260 research outputs found
A prospective cohort study assessing clinical referral management & workforce allocation within a UK regional medical genetics service
Abstract
Ensuring patient access to genomic information in the face of increasing demand requires clinicians to develop innovative ways of working. This paper presents the first empirical prospective observational cohort study of UK multi-disciplinary genetic service delivery. It describes and explores collaborative working practices including the utilisation and role of clinical geneticists and non-medical genetic counsellors. Six hundred and fifty new patients referred to a regional genetics service were tracked through 850 clinical contacts until discharge. Referral decisions regarding allocation of lead health professional assigned to the case were monitored, including the use of initial clinical contact guidelines. Significant differences were found in the cases led by genetic counsellors and those led by clinical geneticists. Around a sixth, 16.8% (109/650) of referrals were dealt with by a letter back to the referrer or re-directed to another service provider and 14.8% (80/541) of the remaining patients chose not to schedule an appointment. Of the remaining 461 patients, genetic counsellors were allocated as lead health professional for 46.2% (213/461). A further 61 patients did not attend. Of those who did, 86% (345/400) were discharged after one or two appointments. Genetic counsellors contributed to 95% (784/825) of total patient contacts. They provided 93.7% (395/432) of initial contacts and 26.8% (106/395) of patients were discharged at that point. The information from this study informed a planned service re-design. More research is needed to assess the effectiveness and efficiency of different models of collaborative multi-disciplinary working within genetics services. Keywords (MeSH terms)
Genetic Services, Genetic Counseling, Interdisciplinary Communication, Cohort Studies, Delivery of Healthcare, Referral and Consultation
International Veterinary Epilepsy Task Force consensus proposal: Medical treatment of canine epilepsy in Europe
In Europe, the number of antiepileptic drugs (AEDs) licensed for dogs has grown considerably over the last years. Nevertheless, the same questions remain, which include, 1) when to start treatment, 2) which drug is best used initially, 3) which adjunctive AED can be advised if treatment with the initial drug is unsatisfactory, and 4) when treatment changes should be considered. In this consensus proposal, an overview is given on the aim of AED treatment, when to start long-term treatment in canine epilepsy and which veterinary AEDs are currently in use for dogs. The consensus proposal for drug treatment protocols, 1) is based on current published evidence-based literature, 2) considers the current legal framework of the cascade regulation for the prescription of veterinary drugs in Europe, and 3) reflects the authorsâ experience. With this paper it is aimed to provide a consensus for the management of canine idiopathic epilepsy. Furthermore, for the management of structural epilepsy AEDs are inevitable in addition to treating the underlying cause, if possible
Gamma Ray Flashes Produced by Lightning Observed at Ground Level by TETRA-II
In its first 2 years of operation, the ground-based Terrestrial gamma ray
flash and Energetic Thunderstorm Rooftop Array(TETRA)-II array of gamma ray
detectors has recorded 22 bursts of gamma rays of millisecond-scale duration
associated with lightning. In this study, we present the TETRA-II observations
detected at the three TETRA-II ground-level sites in Louisiana, Puerto Rico,
and Panama together with the simultaneous radio frequency signals from the
VAISALA Global Lightning Data set, VAISALA National Lightning Detection
Network, Earth Networks Total Lightning Network, and World Wide Lightning
Location Network. The relative timing between the gamma ray events and the
lightning activity is a key parameter for understanding the production
mechanism(s) of the bursts. The gamma ray time profiles and their correlation
with radio sferics suggest that the gamma ray events are initiated by lightning
leader activity and are produced near the last stage of lightning leader
channel development prior to the lightning return stroke.Comment: 10 pages, 9 figure
Gamma-ray observations of Tycho's SNR with VERITAS and Fermi
High-energy gamma-ray emission from supernova remnants (SNRs) has provided a
unique perspective for studies of Galactic cosmic-ray acceleration. Tycho's SNR
is a particularly good target because it is a young, type Ia SNR that is
well-studied over a wide range of energies and located in a relatively clean
environment. Since the detection of gamma-ray emission from Tycho's SNR by
VERITAS and Fermi-LAT, there have been several theoretical models proposed to
explain its broadband emission and high-energy morphology. We report on an
update to the gamma-ray measurements of Tycho's SNR with 147 hours of VERITAS
and 84 months of Fermi-LAT observations, which represents about a factor of two
increase in exposure over previously published data. About half of the VERITAS
data benefited from a camera upgrade, which has made it possible to extend the
TeV measurements toward lower energies. The TeV spectral index measured by
VERITAS is consistent with previous results, but the expanded energy range
softens a straight power-law fit. At energies higher than 400 GeV, the
power-law index is . It
is also softer than the spectral index in the GeV energy range, , measured by this study using
Fermi--LAT data. The centroid position of the gamma-ray emission is coincident
with the center of the remnant, as well as with the centroid measurement of
Fermi--LAT above 1 GeV. The results are consistent with an SNR shell origin of
the emission, as many models assume. The updated spectrum points to a lower
maximum particle energy than has been suggested previously.Comment: Accepted for publication in The Astrophysical Journa
Dark Matter Constraints from a Joint Analysis of Dwarf Spheroidal Galaxy Observations with VERITAS
We present constraints on the annihilation cross section of WIMP dark matter
based on the joint statistical analysis of four dwarf galaxies with VERITAS.
