Threats to safe transitions from hospital to home: a consensus study in North West London primary care.

BACKGROUND: Transitions between healthcare settings are vulnerable points for patients. AIM: To identify key threats to safe patient transitions from hospital to primary care settings. DESIGN AND SETTING: Three-round web-based Delphi consensus process among clinical and non-clinical staff from 39 primary care practices in North West London, England. METHOD: Round 1 was a free-text idea-generating round. Rounds 2 and 3 were consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1-3: 'not important', 4-6: 'somewhat important', 7-9: 'very important'). Percentage of votes cast for each patient or medication group were recorded; consensus was defined as ≥75%. RESULTS: A total of 39 practices completed round 1, 36/39 (92%) completed round 2, and 30/36 (83%) completed round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision, and patients who were most at risk. 'Poor quality of handover instructions from secondary to primary care teams' achieved the highest rating (mean rating at round 3 = 8.43) and a 100% consensus that it was a 'very important' threat. Older individuals (97%) and patients with complex medical problems taking >5 medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients. CONCLUSION: This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work would need to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise

Using MATLAB software with Tomcat server and Java platform for remote image analysis in pathology

<p>Abstract</p> <p>Background</p> <p>The Matlab software is a one of the most advanced development tool for application in engineering practice. From our point of view the most important is the image processing toolbox, offering many built-in functions, including mathematical morphology, and implementation of a many artificial neural networks as AI. It is very popular platform for creation of the specialized program for image analysis, also in pathology. Based on the latest version of Matlab Builder Java toolbox, it is possible to create the software, serving as a remote system for image analysis in pathology via internet communication. The internet platform can be realized based on Java Servlet Pages with Tomcat server as servlet container.</p> <p>Methods</p> <p>In presented software implementation we propose remote image analysis realized by Matlab algorithms. These algorithms can be compiled to executable <it>jar</it> file with the help of Matlab Builder Java toolbox. The Matlab function must be declared with the set of input data, output structure with numerical results and Matlab web figure. Any function prepared in that manner can be used as a Java function in Java Servlet Pages (JSP). The graphical user interface providing the input data and displaying the results (also in graphical form) must be implemented in JSP. Additionally the data storage to database can be implemented within algorithm written in Matlab with the help of Matlab Database Toolbox directly with the image processing. The complete JSP page can be run by Tomcat server.</p> <p>Results</p> <p>The proposed tool for remote image analysis was tested on the Computerized Analysis of Medical Images (CAMI) software developed by author. The user provides image and case information (diagnosis, staining, image parameter etc.). When analysis is initialized, input data with image are sent to servlet on Tomcat. When analysis is done, client obtains the graphical results as an image with marked recognized cells and also the quantitative output. Additionally, the results are stored in a server database. The internet platform was tested on PC Intel Core2 Duo T9600 2.8GHz 4GB RAM server with 768x576 pixel size, 1.28Mb tiff format images reffering to meningioma tumour (x400, Ki-67/MIB-1). The time consumption was as following: at analysis by CAMI, locally on a server – 3.5 seconds, at remote analysis – 26 seconds, from which 22 seconds were used for data transfer via internet connection. At jpg format image (102 Kb) the consumption time was reduced to 14 seconds.</p> <p>Conclusions</p> <p>The results have confirmed that designed remote platform can be useful for pathology image analysis. The time consumption is depended mainly on the image size and speed of the internet connections. The presented implementation can be used for many types of analysis at different staining, tissue, morphometry approaches, etc. The significant problem is the implementation of the JSP page in the multithread form, that can be used parallelly by many users. The presented platform for image analysis in pathology can be especially useful for small laboratory without its own image analysis system.</p

