The impact of facilities management on patient outcomes

Purpose – The purpose of this paper is to investigate the extent to which practicing National Health Service (NHS) facilities managers thought that the contribution of facilities management (FM) could be measured in terms of health outcomes. Design/methodology/approach – A questionnaire was distributed to NHS facilities or estate managers from the majority of NHS trusts in England and Wales. Findings – In general, there is little or no evidence from pre-existing research to prove the contribution of FM in terms of health outcomes. However, in spite of this, 59 per cent of facilities managers in the NHS believe that the contribution of FM could be measured yet only a relatively small number of Trusts (16 per cent) have attempted to measure the contribution of FM. The analysis of the secondary data does not show any conclusive evidence of a correlation between FM and health outcomes. Research limitations/implications – The scope of the study did not extend to collecting empirical evidence to prove the contribution of FM to health outcomes – it was only focusing on whether facilities managers thought it was possible, and if so how they would measure the contribution. However, as part of the project some secondary data were tested for a relationship between FM services and health outcomes. Originality/value – This is the first time any study has gathered opinion from facilities managers as to whether they believe their contribution can be measured in terms of organisational outcomes, in this case patient care or health outcomes. It provides a useful starting point in order to develop a future study to prove the contribution from FM to health outcomes.</p

How to find an attractive solution to the liar paradox

The general thesis of this paper is that metasemantic theories can play a central role in determining the correct solution to the liar paradox. I argue for the thesis by providing a specific example. I show how Lewis’s reference-magnetic metasemantic theory may decide between two of the most influential solutions to the liar paradox: Kripke’s minimal fixed point theory of truth and Gupta and Belnap’s revision theory of truth. In particular, I suggest that Lewis’s metasemantic theory favours Kripke’s solution to the paradox over Gupta and Belnap’s. I then sketch how other standard criteria for assessing solutions to the liar paradox, such as whether a solution faces a so-called revenge paradox, fit into this picture. While the discussion of the specific example is itself important, the underlying lesson is that we have an unused strategy for resolving one of the hardest problems in philosophy

Characterisation of putative class 1A DHODH-like proteins from Mucorales and dematiaceous mould species

Olorofim is a new antifungal in clinical development which has a novel mechanism of action against dihydroorotate dehydrogenase (DHODH). DHODH form a ubiquitous family of enzymes in the de novo pyrimidine biosynthetic pathway and are split into class 1A, class 1B and class 2. Olorofim specifically targets the fungal class 2 DHODH present in a range of pathogenic moulds. The nature and number of DHODH present in many fungal species have not been addressed for large clades of this kingdom. Mucorales species do not respond to olorofim; previous work suggests they have only class 1A DHODH and so lack the class 2 target that olorofim inhibits. The dematiaceous moulds have mixed susceptibility to olorofim, yet previous analyses imply that they have class 2 DHODH. As this is at odds with their intermediate susceptibility to olorofim, we hypothesised that these pathogens may maintain a second class of DHODH, facilitating pyrimidine biosynthesis in the presence of olorofim. The aim of this study was to investigate the DHODH repertoire of clinically relevant species of Mucorales and dematiaceous moulds to further characterise these pathogens and understand variations in olorofim susceptibility. Using bioinformatic analysis, S. cerevisiae complementation and biochemical assays of recombinant protein, we provide the first evidence that two representative members of the Mucorales have only class 1A DHODH, substantiating a lack of olorofim susceptibility. In contrast, bioinformatic analyses initially suggested that seven dematiaceous species appeared to harbour both class 1A-like and class 2-like DHODH genes. However, further experimental investigation of the putative class 1A-like genes through yeast complementation and biochemical assays characterised them as dihydrouracil oxidases rather than DHODHs. These data demonstrate variation in dematiaceous mould olorofim susceptibility is not due to a secondary DHODH and builds on the growing picture of fungal dihydrouracil oxidases as an example of horizontal gene transfer

An observational study to examine how Cumulative Impact Zones influence alcohol availability from different types of licensed outlets in an inner London Borough

