Quantifying patient satisfaction with process metrics using a weighted bundle approach.

Background:Current patient satisfaction assessment results are delayed and obtained from select patient surveys. As a result, these assessments may not represent the experience of the entire patient population. This study developed a method to measure and evaluate all patients\u27 experiences while they are within the care episode and link it to processes within the organisation. Methods:Using the Six Sigma methodology, sites assembled diverse teams to categorise and analyse negative experience comments from patients to understand the drivers of dissatisfaction. These customer expectations lead to the development of the four components in the Patient Experience Bundle (PEB): communication, environment, basic needs/comfort and logistics. Individual process elements were ranked to create a numerical relationship between service and the needs expressed by the voice of the customer. Sites created surveys incorporating questions that focused on the bundle elements and measured daily bundle compliance. Graphical analysis and hypothesis testing enabled sites to determine key drivers of patient dissatisfaction within the bundle elements. Improvement strategies were developed and implemented to address the key drivers of patient dissatisfaction. Results:After implementing process improvements focused on issues identified by the PEB, bundle compliance improved from an average of 51% to an average of 82.5% and Press Ganey Likelihood to Recommend (PG LTR) scores improved from an average of 64.73% to an average 74.64%. The data demonstrated that the trends in improving PEB are followed by meaningful changes in PG LTR scores. Conclusion:This work is built on the identification of common elements of care that impact patient satisfaction and detailed mathematical analysis of the relationship between factors. Using the bundle concept, these improvement efforts maintain highly reliable processes to drive outcomes and provide real-time feedback on patient experience

Enhanced nonlinear spectral compression in fiber by external sinusoidal phase modulation

We propose a new, simple approach to enhance the spectral compression process arising from nonlinear pulse propagation in an optical fiber. We numerically show that an additional sinusoidal temporal phase modulation of the pulse enables efficient reduction of the intensity level of the side lobes in the spectrum that are produced by the mismatch between the initial linear negative chirp of the pulse and the self-phase modulation-induced nonlinear positive chirp. Remarkable increase of both the extent of spectrum narrowing and the quality of the compressed spectrum is afforded by the proposed approach across a wide range of experimentally accessible parameters

Factors associated with unvaccinated caregivers who plan to vaccinate their children

Vaccine hesitancy is complex and a threat to global public health during the ongoing COVID-19 pandemic. Our objective was to determine factors associated with caregivers' willingness to vaccinate children despite not being immunized themselves against COVID-19. The International COVID-19 Parental Attitude Study (COVIPAS), a multinational cohort study, recruited caregivers of children 0-18 years old in 21 Emergency Departments (EDs) in USA, Canada, Israel, and Switzerland during November-December 2021. Of a total of 4536 caregivers who completed the survey, 882 (19.4%) were unvaccinated, and 62 (7.0%) of the unvaccinated planned to vaccinate their children. Unvaccinated caregivers with children that had their childhood vaccines up-to-date (OR 3.03 (1.36, 8.09), p = 0.01), and those very worried their child has COVID-19 in the ED (OR 3.11 (1.44, 6.34), p < 0.01) were much more likely to plan to immunize their children. Primary care providers and public health agencies should not assume that unvaccinated parents will not vaccinate their children. Determining child's vaccination status and parental level of concern about COVID-19 may help identify caregivers who are open to give their children the vaccine. Keywords: COVID-19; Sars-cov-2; Unvaccinated; Vaccination; Vaccine hesitancy

TELEMAC model archive: Integrating open–source tools for the management and visualisation of model data

