Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network.

BACKGROUND: Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. METHOD: We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. RESULTS: We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR - Patients at risk of readmission and ACG - Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. CONCLUSIONS: Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don't change

How bees and foams respond to curved confinement:Level set boundary representations in the Surface Evolver

We investigate the equilibrium properties of a single area-minimising bubble trapped between two narrowly-separated parallel curved plates. We begin with the simple case of a bubble trapped between concentric spherical plates. We develop a model that shows that the surface tension energy of the bubble is lower when confined between spherical plates as compared to a bubble trapped between flat plates. We confirm our findings by comparing against Surface Evolver simulations. Next, we derive a simple model for a bubble between arbitrarily curved parallel plates. The energy is found to be higher when the local Gaussian curvature of the plates is negative and lower when the curvature is positive. To check the validity of the model we consider a bubble trapped between concentric tori. In the toroidal case we find that the sensitivity of the bubble's energy to the local curvature acts as a geometric potential capable of driving bubbles from regions with negative to positive curvature

Ice formation within a thin film flowing over a flat plate

We present a model for ice formation in a thin, viscous liquid film driven by a Blasius boundary layer after heating is switched off along part of the flat plate. The flow is assumed to initially be in the Nelson et al. (J. Fluid Mech., vol. 284, 1995, pp. 159–169) steady-state configuration with a constant flux of liquid supplied at the tip of the plate, so that the film thickness grows lik

Clinical utility and cost-effectiveness of bacterial 16S rRNA and targeted PCR based diagnostic testing in a UK microbiology laboratory network

16S ribosomal-ribonucleic acid polymerase chain reaction (PCR) and targeted PCR aid microbiological diagnosis in culture-negative clinical samples. Despite routine clinical use, there remains a paucity of data on their effectiveness across a variety of clinical sample types, and cost-effectiveness. In this 4 year multicentre retrospective observational study, all clinical samples referred for 16S PCR and/or targeted PCR from a laboratory network serving seven London hospitals were identified. Laboratory, clinical, prescribing, and economic variables were analysed. 78/607 samples were 16S PCR positive; pus samples were most frequently positive (29/84; p < 0.0001), and CSF least (8/149; p = 0.003). 210/607 samples had targeted PCR (361 targets requested across 23 organisms) with 43/361 positive; respiratory samples (13/37; p = 0.01) had the highest detection rate. Molecular diagnostics provided a supportive microbiological diagnosis for 21 patients and a new diagnosis for 58. 14/91 patients with prescribing information available and a positive PCR result had antimicrobial de-escalation. For culture-negative samples, mean cost-per-positive 16S PCR result was £568.37 and £292.84 for targeted PCR, equating to £4041.76 and £1506.03 respectively for one prescription change. 16S PCR is more expensive than targeted PCR, with both assisting in microbiological diagnosis but uncommonly enabling antimicrobial change. Rigorous referral pathways for molecular tests may result in significant fiscal savings

In vivo pathogenicity of hydropericardium hepatitis syndrome (Angara disease)

This study was conducted on 175 one day old broiler chicks in order to observe in vivo pathogenicity of hydropericardium hepatitis syndrome (Angara disease). Chicks were grouped into A (25 chicks; reared at the Poultry Research institute (PRI), Rawalpindi) and B groups (150 chicks; reared at National Veterinary Laboratories (NVL) Islamabad in poultry rearing units). Feed and water were provided adlibitum to all the birds in both groups. The LD50 (lethal dose 50) of the virus was determined at the age of 26 days of broiler chickens divided into sub-groups a, b, c, d and e (each having 5 birds). The LD50 titre of the viral suspension (10%) was prepared from liver extract and determined as 10-2.5 per ml. During the study, potency of the vaccines was determined by vaccinating 150 chicks of sub-group k, l, m, n and o (each having 30 birds) with a dose of 0.2 ml. The vaccinated and non-vaccinated chicks of sub-groups were challenged with viral dose of 2 ml at day 17 post-vaccination to know the protection potency of the vaccines. No chick showed clinical manifestation of disease up to five days post challenge. On the 6th day post challenge, all the chicks were slaughtered and subjected to postmortem. Some of the chicks showed the lesions of hydropericarium. Histopathological findings of liver of all sub-groups revealed different stages of necrosis, cloudy swelling, liquefactive necrosis, cytoplasmic blabing, fatty degeneration and intranuclear inclusion bodies of virus.Key words: In vivo pathogenicity, hydropericardium hepatitis syndrome, Angara disease

