Implementation of a Heart Failure Quality Initiative in a Skilled Nursing Facility: Lessons Learned

Skilled nursing facilities (SNFs) are organizations that represent complex adaptive systems, offering barriers to the implementation of quality improvement (QI) initiatives. The current article describes the authors’ efforts to use the approach of reflective adaptive process to implement a new model of care (i.e., the Skilled Heart Unit Program) for effective heart failure (HF) care in one SNF. A team of stakeholders from the local hospital system and a local SNF was convened to design and implement this new model. Evaluation of the implementation processes confirmed the value of the implementation approach, which centered on team-based approaches, staff engagement, and flexibility of processes to respect the SNF’s needs and culture. Interviews with facility staff and the administrator revealed their perceptions that the strategy resulted in better HF care, enhanced teamwork between staff and clinicians, and improved staff job satisfaction. This work provides a unique blueprint of strategic QI implementation for patients with HF in the SNF setting

Audiovisual, Genre, Neural and Topical Textual Embeddings for TV Programme Content Representation

TV programmes have their contents described by multiple means: textual subtitles, audiovisual files, and metadata such as genres. In order to represent these contents, we develop vectorial representations for their low-level multimodal features, group them with simple clustering techniques, and combine them using middle and late fusion. For textual features, we use LSI and Doc2Vec neural embeddings; for audio, MFCC's and Bags of Audio Words; for visual, SIFT, and Bags of Visual Words. We apply our model to a dataset of BBC TV programmes and use a standard recommender and pairwise similarity matrices of content vectors to estimate viewers' behaviours. The late fusion of genre, audio and video vectors with both of the textual embeddings significantly increase the precision and diversity of the results

Isolation and purification of membrane-bound cytochrome c from Proteus mirabilis

In the present studies, respiratory chain pathogenic bacterium, Proteus mirabilis, was investigated. In the first phase, growth profile study was performed to optimize the P. mirabilis growth. Maximum bacterial growth could be obtained between 10 – 12 h of culturing time. Down-stream processing was performed by using sonication, ultracentrifugation and detergent solubilization techniques. Partially purified respiratory contents were analyzed spectrophotometrically. Pyridine-ferrochrome and redoxspectra showed the presence of heme-c

Selective spin coupling through a single exciton

We present a novel scheme for performing a conditional phase gate between two spin qubits in adjacent semiconductor quantum dots through delocalized single exciton states, formed through the inter-dot Foerster interaction. We consider two resonant quantum dots, each containing a single excess conduction band electron whose spin embodies the qubit. We demonstrate that both the two-qubit gate, and arbitrary single-qubit rotations, may be realized to a high fidelity with current semiconductor and laser technology.Comment: 5 pages, 3 figures; published version, equation formatting improved, references adde

A Unified Mathematical Modelling and Simulation for Cathodic Blistering Mechanism incorporating diffusion and fracture mechanics concepts

A novel mathematical model has been developed to understand the mechanism of blister initiation and propagation. The model employs a two-part theoretical approach encompassing the debondment of a coating film from the substrate, coupled with the design components incorporating diffusion and fracture mechanics, where the latter is derived from equi-biaxial tensile loading. Integrating the two components, a comprehensive mathematical design for the propagation of blister boundaries based on specific toughness functions and mode adjustment parameters has been developed. This approach provided a reliable and efficient prediction method for blister growth rate and mechanisms. The model provided a foundation for holistic design based on diffusion and mechanic components to enable better understanding of the debondment of thin elastic films bonded to a metallic substrate

Phonon-Induced Rabi-Frequency Renormalization of Optically Driven Single InGaAs/GaAs Quantum Dots

The authors thank the EPSRC (U.K.) EP/G001642, and the QIPIRC U.K. for financial support. A. N. is supported by the EPSRC and B.W. L. by the Royal Society.We study optically driven Rabi rotations of a quantum dot exciton transition between 5 and 50 K, and for pulse areas of up to 14 pi. In a high driving field regime, the decay of the Rabi rotations is nonmonotonic, and the period decreases with pulse area and increases with temperature. By comparing the experiments to a weak-coupling model of the exciton-phonon interaction, we demonstrate that the observed renormalization of the Rabi frequency is induced by fluctuations in the bath of longitudinal acoustic phonons, an effect that is a phonon analogy of the Lamb shift.Peer reviewe

A model for cathodic blister growth in coating degradation using mesomechanics approach

