Novel inferences of ionisation & recombination for particle/power balance during detached discharges using deuterium Balmer line spectroscopy

The physics of divertor detachment is determined by divertor power, particle and momentum balance. This work provides a novel analysis technique of the Balmer line series to obtain a full particle/power balance measurement of the divertor. This supplies new information to understand what controls the divertor target ion flux during detachment. Atomic deuterium excitation emission is separated from recombination quantitatively using Balmer series line ratios. This enables analysing those two components individually, providing ionisation/recombination source/sinks and hydrogenic power loss measurements. Probabilistic Monte Carlo techniques were employed to obtain full error propagation - eventually resulting in probability density functions for each output variable. Both local and overall particle and power balance in the divertor are then obtained. These techniques and their assumptions have been verified by comparing the analysed synthetic diagnostic 'measurements' obtained from SOLPS simulation results for the same discharge. Power/particle balance measurements have been obtained during attached and detached conditions on the TCV tokamak.Comment: The analysis results of this paper were formerly in arXiv:1810.0496

Multi-Shooting Differential Dynamic Programming for Hybrid Systems using Analytical Derivatives

Differential Dynamic Programming (DDP) is a popular technique used to generate motion for dynamic-legged robots in the recent past. However, in most cases, only the first-order partial derivatives of the underlying dynamics are used, resulting in the iLQR approach. Neglecting the second-order terms often slows down the convergence rate compared to full DDP. Multi-Shooting is another popular technique to improve robustness, especially if the dynamics are highly non-linear. In this work, we consider Multi-Shooting DDP for trajectory optimization of a bounding gait for a simplified quadruped model. As the main contribution, we develop Second-Order analytical partial derivatives of the rigid-body contact dynamics, extending our previous results for fixed/floating base models with multi-DoF joints. Finally, we show the benefits of a novel Quasi-Newton method for approximating second-order derivatives of the dynamics, leading to order-of-magnitude speedups in the convergence compared to the full DDP method.Comment: https://www.youtube.com/watch?v=C0h6mEpcnA

Does patient satisfaction of general practice change over a decade?

Background The Patient Participation Program (PPP) was a patient satisfaction survey endorsed by the Royal Australian College of General Practitioners and designed to assist general practitioners in continuous quality improvement (CQI). The survey was been undertaken by 3500 practices and over a million patients between 1994 and 2003. This study aimed to use pooled patient questionnaire data to investigate changes in satisfaction with primary care over time. Methods The results of 10 years of the PPP surveys were analyzed with respect to 10 variables including the year of completion, patient age, gender, practice size, attendance at other doctors, and whether the practice had previously undertaken the survey. Comparisons were made using Logistic Generalized Estimating Equations (LGEE). Results There was a very high level of satisfaction with general practice in Australia (99% of respondents). An independent indicator of satisfaction was created by pooling the results of 12 questions. This new indicator had a greater variance than the single overall satisfaction question. Participants were shown to have higher levels of satisfaction if they were male, older, did not attend other practitioners or the practice was small in size. A minimal improvement in satisfaction was detected in this pooled indicator for the second or third survey undertaken by a practice. There was however no statistically significant change in pooled satisfaction with the year of survey. Conclusion The very high level of satisfaction made it difficult to demonstrate change. It is likely that this and the presentation of results made it difficult for GPs to use the survey to improve their practices. A more useful survey would be more sensitive to detect negative patient opinions and provide integrated feedback to GPs. At present, there are concerns about the usefulness of the PPP in continuous quality improvement in general practice.James Allan, Peter Schattner, Nigel Stocks and Emmae Ramsa

CACTO: Continuous Actor-Critic with Trajectory Optimization -- Towards global optimality

This paper presents a novel algorithm for the continuous control of dynamical systems that combines Trajectory Optimization (TO) and Reinforcement Learning (RL) in a single framework. The motivations behind this algorithm are the two main limitations of TO and RL when applied to continuous nonlinear systems to minimize a non-convex cost function. Specifically, TO can get stuck in poor local minima when the search is not initialized close to a "good" minimum. On the other hand, when dealing with continuous state and control spaces, the RL training process may be excessively long and strongly dependent on the exploration strategy. Thus, our algorithm learns a "good" control policy via TO-guided RL policy search that, when used as initial guess provider for TO, makes the trajectory optimization process less prone to converge to poor local optima. Our method is validated on several reaching problems featuring non-convex obstacle avoidance with different dynamical systems, including a car model with 6D state, and a 3-joint planar manipulator. Our results show the great capabilities of CACTO in escaping local minima, while being more computationally efficient than the Deep Deterministic Policy Gradient (DDPG) and Proximal Policy Optimization (PPO) RL algorithms.Comment: 8 pages, 8 figures. Submitted to IEEE RA-

Does patient satisfaction of general practice change over a decade?

