Promoting Digital Innovation for Sustainability in the Public Sector

Digital technologies and their uptake in society have advanced more rapidly than any innovation in history. However, research into how the public sector uses digital innovation has been slow to develop. Government has an essential role to play in sustainability by setting and enforcing policies around subjects such as pollution and carbon taxes, making digital innovation in government critical for digital sustainability. Further, the public sector’s values and priorities differ from those of the private sector, which confounds simple comparisons in areas such as digital ways of working and efficiency drivers. This paper draws on the public management literature and uses an exploratory and interpretive field study of a leading digital government. The research identifies six barriers to digital innovation within the New South Wales government, a world-leader in digital integration. The barriers are: varying digital maturity, non-digital mindset, slow mobilization, service-based silos, premature solutioning, and failure to align investment in digital innovation with broader government priorities. The paper identifies initiatives enabling world-class digital innovation and driving effective change. These enablers are structural service integration, ecosystem engagement, technology modernization, customer-centric strategies and processes, and agility in management. This paper finds that digital capability gaps and core rigidities interact requiring a comprehensive approach to realize the significant benefits offered to citizens and the environment

The Discharge Companion Program: An Interprofessional Collaboration in Transitional Care Model Delivery

To reduce readmission rates and avoid financial penalties from the Centers for Medicare and Medicaid Services, hospitals are seeking to implement innovative transitions of care (TOC) programs. This retrospective study evaluated the Discharge Companion Program (DCP), a pharmacist- and nurse-coordinated interprofessional, collaborative TOC program. Adult patients (18 years and older) from a single hospital, discharged with at least one qualifying diagnosis, were eligible for this service. The hospital transitional care coordinator nurse referred qualified patients to the DCP nurse coordinator, who scheduled telephonic medication therapy management (MTM) reviews with the DCP pharmacist at one- and three-weeks postdischarge. Hospital records and DCP documentation were reviewed to describe respective interventions and assess the impact on 30-day readmissions. A total of 456 patients were referred to the DCP between 31 August, 2015 and 7 September, 2016. Of the 340 patients who participated (DCP group), 44 (13%) compared to 17% (n = 20) of the usual care, were readmitted within 30-days postdischarge. The DCP pharmacists conducted 1242 clinical interventions with participants, demonstrating the benefits of an interprofessional TOC model involving multiple, pharmacist-delivered MTM intervention touchpoints within 30 days post-hospital discharge.SinfoniaRxOpen access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Novel real-time PCR species identification assays for British and Irish bats and their application to a non-invasive survey of bat roosts in Ireland

Detection and monitoring of extant bat populations are crucial for conservation success. Non-invasive genetic analysis of bat droppings collected at roosts could be very useful in this respect as a rapid, cost‐efficient monitoring tool. We developed species‐specific real-time PCR assays for 18 British and Irish bat species to enable non‐invasive, large‐scale distribution monitoring, which were then applied to a field survey in Ireland. One hundred and sixty-four DNA samples were collected from 95 bat roosts, of which 73% of samples were identified to species, and the resident bat species were identified at 89% of roosts. However, identification success varied between roost types, ranging from 22% for underground sites to 92% for bat boxes. This panel of DNA tests will be especially useful in cases where roosts contain multiple species, where the number of bats present is small, or bats are otherwise difficult to directly observe. The methodology could be applied to the surveillance of proposed development sites, post development mitigation measures, distribution surveys, bat box schemes and the evaluation of agri-environmental bat box schemes

Progenitor cell markers predict outcome of patients with hepatocellular carcinoma beyond Milan criteria undergoing liver transplantation.

BACKGROUND & AIMS: In patients with hepatocellular carcinoma (HCC), liver transplantation (LT) is an excellent therapy if tumor characteristics are within the Milan criteria. We aimed to define genomic features enabling to identify HCC patients beyond Milan criteria who have acceptable transplant outcomes. METHODS: Among 770 consecutive HCC patients transplanted between 1990 and 2013, 132 had tumors exceeding Milan criteria on pathology and were enrolled in the study; 44% of the patients satisfied the 'up-to-7 rule' [7=sum of the size of the largest tumor and the number of tumors]. Explant tumors were assessed for genomic signatures and immunohistochemical markers associated with poor outcome. RESULTS: At a median follow-up of 88months, 64 patients had died and 45 recurred; the 5-year overall survival (OS) and recurrence rates were 57% and 35%, respectively. Cytokeratin 19 (CK19) gene signature was independently associated with recurrence [Hazard ratio (HR)=2.95, p<0.001], along with tumor size (HR=3.37, p=0.023) and presence of satellites (HR=2.98, p=0.001). S2 subclass signature was independently associated with poor OS (HR=3.18, p=0.001), along with tumor size (HR=5.06, p<0.001) and up-to-7 rule (HR=2.50, p=0.002). Using the presence of progenitor cell markers (either CK19 or S2 signatures) patients were classified into poor prognosis (n=58; 5-year recurrence 53%, survival 45%) and good prognosis (n=74; 5-year recurrence 19%, survival 67%) (HR=3.16, p<0.001 for recurrence, and HR=1.72, p=0.04 for OS). CONCLUSIONS: HCC patients transplanted beyond Milan criteria without gene signatures of progenitor markers (CK19 and S2) achieved survival rates similar as those within Milan criteria. Once prospectively validated, these markers may support a limited expansion of LT indications