The paper presents a novel theoretical model of blistering initiation and propagation especially useful for coating life assessment. The focus is on initially circular blisters. A two-part theoretical analysis of blistering is conducted using mesomechanics approach coupling diffusion concepts with fracture mechanics concepts. The diffusion concept is used to treat the corrosive species transport, eventually causing corrosion and blistering, while the fracture mechanics concept is used to treat the blister growth as circular crack propagation. Effects of thickness ratio and modulus ratio on blistering propagation are discussed. A simple criterion is identified which excludes the possibility of widespread blister propagation. Furthermore, a comparative study with the existing blistering models is carried out. Experiments are reported for blistering using a model coating-substrate system, chosen to allow visualisation of interface and to permit coupled (diffusion and residual) stresses in the coating over a full range of interest. The predicted limits from theoretical model are expected to be useful for the manufacturers in the design and deposition of coatings

Psychotropic prescribing after hospital discharge in survivors of critical illness, a retrospective cohort study (2012–2019)

Background:Many people survive critical illness with the burden of new or worsened mental health issues and sleep disturbances. We examined the frequency of psychotropic prescribing after critical illness, comparing critical care to non-critical care hospitalised survivors, and whether this varied in important subgroups.Methods:This retrospective cohort study included 23,340 critical care and 367,185 non-critical care hospitalised adults from 2012 through 2019 in Lothian, Scotland, who survived to discharge.Results:One-third of critical care survivors (32 7527/23,340) received a psychotropic prescription within 90 days after hospital discharge (25 14hypnotics; 4mania medicines). In contrast, 1554,589/367,185) of non-critical care survivors received a psychotropic prescription (12 5hypnotics; 2mania medicines). Among patients without psychotropic prescriptions within 180 days prior to hospitalisation, after hospital discharge, the critical care group had a higher incidence of psychotropic prescription (10.3 1610/15,609) compared with the non-critical care group (3.2 9743/307,429); unadjusted hazard ratio (HR) 3.39, 95 3.22–3.57. After adjustment for potential confounders, the risk remained elevated (adjusted HR 2.03, 95 1.91–2.16), persisted later in follow-up (90–365 days; adjusted HR 1.38, 95 1.30–1.46), and was more pronounced in those without recorded comorbidities (adjusted HR 3.49, 95 3.22–3.78).Conclusions:Critical care survivors have a higher risk of receiving psychotropic prescriptions than hospitalised patients, with a significant proportion receiving benzodiazepines and other hypnotics. Future research should focus on the requirement for and safety of psychotropic medicines in survivors of critical illness, to help guide policy for clinical practice

An Interim Analysis of an Advance Care Planning Intervention in the Nursing Home Setting

Objectives To describe processes and preliminary outcomes from the implementation of a systematic advance care planning (ACP) intervention in the nursing home setting. Design Specially trained project nurses were embedded in 19 nursing homes and engaged in ACP as part of larger demonstration project to reduce potentially avoidable hospitalizations. Setting Nursing homes. Participants Residents enrolled in the demonstration project for a minimum of 30 days between August 2013 and December 2014 (n = 2,709) and residents currently enrolled in March 2015 (n = 1,591). Measurements ACP conversations were conducted with residents, families, and the legal representatives of incapacitated residents using a structured ACP interview guide with the goal of offering ACP to all residents. Project nurses reviewed their roster of currently enrolled residents in March 2015 to capture barriers to engaging in ACP. Results During the initial implementation phase, 27% (731/2,709) of residents had participated in one or more ACP conversations with a project nurse, resulting in a change in documented treatment preferences for 69% (504/731). The most common change (87%) was the generation of a Physician Orders for Scope of Treatment form. The most frequently reported barrier to ACP was lack of time. Conclusion The time- and resource-intensive nature of robust ACP must be anticipated when systematically implementing ACP in the nursing home setting. The fact that these conversations resulted in changes over 2/3 of the time reinforces the importance of deliberate, systematic ACP to ensure that current treatment preferences are known and documented so that these preferences can be honored

Optimisation of Interface Roughness and Coating Thickness to Maximise Coating-Substrate Adhesion - A Failure Prediction and Reliability Assessment Modelling

This paper addresses a novel modelling technique which is based on a multidisciplinary approach to predict the coating-substrate adhesion. It proposes new equations governing coating debondment that combines material science concepts with and solid mechanics concepts. The effects of two parameters i.e. interface roughness λ and coating thickness h on coating-substrate adhesion has been analysed. The reliability of newly developed technique has been validated by comparison with the experimental results