Limb imaging of the Venus O2 visible nightglow with the Venus Monitoring Camera

We investigated the Venus O2 visible nightglow with imagery from the Venus Monitoring Camera on Venus Express. Drawing from data collected between April 2007 and January 2011, we study the global distribution of this emission, discovered in the late 70s by the Venera 9 and 10 missions. The inferred limb-viewing intensities are on the order of 150 kiloRayleighs at the lower latitudes and seem to drop somewhat towards the poles. The emission is generally stable, although there are episodes when the intensities rise up to 500 kR. We compare a set of Venus Monitoring Camera observations with coincident measurements of the O2 nightglow at 1.27 {\mu}m made with the Visible and Infrared Thermal Imaging Spectrometer, also on Venus Express. From the evidence gathered in this and past works, we suggest a direct correlation between the instantaneous emissions from the two O2 nightglow systems. Possible implications regarding the uncertain origin of the atomic oxygen green line at 557.7 nm are noted.Comment: 7 pages, 3 figure

Pinned Balseiro-Falicov Model of Tunneling and Photoemission in the Cuprates

The smooth evolution of the tunneling gap of Bi_2Sr_2CaCu_2O_8 with doping from a pseudogap state in the underdoped cuprates to a superconducting state at optimal and overdoping, has been interpreted as evidence that the pseudogap must be due to precursor pairing. We suggest an alternative explanation, that the smoothness reflects a hidden SO(N) symmetry near the (pi,0) points of the Brillouin zone (with N = 3, 4, 5, or 6). Because of this symmetry, the pseudogap could actually be due to any of a number of nesting instabilities, including charge or spin density waves or more exotic phases. We present a detailed analysis of this competition for one particular model: the pinned Balseiro-Falicov model of competing charge density wave and (s-wave) superconductivity. We show that most of the anomalous features of both tunneling and photoemission follow naturally from the model, including the smooth crossover, the general shape of the pseudogap phase diagram, the shrinking Fermi surface of the pseudogap phase, and the asymmetry of the tunneling gap away from optimal doping. Below T_c, the sharp peak at Delta_1 and the dip seen in the tunneling and photoemission near 2Delta_1 cannot be described in detail by this model, but we suggest a simple generalization to account for inhomogeneity, which does provide an adequate description. We show that it should be possible, with a combination of photoemission and tunneling, to demonstrate the extent of pinning of the Fermi level to the Van Hove singularity. A preliminary analysis of the data suggests pinning in the underdoped, but not in the overdoped regime.Comment: 18 pages LaTeX, 26 ps. figure

Flux Phase as a Dynamic Jahn-Teller Phase: Berryonic Matter in the Cuprates?

There is considerable evidence for some form of charge ordering on the hole-doped stripes in the cuprates, mainly associated with the low-temperature tetragonal phase, but with some evidence for either charge density waves or a flux phase, which is a form of dynamic charge-density wave. These three states form a pseudospin triplet, demonstrating a close connection with the E X e dynamic Jahn-Teller effect, suggesting that the cuprates constitute a form of Berryonic matter. This in turn suggests a new model for the dynamic Jahn-Teller effect as a form of flux phase. A simple model of the Cu-O bond stretching phonons allows an estimate of electron-phonon coupling for these modes, explaining why the half breathing mode softens so much more than the full oxygen breathing mode. The anomalous properties of $O^{2-}$ provide a coupling (correlated hopping) which acts to stabilize density wave phases.Comment: Major Revisions: includes comparisons with specific cuprate phonon modes, 16 eps figures, revte

Avoidable 30‐day readmissions in patients undergoing vascular surgery

Background: Vascular surgery has one of the highest unplanned 30-day readmission rates of all surgical specialities. The degree to which these may be avoidable and the optimal strategies to reduce their occurrence is unknown. The aim of this study was to identify and classify avoidable 30-day readmissions in patients undergoing vascular surgery in order to plan targeted interventions to reduce their occurrence, improve outcomes and reduce cost. Methods: A retrospective analysis of discharges over a 12-month period from a single tertiary vascular unit was performed. A multidisciplinary panel conducted a manual case note review to identify and classify those 30-day unplanned emergency readmissions deemed avoidable. Results: An unplanned 30-day readmission occurred in 72/885 (8.1%) admissions. These unplanned readmissions were deemed avoidable in 50.0% (36/72) and were most frequently due to unresolved medical issues (19/36, 52.8%) and inappropriate admission with the potential for outpatient management (7/36, 19.4%). A smaller number were due to inadequate social care provision (4/36, 11.1%) and the occurrence of other avoidable adverse events (4/36, 11.1%). Conclusion: Half of all 30-day readmissions in vascular patients are potentially avoidable. Multidisciplinary coordination of inpatient care and the transition from hospital to community care following discharge need to be improved