These results are derived from an optimized photon weighting statistical
technique that improves on standard imaging atmospheric Cherenkov telescope
(IACT) analyses by utilizing the spectral and spatial properties of individual
photon events. We report on the results of 230 hours of observations of
five dwarf galaxies and the joint statistical analysis of four of the dwarf
galaxies. We find no evidence of gamma-ray emission from any individual dwarf
nor in the joint analysis. The derived upper limit on the dark matter
annihilation cross section from the joint analysis is at 1 TeV for the bottom quark () final state,
at 1 TeV for the tau lepton
() final state and at 1 TeV for the gauge boson () final state.Comment: 14 pages, 9 figures, published in PRD, Ascii tables containing
annihilation cross sections limits are available for download as ancillary
files with readme.txt file description of limit
Gamma-ray Observations Under Bright Moonlight with VERITAS
Imaging atmospheric Cherenkov telescopes (IACTs) are equipped with sensitive
photomultiplier tube (PMT) cameras. Exposure to high levels of background
illumination degrades the efficiency of and potentially destroys these
photo-detectors over time, so IACTs cannot be operated in the same
configuration in the presence of bright moonlight as under dark skies. Since
September 2012, observations have been carried out with the VERITAS IACTs under
bright moonlight (defined as about three times the night-sky-background (NSB)
of a dark extragalactic field, typically occurring when Moon illumination >
35%) in two observing modes, firstly by reducing the voltage applied to the
PMTs and, secondly, with the addition of ultra-violet (UV) bandpass filters to
the cameras. This has allowed observations at up to about 30 times previous NSB
levels (around 80% Moon illumination), resulting in 30% more observing time
between the two modes over the course of a year. These additional observations
have already allowed for the detection of a flare from the 1ES 1727+502 and for
an observing program targeting a measurement of the cosmic-ray positron
fraction. We provide details of these new observing modes and their performance
relative to the standard VERITAS observations
Roadmap on Wilson loops in 3d Chern-Simons-matter theories
This is a compact review of recent results on supersymmetric Wilson loops in ABJ(M) and related theories. It aims to be a quick introduction to the state of the art in the field and a discussion of open problems. It is divided into short chapters devoted to different questions and techniques. Some new results, perspectives and speculations are also presented. We hope this might serve as a baseline for further studies of this topic
Hereditary cancer risk assessment: insights and perspectives for the Next-Generation Sequencing era
Construction and Performance Monitoring of Various Asphalt Mixes in Illinois: 2016 Interim Report
series of five experimental projects were constructed to better determine the life-cycle cost and performance of pavement overlays using various levels of asphalt binder replacement (ABR) from use of reclaimed asphalt pavement (RAP), recycled asphalt shingles (RAS) and crushed concrete. The ABR varies from 15% to 48% in the experimental sections. The study of these projects prior to construction, during construction, and for a short monitoring period after construction is intended to determine the impact of various pavement conditions, pavement cross-section, mix design, and material properties on the ultimate performance of the hot-mix asphalt (HMA) overlay. This second interim report documents the construction and initial testing of three of the five projects in the studyânamely, Washington Street, US 52 (Laraway Road to Gougar Road) and US 52 (Gougar Road to Second Street)âwhich were constructed in 2015. Distress and profile surveys were conducted before and after construction. Samples were obtained of the HMA surface and binder courses and were tested for basic properties, plus Cantabro, stability/flow, Texas overlay cracking potential, fracture energy, Flexibility Index, fatigue, modulus, creep, and Hamburg rutting. Presented are early performance trends and baseline conditions that future performance can be compared with. Also included in this report is an update of performance on the sections constructed in 2014 and the total recycle asphalt (TRA) sections constructed in 2013.Illinois Department of Transportation, R27-161Ope
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