Water Qualit

Soft X-ray analysis of a loop flare on the Sun

We present the results of an analysis of soft X-ray images for a solar flare which occurred on 1992 July 11. This flare, as seen in Yohkoh Soft X-ray Telescope (SXT) images was of comparatively simple geometry, consisting of two bright footpoints early in the flare with a bright loop seen later in the flare. We examine how closely this flare compares with the supposed paradigm of a confined simple-loop flare. Closer examination of the SXT images reveals that the flare structure consisted of at least two adjacent loops, one much fainter than the other. We examine the brighter of the two soft X-ray loops. The SXT images reveal an apparent slow, northward motion of this loop (roughly transverse to its major axis). Examination of derived emission measure and temperature images also indicate an apparent northward motion. In addition, we find an increase in the cross-sectional width at the top of the loop with time. Emission measure maps derived from the SXT images also indicates an apparent broadening of the loop-top region. We infer that the apparent northward motion and the apparent broadening of the soft X-ray emission can be explained in a reconnection scenario where successive magnetic field structures do not lie in a plane but are tilted to the south of the line of sight but with successively brightening loops oriented at less tilted angles. Halpha images for this flare reveal an evolution from a few brilliant points to a short two- ribbon-like appearance. Comparison of the SXT images with the Halpha images shows that the Halpha patches are aligned with the footpoints of the soft X-ray loops, suggesting the presence of a small arcade structure. There is no clear evidence for an eruptive signature in our observations nor in reports from other observations. The lack of an eruptive signature could suggest that the flare may have been a confined simple-loop flare, but this is not compelling due to a gap in the coronal observations prior to and early in the event. Analysis of our observations indicate that the flare exhibited characteristics suggesting that it may be better understood as a mini-arcade flare. These results casts doubt on the validity of the supposed paradigm of a confined simple-loop flare, at least for this flare. They indicate that even an apparently simple-loop flare may be considered to be a variety of arcade flare. We also find an effect which, to our knowledge, has not been reported before: the hot flaring regions later become cooler than the surrounding quiescent corona. That is, the flare loops do not evolve into bright active region loops, but into cooler loops. This may indicate an increase in the efficiency of the cooling mechanism or a transformed equilibrium state within the flaring loops

Kidney transplant nephrotic syndrome: Relationship between allograft histopathology and natural course

Kidney transplant nephrotic syndrome: Relationship between allograft histopathology and natural course. We analyzed clinical and pathologic data from 36 recipients of 38 renal allografts who developed nephrotic syndrome following transplantation. Three groups were identified on the basis of histologic changes in the graft, and each group had a distinct clinical course. Nine grafts (23.7%) had recurrent glomerulonephritis (GN) (5 membrano-proliferative, 4 focal glomerulosclerosis) and developed nephrotic syndrome at 5.1 months (mean) posttransplant. Renal function deteriorated rapidly, with a 2-year graft survival of 29.7%. Four grafts (10.5%) with de novo GN (3 epimembranous, 1 minimal change) developed nephrotic syndrome at 32 months post-transplant, and all functioned for more than 3 years. Twenty-five grafts (65.8%) had allograft glomerulopathy with the onset of nephrotic syndrome at 9.1 months posttransplant and a 2-year graft survival of 66.6%. The differences in duration of graft function between grafts with allograft glomerulopathy and recurrent GN (P < 0.01) and in graft survival rates at 2 years among the three groups (P < 0.05) are statistically significant. This analysis indicates that allograft glomerulopathy is the most common cause of kidney transplant nephrotic syndrome. Membranopro-liferative GN and focal glomerulosclerosis may recur soon after transplantation and rapidly progress to renal failure in marked contrast to grafts with either de novo epimembranous nephropathy or minimal glomerular change, lesions that are compatible with prolonged graft function.Syndrome néphrotique du rein transplanté: Relations entre l'histopathologies de l'allogreffe et l'évolution. Nous avons analysé les dossiers cliniques et anatomo-pathologiques de 36 receveurs de 38 allogreffes qui ont développé un syndrome néphrotique après transplantation. Trois groupes ont été identifiés sur la base des modifications histologiques de la greffe et chaque groupe a eu une évolution distincte. Neuf greffes (23,7%) ont eu une récidive de glomérulonéphrite (GN) (5 membrano-prolifératives, 4 gloméruloscléroses focales) et ont développé un syndrome néphrotique 5,1 mois (moyenne) après la transplantation. La fonction rénale s'est détériorée rapidement, avec une survie de la greffe à 2 ans de 29,7%. Quatre greffes (10,5%) atteintes de GN nouvelle (3 extra-membraneuses, 1 à modifications minimes) ont développé un syndrome néphrotique 32 mois après la transplantation et ont toutes fonctionné plus de 3 ans. Vingt cinq greffes (65,8%) ont eu une glomérulopathie de greffe avec l'installation d'un syndrome néphrotique à 9,1 mois après la transplantation et une survie de la greffe à 2 ans de 66,6%. Les différences de durée du fonctionnement de la greffe selon l'atteinte par une récidive de GN ou une glomérulopathie de greffe (P < 0,01) et dans la survie des greffes à 2 ans dans les trois groupes (P < 0,05) sont statistiquement significatives. Cette analyse indique que la glomérulonéphrite de la greffe est la cause la plus répandue de syndrome néphrotique du rein transplanté. La GN membrano-proliférative et la glomérulosclérose focale peuvent récidiver précocement après la transplantation et progresser rapidement vers l'insuffisance rénale à la différence des greffes atteintes de néphropathie extramembraneuse ou de modifications minimes, lésions compatibles avec une fonction prolongée de la greffe