Pro-environmental Diversification of Pasture-Based Dairy and Beef Production in Ireland, the United Kingdom and New Zealand: A scoping review of impacts and challenges

Grass-fed dairy and beef products are valued by consumers for their unique nutrient profile, enhanced animal welfare and lower environmental footprint compared to conventional produce derived from animals reared indoors on higher volumes of concentrate feeds (O\u27Callaghan et al., Reference O\u27Callaghan, Vázquez-Fresno, Serra-Cayuela, Dong, Mandal, Hennessy, McAuliffe, Dillon, Wishart, Stanton and Ross2018; Moscovici Joubran et al., Reference Moscovici Joubran, Pierce, Garvey, Shalloo and O\u27Callaghan2021). For the current study, pasture-based production of dairy and beef is defined as a system within which cattle graze freely outdoors on green pasture for ≥6 months per year, using grazed grass as the primary feed source (Läpple et al., Reference Läpple, Hennessy and O\u27Donovan2012). While pasture-based milk and beef production systems typically exhibit a considerably lower carbon footprint than indoor systems (Wassenaar et al., Reference Wassenaar, Grandgirard, Monni, Biala, Leip and Weiss2009; O\u27Brien et al., Reference O\u27Brien, Shalloo, Patton, Buckley, Grainger and Wallace2012, Reference O\u27Brien, Capper, Garnsworthy, Grainger and Shalloo2014), the impacts of intensive management of perennial ryegrass pastures and high stocking rates may have adverse effects on the environment and biodiversity (Delaby et al., Reference Delaby, Finn, Grange and Horan2020). This type of intensive grass-based production is particularly popular in island countries characterized by temperate maritime/oceanic climates where grass grows for most of the year; and is predominant in the Republic of Ireland (ROI) and New Zealand (NZ) and widely practiced throughout the United Kingdom (UK) (DEFRA, 2019). For example, according to Teagasc National Farm Survey, in Ireland, in 2017, the diet of a typical Irish dairy cow constituted 95.4% of grass, from which 73.4% was grazed grass and 22.1% was grass silage (O\u27Brien et al., Reference O\u27Brien, Moran and Shalloo2019). Due to the length of grass growing season, pasture-based agriculture in these countries differs from continental pasture-based systems, e.g., Alpine cattle grazing in which cows graze high mountain meadows during summer, transhumance and other traditional approaches practiced on the continent (Carafa et al., Reference Carafa, Navarro, Bittante, Tagliapietra, Gallo, Tuohy and Franciosi2020). Moreover, in contrast to continental pasture-based agriculture, pasture-based dairy and beef sectors in island countries presented in this review are major contributors to growth in economic activity across the rural economy, milk processing/distribution, export marketing (\u3e90% of milk and beef produced in ROI and NZ are destinated for exports) and research (Fitzgerald, Reference Fitzgerald2019; Lee-Jones, Reference Lee-Jones2019). Thus, to identify pro-environmental activities specific to the pasture-based system of interest, the selection of the reviewed studies was limited to research conducted in ROI, the UK and NZ—main island countries producing pasture-based milk and beef

Phase Separation Models for Cuprate Stripe Arrays

An electronic phase separation model provides a natural explanation for a large variety of experimental results in the cuprates, including evidence for both stripes and larger domains, and a termination of the phase separation in the slightly overdoped regime, when the average hole density equals that on the charged stripes. Several models are presented for charged stripes, showing how density waves, superconductivity, and strong correlations compete with quantum size effects (QSEs) in narrow stripes. The energy bands associated with the charged stripes develop in the middle of the Mott gap, and the splitting of these bands can be understood by considering the QSE on a single ladder.Comment: significant revisions: includes island phase, 16 eps figures, revte