Patient safety in transitional care of the elderly: effects of a quasi-experimental interorganisational educational intervention

Objective The study objective was to assess the effects of an interorganisational educational intervention called the ‘Meeting Point’ on patient safety culture among staff in hospital and nursing home wards. Design The study employs a quasi-experimental, non-randomised design with a hospital and nursing home intervention group and a hospital and nursing home control group. The study uses one preintervention and two postintervention survey measurements. The intervention group participated in an educational programme ‘The Meeting Point’ including interorganisational staff meetings combining educational sessions with a discussion platform focusing on quality and safety in transitional care of the elderly. Results The results show a stable development over time for the patient safety culture factor ‘Handoff and transitions’, and small improvements for ‘Overall perceptions of patient safety culture’ and ‘Organisational learning - continuous improvement’ for the hospital intervention group. No similar development was reported in the nursing home intervention group, which is most likely explained by ongoing organisational changes. Qualitative data show the existence of ongoing initiatives in the hospital to improve transitional care, but not all were connected to the ‘Meeting Point’. Conclusion The ‘Meeting Point’ has the potential to be a useful measure for healthcare professionals when aiming to improve patient safety culture in transitional care. Further refinement of the key components and testing with a more robust study design will be beneficial.publishedVersio

Spectroscopy of the stellar wind in the Cygnus X-1 system

The X-ray luminosity of black holes is produced through the accretion of material from their companion stars. Depending on the mass of the donor star, accretion of the material falling onto the black hole through the inner Lagrange point of the system or accretion by the strong stellar wind can occur. Cygnus X-1 is a high mass X-ray binary system, where the black hole is powered by accretion of the stellar wind of its supergiant companion star HDE226868. As the companion is close to filling its Roche lobe, the wind is not symmetric, but strongly focused towards the black hole. Chandra-HETGS observations allow for an investigation of this focused stellar wind, which is essential to understand the physics of the accretion flow. We compare observations at the distinct orbital phases of 0.0, 0.2, 0.5 and 0.75. These correspond to different lines of sights towards the source, allowing us to probe the structure and the dynamics of the wind.Comment: conference proceeding from Integral/Bart Workshop Karlsbad, CZ, 14.4-18.4 201

Non-linear Hypothesis Testing of Geometric Object Properties of Shapes Applied to Hippocampi

This paper presents a novel method to test mean differences of geometric object properties (GOPs). The method is designed for data whose representations include both Euclidean and non-Euclidean elements. It is based on advanced statistical analysis methods such as backward means on spheres. We develop a suitable permutation test to find global and simultaneously individual morphological differences between two populations based on the GOPs. To demonstrate the sensitivity of the method, an analysis exploring differences between hippocampi of first-episode schizophrenics and controls is presented. Each hippocampus is represented by a discrete skeletal representation (s-rep). We investigate important model properties using the statistics of populations. These properties are highlighted by the s-rep model that allows accurate capture of the object interior and boundary while, by design, being suitable for statistical analysis of populations of objects. By supporting non-Euclidean GOPs such as direction vectors, the proposed hypothesis test is novel in the study of morphological shape differences. Suitable difference measures are proposed for each GOP. Both global and simultaneous GOP analyses showed statistically significant differences between the first-episode schizophrenics and controls

X-ray monitoring of the radio and gamma-ray loud Narrow-Line Seyfert 1 Galaxy PKS 2004-447

We present preliminary results of the X-ray analysis of XMM-Newton and Swift observations as part of a multi-wavelength monitoring campaign in 2012 of the radio-loud narrow line Seyfert 1 galaxy PKS 2004-447. The source was recently detected in gamma-rays by Fermi/LAT among only four other galaxies of that type. The 0.5-10 keV X-ray spectrum is well-described by a simple absorbed powerlaw (photon index ~ 1.6). The source brightness exhibits variability on timescales of months to years with indications for spectral variability, which follows a 'bluer-when-brighter' behaviour, similar to blazars.Comment: Proceedings for the 'Jet 2013' conference. Includes 3 pages, 3 figure

Non-Euclidean classification of medically imaged objects via s-reps

AbstractClassifying medically imaged objects, e.g., into diseased and normal classes, has been one of the important goals in medical imaging. We propose a novel classification scheme that uses a skeletal representation to provide rich non-Euclidean geometric object properties. Our statistical method combines distance weighted discrimination (DWD) with a carefully chosen Euclideanization which takes full advantage of the geometry of the manifold on which these non-Euclidean geometric object properties (GOPs) live. Our method is evaluated via the task of classifying 3D hippocampi between schizophrenics and healthy controls. We address three central questions. 1) Does adding shape features increase discriminative power over the more standard classification based only on global volume? 2) If so, does our skeletal representation provide greater discriminative power than a conventional boundary point distribution model (PDM)? 3) Especially, is Euclideanization of non-Euclidean shape properties important in achieving high discriminative power? Measuring the capability of a method in terms of area under the receiver operator characteristic (ROC) curve, we show that our proposed method achieves strongly better classification than both the classification method based on global volume alone and the s-rep-based classification method without proper Euclideanization of non-Euclidean GOPs. We show classification using Euclideanized s-reps is also superior to classification using PDMs, whether the PDMs are first Euclideanized or not. We also show improved performance with Euclideanized boundary PDMs over non-linear boundary PDMs. This demonstrates the benefit that proper Euclideanization of non-Euclidean GOPs brings not only to s-rep-based classification but also to PDM-based classification