OBJECTIVES: Cumulative Impact Zones (CIZs) are a widely implemented local policy intended to restrict alcohol availability in areas proliferated with licensed outlets. Limited previous research has questioned their effectiveness and suggested they may play a more nuanced role in shaping local alcohol environments. This study evaluates the association between CIZ implementation and the number of licence applications made and the number issued, relative to a control region. DESIGN: A quantitative observational study. SETTING: The inner London Borough of Southwark, which currently enforces three CIZs. POPULATION: Licence applications received by Southwark Council’s Licensing Authority between 1 April 2006 and 31 March 2017 (N = 1254). INTERVENTIONS: CIZ implementation. PRIMARY OUTCOME MEASURES: Five outlet types were categorised and evaluated: Drinking Establishments, Eateries, Takeaways, Off Sales, and Other Outlets. Primary outcome measures were the number of applications received and the number of licences issued. These were analysed using Poisson regression of counts over time. RESULTS: Across all CIZs, implementation was associated with greater increases in the number of eateries in CIZ regions (IRR = 1.58, 95% CI: 1.02 – 2.52, P = 0.04) and number of takeaway venues (IRR = 3.89, 95% CI: 1.32 – 11.49, P = 0.01), relative to the control area. No discernible association was found for the remaining outlet types. Disaggregating by area indicated a 10-fold relative increase in the number of new eateries in Peckham CIZ (IRR = 10.38, 95% CI: 1.39 – 77.66, P = 0.02) and a four-fold relative increase in the number of newly licensed takeaways in Bankside CIZ (IRR = 4.38, 95% CI: 1.20 – 15.91, P = 0.03). CONCLUSIONS: Cumulative Impact Zones may be useful as policy levers to shape local alcohol environments to support the licensing goals of specific geographical areas and diversify the night-time economy

Evidence of high bed net usage from a list randomization experiments in rural Gambia.

Label: BACKGROUND NlmCategory: BACKGROUND content: Recording behaviours that have the potential to impact health can be doubly challenging if the behaviour takes place in private spaces that cannot be observed directly, and where respondents answer what they think the recorder may want to hear. Sleeping under a long-lasting insecticidal net (LLIN) is an important intervention for malaria prevention, yet it is difficult to gauge the extent to which coverage (how many nets are in the community) differs from usage (how many people actually sleep under a net). List randomization, a novel method which partially obscures respondents' answers to sensitive questions, was employed to estimate LLIN usage in The Gambia. - Label: METHODS NlmCategory: METHODS content: "802 heads-of-household from 15 villages were recruited into a randomized controlled trial assessing the effect of a housing intervention on malaria. These houses were randomly assigned to a housing intervention versus control, with stratification by village so as to ensure balance between arms. From these, 125 households (63 intervention, 52 control) were randomly selected for participation in the list randomization experiment, along with 68 households from the same villages but which were not part of the housing improvement study, resulting in a total of 196 households for the list randomization experiment. Approximately half (n\xE2\x80\x89=\xE2\x80\x8997) of the 196 study participants were randomly assigned to the control group and received a four-question list about non-sensitive behaviours; the intervention group (n\xE2\x80\x89=\xE2\x80\x8999) received the same list, with the addition of one question on a sensitive behaviour: whether or not they had used a bed net the previous night. Participants were read the list of questions and then said how many of the statements were true. Bed net usage was estimated by calculating the difference in means between the number of affirmative responses between the two groups." - Label: RESULTS NlmCategory: RESULTS content: The mean number of affirmative responses in the control group was 2.60 of four statements (95% confidence interval, 95% CI 2.50-2.70), compared with 3.68 (95% CI 3.59-3.78) in the intervention group. Such difference (1.08; 95% CI 94.9-100%) suggests near universal bed net usage. - Label: CONCLUSIONS NlmCategory: CONCLUSIONS content: Bed net usage by household heads in these rural villages was found to be high. Though not entirely unexpected given other studies' estimates of high bed net usage in the area, the list randomization method should be further validated in an area with lower coverage

Impact of lightning-NO on eastern United States photochemistry during the summer of 2006 as determined using the CMAQ model