Background The Patient Participation Program (PPP) was a patient satisfaction survey endorsed by the Royal Australian College of General Practitioners and designed to assist general practitioners in continuous quality improvement (CQI). The survey was been undertaken by 3500 practices and over a million patients between 1994 and 2003. This study aimed to use pooled patient questionnaire data to investigate changes in satisfaction with primary care over time. Methods The results of 10 years of the PPP surveys were analyzed with respect to 10 variables including the year of completion, patient age, gender, practice size, attendance at other doctors, and whether the practice had previously undertaken the survey. Comparisons were made using Logistic Generalized Estimating Equations (LGEE). Results There was a very high level of satisfaction with general practice in Australia (99% of respondents). An independent indicator of satisfaction was created by pooling the results of 12 questions. This new indicator had a greater variance than the single overall satisfaction question. Participants were shown to have higher levels of satisfaction if they were male, older, did not attend other practitioners or the practice was small in size. A minimal improvement in satisfaction was detected in this pooled indicator for the second or third survey undertaken by a practice. There was however no statistically significant change in pooled satisfaction with the year of survey. Conclusion The very high level of satisfaction made it difficult to demonstrate change. It is likely that this and the presentation of results made it difficult for GPs to use the survey to improve their practices. A more useful survey would be more sensitive to detect negative patient opinions and provide integrated feedback to GPs. At present, there are concerns about the usefulness of the PPP in continuous quality improvement in general practice.James Allan, Peter Schattner, Nigel Stocks and Emmae Ramsa

Tearing down walls: opening the border between hospital and ambulatory care for quality improvement in Germany

The hospital benchmarking system in Germany was originally introduced to detect unintended consequences of reimbursement based on diagnosis-related groups. The new nationwide SQG programme aims to provide information on quality and outcomes of health care provided in hospital, ambulatory specialist and primary care settings, including the healthcare delivery across different sectors. In 2010 the topics for indicator development were cataract surgery, cervical conization, colectoral cancer and percutaneous coronary interventions or coronary angiography. A systematic stepwise modified RAND/UCLA procedure is applied to develop quality indicators in each of these domains. A general framework for data collection is implemented. Benchmarking results are fed back to providers on a regular basis

Hybrid Volitional Control of a Robotic Transtibial Prosthesis using a Phase Variable Impedance Controller

For robotic transtibial prosthesis control, the global kinematics of the tibia can be used to monitor the progression of the gait cycle and command smooth and continuous actuation. In this work, these global tibia kinematics are used to define a phase variable impedance controller (PVIC), which is then implemented as the nonvolitional base controller within a hybrid volitional control framework (PVI-HVC). The gait progression estimation and biomechanic performance of one able-bodied individual walking on a robotic ankle prosthesis via a bypass adapter are compared for three control schemes: a passive benchmark controller, PVIC, and PVI-HVC. The different actuation of each controller had a direct effect on the global tibia kinematics, but the average deviation between the estimated and ground truth gait percentage were 1.6%, 1.8%, and 2.1%, respectively, for each controller. Both PVIC and PVI-HVC produced good agreement with able-bodied kinematic and kinetic references. As designed, PVI-HVC results were similar to those of PVIC when the user used low volitional intent, but yielded higher peak plantarflexion, peak torque, and peak power when the user commanded high volitional input in late stance. This additional torque and power also allowed the user to volitionally and continuously achieve activities beyond level walking, such as ascending ramps, avoiding obstacles, standing on tip-toes, and tapping the foot. In this way, PVI-HVC offers the kinetic and kinematic performance of the PVIC during level ground walking, along with the freedom to volitionally pursue alternative activities.Comment: 7 pages, 7 figures, submitted to ICRA 202