Disk Dominated States of 4U 1957+11: Chandra, XMM, and RXTE Observations of Ostensibly the Most Rapidly Spinning Galactic Black Hole

We present simultaneous Chandra-HETG and RXTE observations of a moderate flux `soft state' of the black hole candidate 4U1957+11. These spectra, having a minimally discernible hard X-ray excess, are an excellent test of modern disk atmosphere models that include the effects of black hole spin. The HETG data show that the soft disk spectrum is only very mildly absorbed with N_H =1-2 X 10^{21} cm^-2. These data additionally reveal 13.449 A NeIX absorption consistent with the warm/hot phase of the interstellar medium. The fitted disk model implies a highly inclined disk around a low mass black hole rapidly rotating with normalized spin a*~1. We show, however, that pure Schwarzschild black hole models describe the data extremely well, albeit with large disk atmosphere ``color-correction'' factors. Standard color-correction factors can be attained if one additionally incorporates mild Comptonization. We find that the Chandra observations do not uniquely determine spin. Similarly, XMM/RXTE observations, taken only six weeks later, are equally unconstraining. This lack of constraint is partly driven by the unknown mass and unknown distance of 4U1957+11; however, it is also driven by the limited bandpass of Chandra and XMM. We therefore present a series of 48 RXTE observations taken over the span of several years and at different brightness/hardness levels. These data prefer a spin of a*~1, even when including a mild Comptonization component; however, they also show evolution of the disk atmosphere color-correction factors. If the rapid spin models with standard atmosphere color-correction factors of h_d=1.7 are to be believed, then the RXTE observations predict that 4U1957+11 can range from a 3 M_sun black hole at 10 kpc with a*~0.83 to a 16 M_sun black hole at 22 kpc with a* ~ 1, with the latter being statistically preferred.Comment: 16 pages (emulateapj style). Accepted for Publication in the Astrophysical Journa

Chandra X-ray spectroscopy of the focused wind in the Cygnus X-1 system III. Dipping in the low/hard state

We present an analysis of three Chandra High Energy Transmission Gratings observations of the black hole binary Cyg X-1/HDE 226868 at different orbital phases. The stellar wind that is powering the accretion in this system is characterized by temperature and density inhomogeneities including structures, or "clumps", of colder, more dense material embedded in the photoionized gas. As these clumps pass our line of sight, absorption dips appear in the light curve. We characterize the properties of the clumps through spectral changes during various dip stages. Comparing the silicon and sulfur absorption line regions (1.6-2.7 keV $\equiv$ 7.7-4.6 {\AA}) in four levels of varying column depth reveals the presence of lower ionization stages, i.e., colder or denser material, in the deeper dip phases. The Doppler velocities of the lines are roughly consistent within each observation, varying with the respective orbital phase. This is consistent with the picture of a structure that consists of differently ionized material, in which shells of material facing the black hole shield the inner and back shells from the ionizing radiation. The variation of the Doppler velocities compared to a toy model of the stellar wind, however, does not allow us to pin down an exact location of the clump region in the system. This result, as well as the asymmetric shape of the observed lines, point at a picture of a complex wind structure.Comment: 19 pages, 15 figures, accepted for publication in A&

State transition modeling of complex monitored health data

This article considers the analysis of complex monitored health data, where often one or several signals are reflecting the current health status that can be represented by a finite number of states, in addition to a set of covariates. In particular, we consider a novel application of a non-parametric state intensity regression method in order to study time-dependent effects of covariates on the state transition intensities. The method can handle baseline, time varying as well as dynamic covariates. Because of the non-parametric nature, the method can handle different data types and challenges under minimal assumptions. If the signal that is reflecting the current health status is of continuous nature, we propose the application of a weighted median and a hysteresis filter as data pre-processing steps in order to facilitate robust analysis. In intensity regression, covariates can be aggregated by a suitable functional form over a time history window. We propose to study the estimated cumulative regression parameters for different choices of the time history window in order to investigate short- and long-term effects of the given covariates. The proposed framework is discussed and applied to resuscitation data of newborns collected in Tanzania