A lightning-nitrogen oxide (NO) algorithm is implemented in the Community Multiscale Air Quality Model (CMAQ) and used to evaluate the impact of lightning-NO emissions (LNO&lt;sub&gt;x&lt;/sub&gt;) on tropospheric photochemistry over the United States during the summer of 2006. &lt;br&gt;&lt;br&gt; For a 500 mole per flash lightning-NO source, the mean summertime tropospheric NO&lt;sub&gt;2&lt;/sub&gt; column agrees with satellite-retrieved columns to within −5 to +13%. Temporal fluctuations in the column are moderately well simulated; however, the addition of LNO&lt;sub&gt;x&lt;/sub&gt; does not lead to a better simulation of day-to-day variability. The contribution of lightning-NO to the model column ranges from &amp;sim;10% in the northern US to &gt;45% in the south-central and southeastern US. Lightning-NO adds up to 20 ppbv to upper tropospheric model ozone and 1.5–4.5 ppbv to 8-h maximum surface layer ozone, although, on average, the contribution of LNO&lt;sub&gt;x&lt;/sub&gt; to model surface ozone is 1–2 ppbv less on poor air quality days. LNO&lt;sub&gt;x&lt;/sub&gt; increases wet deposition of oxidized nitrogen by 43% and total deposition of nitrogen by 10%. This additional deposition reduces the mean magnitude of the CMAQ low-bias in nitrate wet deposition with respect to National Atmospheric Deposition monitors to near zero. &lt;br&gt;&lt;br&gt; Differences in urban/rural biases between model and satellite-retrieved NO&lt;sub&gt;2&lt;/sub&gt; columns were examined to identify possible problems in model chemistry and/or transport. CMAQ columns were too large over urban areas. Biases at other locations were minor after accounting for the impacts of lightning-NO emissions and the averaging kernel on model columns. &lt;br&gt;&lt;br&gt; In order to obtain an upper bound on the contribution of uncertainties in NO&lt;sub&gt;y&lt;/sub&gt; chemistry to upper tropospheric NO&lt;sub&gt;x&lt;/sub&gt; low biases, sensitivity calculations with updated chemistry were run for the time period of the Intercontinental Chemical Transport Experiment (INTEX-A) field campaign (summer 2004). After adjusting for possible interferences in NO&lt;sub&gt;2&lt;/sub&gt; measurements and averaging over the entire campaign, these updates reduced 7–9 km biases from 32 to 17% and 9–12 km biases from 57 to 46%. While these changes lead to better agreement, a considerable unexplained NO&lt;sub&gt;2&lt;/sub&gt; low-bias remains in the uppermost troposphere

Ammonia Emissions in the United States, European Union, and China Derived by High-Resolution Inversion of Ammonium Wet Deposition Data: Interpretation with a New Agricultural Emissions Inventory (MASAGE_NH3)

We use the adjoint of a global 3-D chemical transport model (GEOS-Chem) to optimize ammonia $(NH_3)$ emissions in the U.S., European Union, and China by inversion of 2005–2008 network data for $NH^+_4$ wet deposition fluxes. Optimized emissions are derived on a 2° × 2.5° grid for individual months and years. Error characterization in the optimization includes model errors in precipitation. Annual optimized emissions are $2.8 Tg NH_3−N a^{−1}$ for the contiguous U.S., $3.1 Tg NH_3−N a^{−1}$ for the European Union, and $8.4 Tg NH_3−N a^{−1}$ for China. Comparisons to previous inventories for the U.S. and European Union show consistency $(\sim \pm 15$ in annual totals but some large spatial and seasonal differences. We develop a new global bottom-up inventory of $NH_3$ emissions (Magnitude And Seasonality of Agricultural Emissions model for NH3 (MASAGE_NH3)) to interpret the results of the adjoint optimization. MASAGE_NH3 provides information on the magnitude and seasonality of $NH_3$ emissions from individual crop and livestock sources on a 0.5° × 0.5° grid. We find that U.S. emissions peak in the spring in the Midwest due to corn fertilization and in the summer elsewhere due to manure. The seasonality of European emissions is more homogeneous with a well-defined maximum in spring associated with manure and mineral fertilizer application. There is some evidence for the effect of European regulations of $NH_3$ emissions, notably a large fall decrease in northern Europe. Emissions in China peak in summer because of the summertime application of fertilizer for double cropping.Engineering and Applied Science

Perturbative Calculation of the Adiabatic Geometric Phase and Particle in a Well with Moving Walls

We use the Rayleigh-Schr\"odinger perturbation theory to calculate the corrections to the adiabatic geometric phase due to a perturbation of the Hamiltonian. We show that these corrections are at least of second order in the perturbation parameter. As an application of our general results we address the problem of the adiabatic geometric phase for a one-dimensional particle which is confined to an infinite square well with moving walls.Comment: Plain Latex, accepted for publication in J. Phys. A: Math. Ge

A consensus prognostic gene expression classifier for ER positive breast cancer.

BACKGROUND: A consensus prognostic gene expression classifier is still elusive in heterogeneous diseases such as breast cancer. RESULTS: Here we perform a combined analysis of three major breast cancer microarray data sets to hone in on a universally valid prognostic molecular classifier in estrogen receptor (ER) positive tumors. Using a recently developed robust measure of prognostic separation, we further validate the prognostic classifier in three external independent cohorts, confirming the validity of our molecular classifier in a total of 877 ER positive samples. Furthermore, we find that molecular classifiers may not outperform classical prognostic indices but that they can be used in hybrid molecular-pathological classification schemes to improve prognostic separation. CONCLUSION: The prognostic molecular classifier presented here is the first to be valid in over 877 ER positive breast cancer samples and across three different microarray platforms. Larger multi-institutional studies will be needed to fully determine the added prognostic value of molecular classifiers when combined with standard prognostic factors