Healthcare services managers: what information do they need and use?

Objectives: To gain insight into the information behaviour of healthcare services managers as they draw on information while engaged in decision making unrelated to individual patient care. Objectives – The purpose of this research project was to gain insight into the information behaviour of healthcare services managers as they use information while engaged in decision-making unrelated to individual patient care. Methods – This small-scale, exploratory, multiple case study used the critical incident technique in nineteen semi-structured interviews. Responses were analyzed using ‘Framework,’ a matrix-based content analysis system. Results – This paper presents findings related to the internal information that healthcare services managers need and use. Their decisions are influenced by a wide variety of factors. They must often make decisions without all of the information they would prefer to have. Internal information and practical experience set the context for new research-based information, so they are generally considered first. Conclusions – Healthcare services managers support decisions with both facts and value-based information. These results may inform both delivery of health library services delivery and strategic health information management planning. They may also support librarians who extend their skills beyond managing library collections and teaching published information retrieval skills, to managing internal and external information, teaching information literacy, and supporting information sharing

Information sheets for patients with acute chest pain: randomised controlled trial

Objectives: To determine whether providing an information sheet to patients with acute chest pain reduces anxiety, improves health related quality of life, improves satisfaction with care, or alters subsequent symptoms or actions. Design: Single centre, non-blinded, randomised controlled trial. Setting: Chest pain unit of an emergency department. Participants: 700 consecutive patients with acute chest pain and no clear diagnosis at initial presentation. Interventions: After a diagnostic assessment patients were randomised to receive either standard verbal advice or verbal advice followed by an information sheet. Main outcome measures: The primary outcome was anxiety (hospital anxiety and depression scale). Secondary outcomes were depression (hospital anxiety and depression scale), health related quality of life (SF-36), patient satisfaction, presentation with further chest pain within one month, lifestyle change (smoking cessation, diet, exercise), further information sought from other sources, and planned healthcare seeeking behaviour in response to further pain. Results 494 of 700 (70.6%) patients responded. Compared with those receiving standard verbal advice those receiving advice and an information sheet had lower mean hospital anxiety and depression scale scores for anxiety (7.61v8.63, difference 1.02, 95% confidence interval 0.20 to 1.84) and depression (4.14 v 5.28, difference 1.14, 0.41 to 1.86) and higher scores for mental health and perception of general health on the SF-36. The information sheet had no significant effect on satisfaction with care, subsequent symptoms, lifestyle change, information seeking, or planned actions in the event of further pain. Conclusions: Provision of an information sheet to patients with acute chest pain can reduce anxiety and depression and improve mental health and perception of general health but does not alter satisfaction with care or other outcomes. Trial registration Current Controlled Trials ISRCTN85248020

Remote Toehold: A Mechanism for Flexible Control of DNA Hybridization Kinetics

Hybridization of DNA strands can be used to build molecular devices, and control of the kinetics of DNA hybridization is a crucial element in the design and construction of functional and autonomous devices. Toehold-mediated strand displacement has proved to be a powerful mechanism that allows programmable control of DNA hybridization. So far, attempts to control hybridization kinetics have mainly focused on the length and binding strength of toehold sequences. Here we show that insertion of a spacer between the toehold and displacement domains provides additional control: modulation of the nature and length of the spacer can be used to control strand-displacement rates over at least 3 orders of magnitude. We apply this mechanism to operate displacement reactions in potentially useful kinetic regimes: the kinetic proofreading and concentration-robust regimes

Wind-accretion disks in wide binaries, second generation protoplanetary disks and accretion onto white dwarfs

