Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis.

BACKGROUND:Assessment of clinical variation has attracted increasing interest in health systems internationally due to growing awareness about better value and appropriate health care as a mechanism for enhancing efficient, effective and timely care. Feedback using administrative databases to provide benchmarking data has been utilised in several countries to explore clinical care variation and to enhance guideline adherent care. Whilst methods for detecting variation are well-established, methods for determining variation that is unwarranted and addressing this are strongly debated. This study aimed to synthesize published evidence of the use of feedback approaches to address unwarranted clinical variation (UCV). METHODS:A rapid review and narrative evidence synthesis was undertaken as a policy-focused review to understand how feedback approaches have been applied to address UCV specifically. Key words, synonyms and subject headings were used to search the major electronic databases Medline and PubMed between 2000 and 2018. Titles and abstracts of publications were screened by two reviewers and independently checked by a third reviewer. Full text articles were screened against the eligibility criteria. Key findings were extracted and integrated in a narrative synthesis. RESULTS:Feedback approaches that occurred over a duration of 1 month to 9 years to address clinical variation emerged from 27 publications with quantitative (20), theoretical/conceptual/descriptive work (4) and mixed or multi-method studies (3). Approaches ranged from presenting evidence to individuals, teams and organisations, to providing facilitated tailored feedback supported by a process of ongoing dialogue to enable change. Feedback approaches identified primarily focused on changing clinician decision-making and behaviour. Providing feedback to clinicians was identified, in a range of a settings, as associated with changes in variation such as reducing overuse of tests and treatments, reducing variations in optimal patient clinical outcomes and increasing guideline or protocol adherence. CONCLUSIONS:The review findings suggest value in the use of feedback approaches to respond to clinical variation and understand when action is warranted. Evaluation of the effectiveness of particular feedback approaches is now required to determine if there is an optimal approach to create change where needed

Reengineering legacy software to object-oriented systems

NASA has a legacy of complex software systems that are becoming increasingly expensive to maintain. Reengineering is one approach to modemizing these systems. Object-oriented technology, other modem software engineering principles, and automated tools can be used to reengineer the systems and will help to keep maintenance costs of the modemized systems down. The Software Technology Branch at the NASA/Johnson Space Center has been developing and testing reengineering methods and tools for several years. The Software Technology Branch is currently providing training and consulting support to several large reengineering projects at JSC, including the Reusable Objects Software Environment (ROSE) project, which is reengineering the flight analysis and design system (over 2 million lines of FORTRAN code) into object-oriented C++. Many important lessons have been learned during the past years; one of these is that the design must never be allowed to diverge from the code during maintenance and enhancement. Future work on open, integrated environments to support reengineering is being actively planned

First results of a cryogenic optical photon counting imaging spectrometer using a DROID array

Context. In this paper we present the first system test in which we demonstrate the concept of using an array of Distributed Read Out Imaging Devices (DROIDs) for optical photon detection. Aims. After the successful S-Cam 3 detector the next step in the development of a cryogenic optical photon counting imaging spectrometer under the S-Cam project is to increase the field of view using DROIDs. With this modification the field of view of the camera has been increased by a factor of 5 in area, while keeping the number of readout channels the same. Methods. The test has been performed using the flexible S-Cam 3 system and exchanging the 10x12 Superconducting Tunnel Junction array for a 3x20 DROID array. The extra data reduction needed with DROIDs is performed offline. Results. We show that, although the responsivity (number of tunnelled quasiparticles per unit of absorbed photon energy, e- /eV) of the current array is too low for direct astronomical applications, the imaging quality is already good enough for pattern detection, and will improve further with increasing responsivity. Conclusions. The obtained knowledge can be used to optimise the system for the use of DROIDs.Comment: 7 pages, 9 figures, accepted for publicaiton in A&

Exact Cover with light

We suggest a new optical solution for solving the YES/NO version of the Exact Cover problem by using the massive parallelism of light. The idea is to build an optical device which can generate all possible solutions of the problem and then to pick the correct one. In our case the device has a graph-like representation and the light is traversing it by following the routes given by the connections between nodes. The nodes are connected by arcs in a special way which lets us to generate all possible covers (exact or not) of the given set. For selecting the correct solution we assign to each item, from the set to be covered, a special integer number. These numbers will actually represent delays induced to light when it passes through arcs. The solution is represented as a subray arriving at a certain moment in the destination node. This will tell us if an exact cover does exist or not.Comment: 20 pages, 4 figures, New Generation Computing, accepted, 200

Mechanochemical action of the dynamin protein

Dynamin is a ubiquitous GTPase that tubulates lipid bilayers and is implicated in many membrane severing processes in eukaryotic cells. Setting the grounds for a better understanding of this biological function, we develop a generalized hydrodynamics description of the conformational change of large dynamin-membrane tubes taking into account GTP consumption as a free energy source. On observable time scales, dissipation is dominated by an effective dynamin/membrane friction and the deformation field of the tube has a simple diffusive behavior, which could be tested experimentally. A more involved, semi-microscopic model yields complete predictions for the dynamics of the tube and possibly accounts for contradictory experimental results concerning its change of conformation as well as for plectonemic supercoiling.Comment: 17 pages, 4 figures; typos corrected, reference adde