A Statistical Analysis of the SOT-Hinode Observations of Solar Spicules and their Wave-like Behavior

We consider a first important parameter of spicules as observed above the solar visible limb: their apparent diameter as a function of the height above the limb which determines their aspect ratio and leads to the discussion of their magnetic origin using the flux tube approximation. We found that indeed spicules show a whole range of diameters, including unresolved "interacting spicules" (I-S), depending of the definition chosen to characterize this ubiquitous dynamical phenomenon occurring into a low coronal surrounding. 1-D Fourier amplitude spectra (AS) made at different heights above the limb are shown for the first time. A definite signature in the 0.18 to 0.25 Mm range exists, corresponding to the occurrence of the newly discovered type II spicules and, even more impressively, large Fourier amplitudes are observed in the 0.3 to the 1.2 Mm range of diameters and spacing, in rough agreement with what historical works were reporting. Additionally, some statistically significant behavior, based on AS computed for different heights above the limb, is discussed. "Time slice or x-t diagrams" revealing the dynamical behavior of spicules are also analyzed. They show that most of spicules have multiple structures (similarly to the doublet spicules) and they show impressive transverse periodic fluctuations which were interpreted as upward kink or Alfven waves. Evidence of the helical motion in spicules is now well evidenced, the typical periods of the apparent oscillation being around 120 sec. A fine analysis of the time-slice diagram as a function of the effective heights shows an interesting new feature near the 2 Mm height. We speculate on the interpretation of this feature as being a result of the dynamical specificities of the spicule helical motion as seen in these unprecedented high resolution HCaII line emission time series.Comment: 21 pages, 8 figurs, 1 tabl

A new methodology for performing large scale simulations of tsunami generated by deformable submarine slides

Large tsunamis can be generated by submarine slides, but these events are rare on human timescales and challenging to observe. Experiments and numerical modelling offer methods to understand the mechanisms by which they generate waves and what the potential hazard might be. However, to fully capture the complex waveform generated by a submarine slide, the slide dynamics must also be accurately modelled. It is computationally difficult to model both a three-dimensional submarine slide whilst simultaneously simulating oceanic-scale tsunamis. Past studies have either coupled localised models of the slide generation to oceanic-scale tsunami simulations or simplified the slide dynamics. Here, we present a new methodology of model coupling that generates the wave in the ocean-scale model via boundary-condition coupling of a two-dimensional dynamic slide simulation. We verify our coupling methodology by comparing model results to a previous simulation of a tsunamigenic slide in the Gulf of Mexico. We then examine the effect of slide deformation on the risk posed by hypothetical submarine slides around the UK. We show the deformable submarine slide simulations produce larger waves than the solid slide simulations due to the details of acceleration and velocity of the slide, although lateral spreading is not modelled. This work offers a new methodology for simulating oceanic-scale tsunamis caused by submarine slides using the output of a two–dimensional, multi-material simulation as input into a three–dimensional ocean model. This facilitates future exploration of the tsunami risk posed by tsunamigenic submarine slides that affect coastlines not normally prone to tsunamis

Fabrication of Triangular Nanobeam Waveguide Networks in Bulk diamond Using Single-Crystal Silicon Hard Masks

A scalable approach for integrated photonic networks in single-crystal diamond using triangular etching of bulk samples is presented. We describe designs of high quality factor (Q=2.51x10^6) photonic crystal cavities with low mode volume (Vm=1.062x({\lambda}/n)^3), which are connected via waveguides supported by suspension structures with predicted transmission loss of only 0.05 dB. We demonstrate the fabrication of these structures using transferred single-crystal silicon hard masks and angular dry etching, yielding photonic crystal cavities in the visible spectrum with measured quality factors in excess of Q=3x103.Comment: This article will be published in Applied Physics Letter