Mass transfer from an evolved donor star to its binary companion is a standard feature of stellar evolution in binaries. In wide binaries, the companion star captures some of the mass ejected in a wind by the primary star. The captured material forms an accretion disk. Here, we study the evolution of wind-accretion disks, using a numerical approach which allows us to follow the long term evolution. For a broad range of initial conditions, we derive the radial density and temperature profiles of the disk. In most cases, wind-accretion leads to long-lived stable disks over the lifetime of the AGB donor star. The disks have masses of a few times 10^{-5}-10^{-3} M_sun, with surface density and temperature profiles that follow broken power-laws. The total mass in the disk scales approximately linearly with the viscosity parameter used. Roughly 50% to 80% of the mass falling into the disk accretes onto the central star; the rest flows out through the outer edge of the disk into the stellar wind of the primary. For systems with large accretion rates, the secondary accretes as much as 0.1 M_sun. When the secondary is a white dwarf, accretion naturally leads to nova and supernova eruptions. For all types of secondary star, the surface density and temperature profiles of massive disks resemble structures observed in protoplanetary disks, suggesting that coordinated observational programs might improve our understanding of uncertain disk physics.Comment: ApJ, in press. Some discussion on thermal instabilities, and different viscosities adde

Modelling DNA Origami Self-Assembly at the Domain Level

We present a modelling framework, and basic model parameterization, for the study of DNA origami folding at the level of DNA domains. Our approach is explicitly kinetic and does not assume a specific folding pathway. The binding of each staple is associated with a free-energy change that depends on staple sequence, the possibility of coaxial stacking with neighbouring domains, and the entropic cost of constraining the scaffold by inserting staple crossovers. A rigorous thermodynamic model is difficult to implement as a result of the complex, multiply connected geometry of the scaffold: we present a solution to this problem for planar origami. Coaxial stacking and entropic terms, particularly when loop closure exponents are taken to be larger than those for ideal chains, introduce interactions between staples. These cooperative interactions lead to the prediction of sharp assembly transitions with notable hysteresis that are consistent with experimental observations. We show that the model reproduces the experimentally observed consequences of reducing staple concentration, accelerated cooling and absent staples. We also present a simpler methodology that gives consistent results and can be used to study a wider range of systems including non-planar origami

Systematic reviews as a tool for planning and interpreting trials

Background Systematic reviews followed by ameta-analysis are carried out in medical research to combine the results of two or more related studies. Stroke trials have struggled to show beneficial effects and meta-analysis should be used more widely throughout the research process to either speed up the development of useful interventions, or halt more quickly research with hazardous or ineffective interventions. Summary of review. This review summarises the clinical research process and illustrates how and when systematic reviews may be used throughout the development programme. Meta-analyses should be performed after observational studies, preclinical studies in experimental stroke, and after phase I, II, and III clinical trials and phase IV clinical surveillance studies. Although meta-analyses most commonly work with summary data, they may be performed to assess relationships between variables (meta-regression) and, ideally, should utilise individual patient data. Meta-analysis techniques may alsoworkwith ordered categorical outcome data (ordinal meta-analysis) and be used to perform indirect comparisons where original trial data do not exist. Conclusion Systematic review/meta-analyses are powerful tools in medical research and should be used throughout the development of all stroke and other intervention

The ‘total cost of publication’ in a hybrid open-access environment: Institutional approaches to funding journal article-processing charges in combination with subscriptions

As open-access (OA) publishing funded by article-processing charges (APCs) becomes more widely accepted, academic institutions need to be aware of the ‘total cost of publication’, comprising subscription costs plus APCs and additional administration costs. This study analyses data from 23 UK institutions covering the period 2007 to 2014 modelling the total cost of publication (TCP). It shows a clear rise in centrally-managed APC payments from 2012 onwards, with payments projected to increase further. As well as evidencing the growing availability and acceptance of OA publishing, these trends reflect particular UK policy developments and funding arrangements intended to accelerate the move towards OA publishing (‘Gold’ OA). Whilst the mean value of APCs has been relatively stable, there was considerable variation in APC prices paid by institutions since 2007. In particular, ‘hybrid’ subscription/OA journals were consistently more expensive than fully-OA journals. Most APCs were paid to large ‘traditional’ commercial publishers who also received considerable subscription income. New administrative costs reported by institutions varied considerably. The total cost of publication modelling shows that APCs are now a significant part of the TCP for academic institutions, in 2013 already constituting an average of 10% of the TCP (excluding administrative costs)