Suited for Success? : Suits, Status, and Hybrid Masculinity

This document is the Accepted Manuscript version. The final, definitive version of this paper has been published in Men and Masculinities, March 2017, doi: https://doi.org/10.1177/1097184X17696193, published by SAGE Publishing, All rights reserved.This article analyzes the sartorial biographies of four Canadian men to explore how the suit is understood and embodied in everyday life. Each of these men varied in their subject positions—body shape, ethnicity, age, and gender identity—which allowed us to look at the influence of men’s intersectional identities on their relationship with their suits. The men in our research all understood the suit according to its most common representation in popular culture: a symbol of hegemonic masculinity. While they wore the suit to embody hegemonic masculine configurations of practice—power, status, and rationality—most of these men were simultaneously marginalized by the gender hierarchy. We explain this disjuncture by using the concept of hybrid masculinity and illustrate that changes in the style of hegemonic masculinity leave its substance intact. Our findings expand thinking about hybrid masculinity by revealing the ways subordinated masculinities appropriate and reinforce hegemonic masculinity.Peer reviewe

Characterisation of the Mouse Vasoactive Intestinal Peptide Receptor Type 2 Gene, Vipr2, and Identification of a Polymorphic LINE-1-like Sequence That Confers Altered Promoter Activity

The VPAC(2) receptor is a seven transmembrane spanning G protein-coupled receptor for two neuropeptides, vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating polypeptide (PACAP). It has a distinct tissue-specific, developmental and inducible expression that underlies an important neuroendocrine role. Here, we report the characterisation of the gene that encodes the mouse VPAC(2) receptor (Vipr2), localisation of the transcriptional start site and functional analysis of the promoter region. The Vipr2 gene contains 12 introns within its protein-coding region and spans 68.6 kb. Comparison of the 5′ untranslated region sequences for cloned 5′-RACE products amplified from different tissues showed they all were contained within the same exon, with the longest extending 111 bp upstream of the ATG start site. Functional analysis of the 3.2-kb 5′-flanking region using sequentially deleted sequences cloned into a luciferase gene reporter vector revealed that this region is active as a promoter in mouse AtT20 D16:16 and rat GH4C1 cell lines. The core promoter is located within a 180-bp GC-rich region proximal to the ATG start codon and contains potential binding sites for Sp1 and AP2, but no TATA-box. Further upstream, in two out of three mice strains examined, we have discovered a 496-bp polymorphic DNA sequence that bears a significant identity to mouse LINE-1 DNA. Comparison of the promoter activity between luciferase reporter gene constructs derived from the BALB/c (which contains this sequence) and C57BL/6J (which lacks this sequence) Vipr2 promoter regions has shown three-fold difference in luciferase gene activity when expressed in mouse AtT20 D16:16 and αT3-1 cells, but not when expressed in the rat GH4C1 cells or in COS 7 cells. Our results suggest that the mouse Vipr2 gene may be differentially active in different mouse strains, depending on the presence of this LINE-1-like sequence in the promoter region

Women and Illegal Activities: Gender Differences and Women's Willingness to Comply Over Time

In recent years the topics of illegal activities such as corruption or tax evasion have attracted a great deal of attention. However, there is still a lack of substantial empirical evidence about the determinants of compliance. The aim of this paper is to investigate empirically whether women are more willing to be compliant than men and whether we observe (among women and in general) differences in attitudes among similar age groups in different time periods (cohort effect) or changing attitudes of the same cohorts over time (age effect) using data from eight Western European countries from the World Values Survey and the European Values Survey that span the period from 1981 to 1999. The results reveal higher willingness to comply among women and an age rather than a cohort effect. Working Paper 06-5

Our Globally Changing Climate

Since the Third U.S. National Climate Assessment (NCA3) was published in May 2014, new observations along multiple lines of evidence have strengthened the conclusion that Earth's climate is changing at a pace and in a pattern not explainable by natural influences. While this report focuses especially on observed and projected future changes for the United States, it is important to understand those changes in the global context (this chapter). The world has warmed over the last 150 years, especially over the last six decades, and that warming has triggered many other changes to Earth's climate. Evidence for a changing climate abounds, from the top of the atmosphere to the depths of the oceans. Thousands of studies conducted by tens of thousands of scientists around the world have documented changes in surface, atmospheric, and oceanic temperatures; melting glaciers; disappearing snow cover; shrinking sea ice; rising sea level; and an increase in atmospheric water vapor. Rainfall patterns and storms are changing, and the occurrence of droughts is shifting