A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care

This is the final version of the article. Available from Taylor & Francis via the DOI in this record.BACKGROUND: Healthcare can cause avoidable serious harm to patients. Primary care is not an exception, and the relative lack of research in this area lends urgency to a better understanding of patient safety, the future research agenda and the development of primary care oriented safety programmes. OBJECTIVE: To outline a research agenda for patient safety improvement in primary care in Europe and beyond. METHODS: The LINNEAUS collaboration partners analysed existing research on epidemiology and classification of errors, diagnostic and medication errors, safety culture, and learning for and improving patient safety. We discussed ideas for future research in several meetings, workshops and congresses with LINNEAUS collaboration partners, practising GPs, researchers in this field, and policy makers. RESULTS: This paper summarizes and integrates the outcomes of the LINNEAUS collaboration on patient safety in primary care. It proposes a research agenda on improvement strategies for patient safety in primary care. In addition, it provides background information to help to connect research in this field with practicing GPs and other healthcare workers in primary care. CONCLUSION: Future research studies should target specific primary care domains, using prospective methods and innovative methods such as patient involvement.The research leading to these results has received funding from the European Community’s Seventh Framework Programme FP7/2008–2012 under grant agreement no. 223424

General practitioners' experience and benefits from patient evaluations

<p>Abstract</p> <p>Background</p> <p>It has now for many years been recognised that patient evaluations should be undertaken as an integral part of the complex task of improving the quality of general practice care. Yet little is known about the general practitioners' (GPs') benefit from patient evaluations. Aim 1 was to study the impact on the GPs of a patient evaluation and subsequent feedback of results presented at a plenary session comprising a study guide for the results and group discussions. Aim 2 was to study possible facilitators and barriers to the implementations of the results raised by the patient evaluation process.</p> <p>Methods</p> <p>A patient evaluation survey of 597 voluntarily participating GPs was performed by means of the EUROPEP questionnaire. Evaluation results were fed back to the GPs as written reports at a single feedback meeting with group discussions of the results. Between 3 and 17 months after the feedback, the 597 GPs received a questionnaire with items addressing their experience with and perceived benefit from the evaluations.</p> <p>Results</p> <p>79.4% of the GPs responded. 33% of the responding GPs reported that the patient evaluation had raised their attention to the patient perspective on the quality of general practice care. Job satisfaction had improved among 26%, and 21% had developed a more positive attitude to patient evaluations. 77% of the GPs reported having learnt from the evaluation. 54% had made changes to improve practice, 82% would recommend a patient evaluation to a colleague and 75% would do another patient evaluation if invited. 14% of the GPs had become less positive towards patient evaluations, and job satisfaction had decreased among 3%.</p> <p>Conclusions</p> <p>We found a significant impact on the GPs regarding satisfaction with the process and attitude towards patient evaluations, GPs' attention to the patients' perspective on care quality and their job satisfaction. Being benchmarked against the average seemed to raise barriers to the concept of patient evaluations and difficulties interpreting the results may have formed a barrier to their implementation which was partly overcome by adding qualitative data to the quantitative results. The GPs' significant willingness to share and discuss the results with others may have served as a facilitator.</p

Designing theoretically-informed implementation interventions

Clinical and health services research is continually producing new findings that may contribute to effective and efficient patient care. However, the transfer of research findings into practice is unpredictable and can be a slow and haphazard process. Ideally, the choice of implementation strategies would be based upon evidence from randomised controlled trials or systematic reviews of a given implementation strategy. Unfortunately, reviews of implementation strategies consistently report effectiveness some, but not all of the time; possible causes of this variation are seldom reported or measured by the investigators in the original studies. Thus, any attempts to extrapolate from study settings to the real world are hampered by a lack of understanding of the effects of key elements of individuals, interventions, and the settings in which they were trialled. The explicit use of theory offers a way of addressing these issues and has a number of advantages, such as providing: a generalisable framework within which to represent the dimensions that implementation studies address, a process by which to inform the development and delivery of interventions, a guide when evaluating, and a way to allow for an exploration of potential causal mechanisms. However, the use of theory in designing implementation interventions is methodologically challenging for a number of reasons, including choosing between theories and faithfully translating theoretical constructs into interventions. The explicit use of theory offers potential advantages in terms of facilitating a better understanding of the generalisability and replicability of implementation interventions. However, this is a relatively unexplored methodological area