Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge.

Enhanced recovery after surgery (ERAS) aims to improve perioperative care, hasten recovery to the normal physiological state and shorten length of stay (LoS). There is evidence that ERAS programmes following elective caesarean section (ELCS) confer benefit through faster return to physiological state and reduced LoS for mother and baby. Baseline audit of ELCS in 2013 revealed a mean LoS of 3 days. We piloted an ERAS discharge pathway promoting day 2 discharge, which rose from 5.0% to 40.2%. 19.2% of women went home on day 1. Many women fed back that they would prefer day 1 discharge. We hypothesised that a day 1 discharge pathway for low-risk women could benefit both women and services at our maternity unit. From October 2015, we developed a 'fast-track pathway' (FTP) using a Plan-Do-Study-Act approach. Between October 2015 and April 2016, we prospectively audited clinical outcomes, LoS and maternal satisfaction from all women placed on the FTP. We held regular multidisciplinary team meetings to allow contemporaneous analysis. Satisfaction was analysed by Likert scale at postoperative surveys. Women were identified in antenatal clinic after meeting predefined low-risk criteria. 27.3% of women (n=131/479) delivering by ELCS entered the FTP. 76.2% of women on the FTP were discharged on day 1. Mean LoS fell to 1.31 days. 94.2% of women who established breast feeding at day 1 were still breast feeding at 7 days. Overall satisfaction at day 7 was 4.71 on a 5-point Likert scale. 73.1% of women reported good pain control. Additional financial savings are estimated at £99 886 annually. There were no related cases of readmission. Day 1 discharge after ELCS is safe and acceptable in carefully selected, low-risk women and has high satisfaction. There may be resultant financial savings and improved flow through a maternity unit with no detected adverse effect on breast feeding, maternal morbidity or postnatal readmissions

Community Engagement in Drive Tourism: Case Study of the Wild Atlantic Way

This paper presents research which investigates community engagement with the Wild Atlantic Way (WAW) drive tourism product. This drive tourism product is Ireland’s first long distance drive touring route stretching along the Atlantic coast for 2500km on the western coastline from Donegal to West Cork. Qualitative interviews were employed with a representative sample of community members along the WAW. The results presented in this paper provide a deeper insight into community engagement with drive tourism on the WAW. The research revealed a high level of approval for the project but a low level of community-integrated involvement with the WAW. The research also identified community perspectives in relation to drive tourism in Ireland. Finally this paper concludes that while there are low levels of community engagement with the drive tourism product, there is a significant level of community support for the development of this drive tourism product in Ireland

Can Modal Skepticism Defeat Humean Skepticism?

My topic is moderate modal skepticism in the spirit of Peter van Inwagen. Here understood, this is a conservative version of modal empiricism that severely limits the extent to which an ordinary agent can reasonably believe “exotic” possibility claims. I offer a novel argument in support of this brand of skepticism: modal skepticism grounds an attractive (and novel) reply to Humean skepticism. Thus, I propose that modal skepticism be accepted on the basis of its theoretical utility as a tool for dissolving philosophical paradox

Angle-resolved photoemission and first-principles electronic structure of single-crystalline α\alpha-uranium (001)

Continuing the photoemission study begun with the work of Opeil et al. [Phys. Rev. B \textbf{73}, 165109 (2006)], in this paper we report results of an angle-resolved photoemission spectroscopy (ARPES) study performed on a high-quality single-crystal $\alpha$-uranium at 173 K. The absence of surface-reconstruction effects is verified using X-ray Laue and low-energy electron diffraction (LEED) patterns. We compare the ARPES intensity map with first-principles band structure calculations using a generalized gradient approximation (GGA) and we find good correlations with the calculated dispersion of the electronic bands

Measurements of the diffusion of iron and carbon in single crystal NiAl using ion implantation and secondary ion mass spectrometry