Simple Models of Metal-Line Absorption and Emission from Cool Gas Outflows

We analyze the absorption and emission-line profiles produced by a set of simple, cool gas wind models motivated by galactic-scale outflow observations. We implement monte carlo radiative transfer techniques that track the propagation of scattered and fluorescent photons to generate 1D spectra and 2D spectral images. We focus on the MgII 2796,28303 doublet and FeII UV1 multiplet at ~2600A, but the results are applicable to other transitions that trace outflows (e.g. NaI, Lya, SiII). By design, the resonance transitions show blue-shifted absorption but one also predicts strong resonance and fine-structure line-emission at roughly the systemic velocity. This line-emission `fills-in' the absorption reducing the equivalent width by up to 50%, shift the absorption-lin centroid by tens of km/s, and reduce the effective opacity near systemic. Analysis of cool gas outflows that ignores this line-emission may incorrectly infer that the gas is partially covered, measure asignificantly lower peak optical depth, and/or conclude that gas at systemic velocity is absent. Because the FeII lines are connected by optically-thin transitions to fine-structure levels, their profiles more closely reproduce the intrinsic opacity of the wind. Together these results naturally explain the absorption and emission-line characteristics observed for star-forming galaxies at z<1. We also study a scenario promoted to describe the outflows of z~3 Lyman break galaxies and find prfiles inconsistent with the observations due to scattered photon emission. Although line-emission complicates the analysis of absorption-line profiles, the surface brightness profiles offer a unique means of assessing the morphology and size of galactic-scale winds. Furthermore, the kinematics and line-ratios offer powerful diagnostics of outflows, motivating deep, spatially-extended spectroscopic observations.Comment: 26 pages, 26 figures. Accepted to the Astrophysical Journa

Human papillomavirus (HPV) related Oropharynx Cancer in the United Kingdom – An evolution in the understanding of disease aetiology

A rising incidence of oropharyngeal squamous cell carcinoma (OPSCC) incidence has occurred throughout the developed world, where it has been attributed to an increasing impact of human papillomavirus (HPV) on disease etiology. This report presents the findings of a multicenter cross-sectional retrospective study aimed at determining the proportion of HPV-positive and HPV-negative OPSCC within the United Kingdom. Archival tumor tissue blocks from 1,602 patients previously diagnosed with OPSCC (2002-2011) were collated from 11 centers. HPV status was determined with three validated commercial tests to provide valid data for 1,474 cases in total. Corresponding national incidence data from the same decade were obtained from UK Cancer registries. The overall proportion of HPV+ OPSCC between 2002 and 2011 was 51.8% [95% confidence interval (CI), 49.3-54.4], and this remained unchanged throughout the decade [unadjusted RR = 1.00 (95% CI, 0.99-1.02)]. However, over the same period, the incidence of OPSCC in the broader UK population underwent a 2-fold increase [age-standardized rate 2002: 2.1 (95% CI, 1.9-2.2); 2011: 4.1 (95% CI, 4.0-4.3)]. Although the number of OPSCCs diagnosed within the United Kingdom from 2002 to 2011 nearly doubled, the proportion of HPV+ cases remained static at approximately 50%. Our results argue that the rapidly increasing incidence of OPSCC in the United Kingdom cannot be solely attributable to the influence of HPV. The parallel increase in HPV+ and HPV- cases we documented warrants further investigation, so that appropriate future prevention strategies for both types of disease can be implemented.</p

Democratization and gender-neutrality in English(es)

"Democratization" and "gender-neutrality" are two concepts commonly used in recent studies on language variation. While both concepts link linguistic phenomena to sociocultural changes, the extent to which they overlap and/or interact has not been studied in detail. In particular, not much is known about how linguistic changes related to democratization and gender-neutrality spread across registers or varieties of English, as well as whether speakers are aware of the changes that are taking place. In this paper we review the main theoretical issues regarding these concepts and relate them to the main findings in the articles in this issue, all of which study lexical and grammatical variation from a corpus-based perspective. Taken together, they help unveil some of the conscious and unconscious mechanisms that operate at the interface between democratization and gender-neutrality.Peer reviewe