherence to exercise, loss to follow-up, and exercise levels in the non-intervention arm (contamination). The secondary outcome of the study is rate of loss of beta cell function. DISCUSSION: The outcomes of the EXTOD study will help define the barriers, uptake and benefits of exercise in adults newly diagnosed with type 1 diabetes. This information will enable design of a formal study to assess the effect of exercise on beta cell preservation in newly diagnosed patients with type 1 diabetes. TRIAL REGISTRATION: Current controlled trials ISRCTN91388505.Funding is provided by the Research for Patient Benefit (RfPB) stream of the National Institute for Health Research UK

Regulation of CD44 binding to hyaluronan by glycosylation of variably spliced exons

The hyaluronan (HA)-binding function (lectin function) of the leukocyte homing receptor, CD44, is tightly regulated. Herein we address possible mechanisms that regulate CD44 isoform-specific HA binding. Binding studies with melanoma transfectants expressing CD44H, CD44E, or with soluble immunoglobulin fusions of CD44H and CD44E (CD44H-Rg, CD44E-Rg) showed that although both CD44 isoforms can bind HA, CD44H binds HA more efficiently than CD44E. Using CD44-Rg fusion proteins we show that the variably spliced exons in CD44E, V8-V10, specifically reduce the lectin function of CD44, while replacement of V8-V10 by an ICAM-1 immunoglobulin domain restores binding to a level comparable to that of CD44H. Conversely, CD44 bound HA very weakly when exons V8-V10 were replaced with a CD34 mucin domain, which is heavily modified by O-linked glycans. Production of CD44E-Rg or incubation of CD44E-expressing transfectants in the presence of an O-linked glycosylation inhibitor restored HA binding to CD44H-Rg and to cell surface CD44H levels, respectively. We conclude that differential splicing provides a regulatory mechanism for CD44 lectin function and that this effect is due in part to O-linked carbohydrate moieties which are added to the Ser/Thr rich regions encoded by the variably spliced CD44 exons. Alternative splicing resulting in changes in protein glycosylation provide a novel mechanism for the regulation of lectin activit

Creativity and Autonomy in Swarm Intelligence Systems

This work introduces two swarm intelligence algorithms -- one mimicking the behaviour of one species of ants (\emph{Leptothorax acervorum}) foraging (a `Stochastic Diffusion Search', SDS) and the other algorithm mimicking the behaviour of birds flocking (a `Particle Swarm Optimiser', PSO) -- and outlines a novel integration strategy exploiting the local search properties of the PSO with global SDS behaviour. The resulting hybrid algorithm is used to sketch novel drawings of an input image, exploliting an artistic tension between the local behaviour of the `birds flocking' - as they seek to follow the input sketch - and the global behaviour of the `ants foraging' - as they seek to encourage the flock to explore novel regions of the canvas. The paper concludes by exploring the putative `creativity' of this hybrid swarm system in the philosophical light of the `rhizome' and Deleuze's well known `Orchid and Wasp' metaphor

Linearization of Cohomology-free Vector Fields

We study the cohomological equation for a smooth vector field on a compact manifold. We show that if the vector field is cohomology free, then it can be embedded continuously in a linear flow on an Abelian group

Visual art inspired by the collective feeding behavior of sand-bubbler crabs

Sand--bubblers are crabs of the genera Dotilla and Scopimera which are known to produce remarkable patterns and structures at tropical beaches. From these pattern-making abilities, we may draw inspiration for digital visual art. A simple mathematical model is proposed and an algorithm is designed that may create such sand-bubbler patterns artificially. In addition, design parameters to modify the patterns are identified and analyzed by computational aesthetic measures. Finally, an extension of the algorithm is discussed that may enable controlling and guiding generative evolution of the art-making process