Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network.

BACKGROUND: Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. METHOD: We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. RESULTS: We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR - Patients at risk of readmission and ACG - Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. CONCLUSIONS: Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don't change

Textural and sensory properties of a calcium-induced milk gel

The textural and sensory properties of a calcium-induced milk gel prepared by heating skim milk with 7-20 mM added calcium chloride were investigated. Gel strength and water holding capacity of the gel increased and syneresis decreased during storage at 7 °C for 28 days at all calcium concentrations. Sensory studies showed that the gels were acceptable at added calcium concentrations of 7-13.5 mM; at higher concentrations, the sensory scores were lower. Adding sugar and flavours did not affect formation of the gels but increased their sensory scores

A Common Love of Science: The One-Hundredth Meeting of the American Society of Ichthyologists and Herpetologists

One of the most important functions of an academic society such as the American Society of Ichthyologists and Herpetologists (ASIH) is to host conferences for colleagues to directly share and debate ideas and data. Academic society meetings have a long history that grew from social meetings of the privileged in the 16th and 17th centuries during which scientific topics were discussed. Scientific meetings of any nature can provide a stimulating environment to discuss and argue points (Unglow, 2002), as alluded to by Joseph Priestley (1733–1804) in the epigraph, which was written with fond memory of the Lunar Society meetings while he was in political exile (Priestley, 1793). In 1812, a gathering of local scientists formally established The Academy of Natural Sciences of Philadelphia (ANSP), a society “to occupy their leisure, in each other\u27s company, on subjects of natural science” for “the advancement and diffusion of useful, liberal human knowledge.” The founders agreed that the ANSP would be “perpetually exclusive of political, religious and national partialities, antipathies, preventions and prejudices” to avoid potential conflicts with “the interests of science” (Stroud, 1997: 227). With the rise and specialization of academic societies, a concomitant specialization of scientific gatherings followed. Narrowly focused meetings have an important role in advancing the field specific to their topic, but regular (i.e., annual) discipline-wide conferences are important for both the tangible (e.g., presentation of fact) and intangible (e.g., inspiration of new avenues of study) effects they have on the attendees. Conferences also allow attendees the opportunity to conduct Society business through board and committee meetings. In 2021, the ASIH held its 100th in-person meeting, the third and final centennial to be celebrated by this Society (2013 was the 100th year of the Society\u27s journal, Copeia, now Ichthyology & Herpetology, Smith and Mitchell, 2013; 2016 was the 100th year of the ASIH\u27s founding, Hilton and Crump, 2016). This paper celebrates this milestone of the ASIH, and reflects upon the history of the ASIH conferences

The Impact of Conservation on the Status of the World\u27s Vertebrates

Using data for 25,780 species categorized on the International Union for Conservation of Nature Red List, we present an assessment of the status of the world\u27s vertebrates. One-fifth of species are classified as Threatened, and we show that this figure is increasing: On average, 52 species of mammals, birds, and amphibians move one category closer to extinction each year. However, this overall pattern conceals the impact of conservation successes, and we show that the rate of deterioration would have been at least one-fifth again as much in the absence of these. Nonetheless, current conservation efforts remain insufficient to offset the main drivers of biodiversity loss in these groups: agricultural expansion, logging, overexploitation, and invasive alien species

Selective Modulation of α5 GABAA Receptors Exacerbates Aberrant Inhibition at Key Hippocampal Neuronal Circuits in APP Mouse Model of Alzheimer’s Disease

Selective negative allosteric modulators (NAMs), targeting α5 subunit-containing GABAA receptors (GABAARs) as potential therapeutic targets for disorders associated with cognitive deficits, including Alzheimer’s disease (AD), continually fail clinical trials. We investigated whether this was due to the change in the expression of α5 GABAARs, consequently altering synaptic function during AD pathogenesis. Using medicinal chemistry and computational modeling, we developed aqueous soluble hybrids of 6,6-dimethyl-3-(2-hydroxyethyl) thio-1-(thiazol-2-yl)-6,7-dihydro-2-benzothiophene-4(5H)-one, that demonstrated selective binding and high negative allosteric modulation, specifically for the α5 GABAAR subtypes in constructed HEK293 stable cell-lines. Using a knock-in mouse model of AD (APPNL−F/NL−F), which expresses a mutant form of human amyloid-β (Aβ), we performed immunofluorescence studies combined with electrophysiological whole-cell recordings to investigate the effects of our key molecule, α5-SOP002 in the hippocampal CA1 region. In aged APPNL−F/NL−F mice, selective preservation of α5 GABAARs was observed in, calretinin- (CR), cholecystokinin- (CCK), somatostatin- (SST) expressing interneurons, and pyramidal cells. Previously, we reported that CR dis-inhibitory interneurons, specialized in regulating other interneurons displayed abnormally high levels of synaptic inhibition in the APPNL−F/NL−F mouse model, here we show that this excessive inhibition was “normalized” to control values with bath-applied α5-SOP002 (1 μM). However, α5-SOP002, further impaired inhibition onto CCK and pyramidal cells that were already largely compromised by exhibiting a deficit of inhibition in the AD model. In summary, using a multi-disciplinary approach, we show that exposure to α5 GABAAR NAMs may further compromise aberrant synapses in AD. We, therefore, suggest that the α5 GABAAR is not a suitable therapeutic target for the treatment of AD or other cognitive deficits due to the widespread neuronal-networks that use α5 GABAARs

Low phase noise frequency synthesis for ultrastable X-band oscillators

In this letter, the design of a low phase noise frequency synthesizer is presented. The synthesizer was designed to produce four frequencies: 10 MHz, 100 MHz, 1 GHz and 10 GHz. The 1-GHz signal is produced by frequency division whereas the 100-MHz output is generated by phase-locking a low phase noise oscillator to the 1-GHz signal, hence significantly reducing its phase noise. Both residual and total phase noise measurements are presented.Waddah A. Al-Ashwal, Ashby Hilton, Andre N. Luiten, and John G. Hartnet

Physical Properties of (2) Pallas

We acquired and analyzed adaptive-optics imaging observations of asteroid (2) Pallas from Keck II and the Very Large Telescope taken during four Pallas oppositions between 2003 and 2007, with spatial resolution spanning 32-88 km (image scales 13-20 km/pix). We improve our determination of the size, shape, and pole by a novel method that combines our AO data with 51 visual light-curves spanning 34 years of observations as well as occultation data. The shape model of Pallas derived here reproduces well both the projected shape of Pallas on the sky and light-curve behavior at all the epochs considered. We resolved the pole ambiguity and found the spin-vector coordinates to be within 5 deg. of [long, lat] = [30 deg., -16 deg.] in the ECJ2000.0 reference frame, indicating a high obliquity of ~84 deg., leading to high seasonal contrast. The best triaxial-ellipsoid fit returns radii of a=275 km, b= 258 km, and c= 238 km. From the mass of Pallas determined by gravitational perturbation on other minor bodies [(1.2 +/- 0.3) x 10-10 Solar Masses], we derive a density of 3.4 +/- 0.9 g.cm-3 significantly different from the density of C-type (1) Ceres of 2.2 +/- 0.1 g.cm-3. Considering the spectral similarities of Pallas and Ceres at visible and near-infrared wavelengths, this may point to fundamental differences in the interior composition or structure of these two bodies. We define a planetocentric longitude system for Pallas, following IAU guidelines. We also present the first albedo maps of Pallas covering ~80% of the surface in K-band. These maps reveal features with diameters in the 70-180 km range and an albedo contrast of about 6% wrt the mean surface albedo.Comment: 16 pages, 8 figures, 6 table