Reply to Comment by Velasco on “High-Resolution, Multilayer Modeling of Singapore’s Urban Climate Incorporating Local Climate Zones”

In response to the comment on our paper “High‐resolution, multilayer modeling of Singapore's urban climate incorporating local climate zones,” we provide detailed response to each of the incorrect accusations with scientifically based evidence. We have evaluated our model using all the available observational data, and the results showed good agreement. Our modeling study includes assumptions, as all modeling work does, and we have discussed their rationales and possible implications

Bimaximal Neutrino Mixing in a Zee-type Model with Badly Broken Flavor Symmetry

A Zee-type neutrino mass matrix model with a badly broken horizontal symmetry SU(3)_H is investigated. By putting a simple ansatz on the symmetry breaking effects of SU(3)_H for transition matrix elements, it is demonstrated that the model can give a nearly bimaximal neutrino mixing with the ratio $\Delta m^2_{solar}/\Delta m^2_{atm} \simeq \sqrt{2} m_e/m_{\mu}=6.7 \times 10^{-3}$, which are in excellent agreement with the observed data. In the near future, the lepton-number violating decay $Z\to \mu^\pm \tau^\mp$ will be observed.Comment: 10 pages, no figures, a comment adde

Spatially resolved depth profiling of residual stress by micro-ring-core method

Analysis and control of residual stresses in advanced engineering materials are important issues for reliability assessment at small scales, e.g. for micro-electromechanical systems (MEMS) and nano-crystalline and amorphous bulk and thin film materials. This presentation gives an overview of the recent advances in the field of sub-micron scale residual stress assessment by the use of focused ion beam (FIB)-controlled material removal techniques. Materials and The two step method consists of incremental FIB ring-core milling combined with high-resolution in-situ SEMFEG imaging of the relaxing surface and a full field strain analysis by digital image correlation (DIC). The through-thickness profile of the residual stress can be also obtained by comparison of the experimentally measured surface strain with finite element modelling using Schajer’s integral method. In this presentation, we will review the most recent advances in the field of FIB-DIC methods for residual stress assessment at the micro and nano scales, with focus on recent efforts for development of automated procedures for local residual stress analysis of (i) thin films, (ii) microelectronics devices and (iii) polycrystalline and amorphous bulk materials. Practical applications of the method on several systems will be described and discussed. In particular, the issues of residual stress assessment on very thin films and micro-devices, stress depth profiling, stress measurement on amorphous materials and the effects of ion induced damage and elastic anisotropy on the relaxation strains will be reviewed

Burnout among primary health-care professionals in low- and middle-income countries: systematic review and meta-analysis

Objective To estimate the prevalence of burnout among primary health-care professionals in low- and middle-income countries and to identify factors associated with burnout. Methods We systematically searched nine databases up to February 2022 to identify studies investigating burnout in primary health-care professionals in low- and middle-income countries. There were no language limitations and we included observational studies. Two independent reviewers completed screening, study selection, data extraction and quality appraisal. Random-effects meta-analysis was used to estimate overall burnout prevalence as assessed using the Maslach Burnout Inventory subscales of emotional exhaustion, depersonalization and personal accomplishment. We narratively report factors associated with burnout. Findings The search returned 1568 articles. After selection, 60 studies from 20 countries were included in the narrative review and 31 were included in the meta-analysis. Three studies collected data during the coronavirus disease 2019 pandemic but provided limited evidence on the impact of the disease on burnout. The overall single-point prevalence of burnout ranged from 2.5% to 87.9% (43 studies). In the meta-analysis (31 studies), the pooled prevalence of a high level of emotional exhaustion was 28.1% (95% confidence interval, CI: 21.5–33.5), a high level of depersonalization was 16.4% (95% CI: 10.1–22.9) and a high level of reduced personal accomplishment was 31.9% (95% CI: 21.7–39.1). Conclusion The substantial prevalence of burnout among primary health-care professionals in low- and middle-income countries has implications for patient safety, care quality and workforce planning. Further cross-sectional studies are needed to help identify evidence-based solutions, particularly in Africa and South-East Asia