Classical diffusion measurements in intermetallic compounds are often complicated by low diffusivities or low solubilities of the elements of interest. Using secondary ion mass spectrometry for measurements over a relatively shallow spatial range may be used to solve the problem of low diffusivity. In order to simultaneously obtain measurements on important impurity elements with low solubilities, the authors have used ion implantation to supersaturate a narrow layer near the surface. Single crystal NiAl was implanted with either {sup 12}C or both {sup 56}Fe and {sup 12}C in order to investigate the measurement of substitutional (Fe) versus interstitial (C) tracer diffusion and the cross effect of both substitutional and interstitial diffusion. When C alone was implanted negligible diffusion was observed over the range of times and temperatures investigated. When both Fe and C were implanted together significantly enhanced diffusion of the C was observed, which is apparently associated with the movement of Fe. This supports one theory of dynamic strain aging in Fe alloys NiAl

Improvement of the realisation of the mass scale

The project 19RPT02“Improvement of the realisation of the mass scale”(EMPIR [1] Call 2019 –Energy, Environment, Normative and Research Potential)has just started.Its aim is to improve the quality of one of the most important tasksin mass metrology,the realisation of the mass scale. After the new definition of the kilogram this technique is getting more important

Interventions to Promote Cancer Awareness and Early Presentation: Systematic Review

Low cancer awareness contributes to delay in presentation for cancer symptoms and may lead to delay in cancer diagnosis. The aim of this study was to review the evidence for the effectiveness of interventions to raise cancer awareness and promote early presentation in cancer to inform policy and future research. We searched bibliographic databases and reference lists for randomised controlled trials of interventions delivered to individuals, and controlled or uncontrolled studies of interventions delivered to communities. We found some evidence that interventions delivered to individuals modestly increase cancer awareness in the short term and insufficient evidence that they promote early presentation. We found limited evidence that public education campaigns reduce stage at presentation of breast cancer, malignant melanoma and retinoblastoma

Investigation of Intestinal Atresia in a Jersey Sire Family

PEER-REVIEWEDIntestinal atresia is a congenital defect resulting in calf mortality within a few days of birth. This study focuses on two half-sibling Jersey sires who were identified as having a high proportion of their progeny exhibiting atresia from a longitudinal study of 39 dairy herds over an 8 year period. The objective of this study was to investigate the genetic cause of intestinal atresia within this family. Phased high-density genotypes of the two half-sibling sires were used to identify if common haplotypes were inherited by all affected animals. Whether or not the paternal haplotype that was inherited by the affected animal at a given locus deviated from the expectation was tested. A total of 16 SNPs were significantly overrepresented, 14 located in one region on chromosome 14 and the remaining 2 located in one region on chromosome 26

Heterozygote Advantage for Fecundity

Heterozygote advantage, or overdominance, remains a popular and persuasive explanation for the maintenance of genetic variation in natural populations in the face of selection. However, despite being first proposed more than 80 years ago, there remain few examples that fit the criteria for heterozygote advantage, all of which are associated with disease resistance and are maintained only in the presence of disease or other gene-by-environment interaction. Here we report five new examples of heterozygote advantage, based around polymorphisms in the BMP15 and GDF9 genes that affect female fecundity in domesticated sheep and are not reliant on disease for their maintenance. Five separate mutations in these members of the transforming growth factor β (TGFβ) superfamily give phenotypes with fitness differentials characteristic of heterozygous advantage. In each case, one copy of the mutant allele increases ovulation rate, and ultimately litter size per ewe lambing, relative to the wildtype. However, homozygous ewes inheriting mutant alleles from both parents have impaired oocyte development and maturation, which results in small undeveloped ovaries and infertility. Using data collected over many years on ovulation rates, litter size, and lambing rates, we have calculated the equilibrium solution for each of these polymorphisms using standard population genetic theory. The predicted equilibrium frequencies obtained for these mutant alleles range from 0.11 to 0.23, which are amongst the highest yet reported for a polymorphism maintained by heterozygote advantage. These are amongst the most frequent and compelling examples of heterozygote advantage yet described and the first documented examples of heterozygote advantage that are not reliant on a disease interaction for their maintenance