Recruiting for values in healthcare: a preliminary review of the evidence

Displaying compassion, benevolence and respect, and preserving the dignity of patients are important for any healthcare professional to ensure the provision of high quality care and patient outcomes. This paper presents a structured search and thematic review of the research evidence relating to values-based recruitment within healthcare. Several different databases, journals and government reports were searched to retrieve studies relating to values-based recruitment published between 1998 and 2013, both in healthcare settings and other occupational contexts. There is limited published research related to values-based recruitment directly, so the available theoretical context of values is explored alongside an analysis of the impact of value congruence. The implications for the design of selection methods to measure values is explored beyond the scope of the initial literature search. Research suggests some selection methods may be appropriate for values-based recruitment, such as situational judgment tests (SJTs), structured interviews and multiple-mini interviews (MMIs). Personality tests were also identified as having the potential to compliment other methods (e.g. structured interviews), as part of a values-based recruitment agenda. Methods including personal statements, references and unstructured/'traditional' interviews were identified as inappropriate for values-based recruitment. Practical implications are discussed in the context of values-based recruitment in the healthcare context. Theoretical implications of our findings imply that prosocial implicit trait policies, which could be measured by selection tools such as SJTs and MMIs, may be linked to individuals' values via the behaviours individuals consider to be effective in given situations. Further research is required to state this conclusively however, and methods for values-based recruitment represent an exciting and relatively unchartered territory for further research

Sacubitril/valsartan reduces serum uric acid concentration, an independent predictor of adverse outcomes in PARADIGM-HF

Aims: Elevated serum uric acid concentration (SUA) has been associated with an increased risk of cardiovascular disease, but this may be due to unmeasured confounders. We examined the association between SUA and outcomes as well as the effect of sacubitril/valsartan on SUA in patients with heart failure with reduced ejection fraction (HFrEF) in PARADIGM-HF. Methods and results: The association between SUA and the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization, its components, and all-cause mortality was examined using Cox regression analyses among 8213 patients using quintiles (Q1–Q5) of SUA adjusted for baseline prognostic variables including estimated glomerular filtration rate (eGFR), diuretic dose, and log N-terminal pro-brain natriuretic peptide. Change in SUA from baseline over 12 months was also evaluated in each treatment group. Patients in Q5 (SUA ≥8.6 mg/dL) compared with Q1 (<5.4 mg/dL) were younger (62.8 vs. 64.2 years), more often male (88.7% vs. 63.1%), had lower systolic blood pressure (119 vs. 123 mmHg), lower eGFR (57.4 vs. 76.6 mL/min/1.73 m2), and greater diuretic use. Higher SUA was associated with a higher risk of the primary outcome (adjusted hazard ratios) Q5 vs. Q1 = 1.28 [95% confidence intervals (1.09–1.50), P = 0.003], cardiovascular death [1.44 (1.11–1.77), P = 0.001], HF hospitalization [1.37 (1.11–1.70), P = 0.004], and all-cause mortality [1.36 (1.13–1.64), P = 0.001]. Compared with enalapril, sacubitril/valsartan reduced SUA by 0.24 (0.17–0.32) mg/dL over 12 months (P < 0.0001). Sacubitril/valsartan improved outcomes, irrespective of SUA concentration. Conclusion: Serum uric acid concentration was an independent predictor of worse outcomes after multivariable adjustment in patients with HFrEF. Compared with enalapril, sacubitril/valsartan reduced SUA and improved outcomes irrespective of SUA

Renal effects and associated outcomes during angiotensin-neprilysin inhibition in heart failure

Objectives: The purpose of this study was to evaluate the renal effects of sacubitril/valsartan in patients with heart failure and reduced ejection fraction. Background: Renal function is frequently impaired in patients with heart failure with reduced ejection fraction and may deteriorate further after blockade of the renin–angiotensin system. Methods: In the PARADIGM-HF (Prospective Comparison of ARNI with ACE inhibition to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial, 8,399 patients with heart failure with reduced ejection fraction were randomized to treatment with sacubitril/valsartan or enalapril. The estimated glomerular filtration rate (eGFR) was available for all patients, and the urinary albumin/creatinine ratio (UACR) was available in 1872 patients, at screening, randomization, and at fixed time intervals during follow-up. We evaluated the effect of study treatment on change in eGFR and UACR, and on renal and cardiovascular outcomes, according to eGFR and UACR. Results: At screening, the eGFR was 70 ± 20 ml/min/1.73 m2 and 2,745 patients (33%) had chronic kidney disease; the median UACR was 1.0 mg/mmol (interquartile range: 0.4 to 3.2 mg/mmol) and 24% had an increased UACR. The decrease in eGFR during follow-up was less with sacubitril/valsartan compared with enalapril (−1.61 ml/min/1.73 m2/year; [95% confidence interval: −1.77 to −1.44 ml/min/1.73 m2/year] vs. −2.04 ml/min/1.73 m2/year [95% CI: −2.21 to −1.88 ml/min/1.73 m2/year ]; p < 0.001) despite a greater increase in UACR with sacubitril/valsartan than with enalapril (1.20 mg/mmol [95% CI: 1.04 to 1.36 mg/mmol] vs. 0.90 mg/mmol [95% CI: 0.77 to 1.03 mg/mmol]; p < 0.001). The effect of sacubitril/valsartan on cardiovascular death or heart failure hospitalization was not modified by eGFR, UACR (p interaction = 0.70 and 0.34, respectively), or by change in UACR (p interaction = 0.38). Conclusions: Compared with enalapril, sacubitril/valsartan led to a slower rate of decrease in the eGFR and improved cardiovascular outcomes, even in patients with chronic kidney disease, despite causing a modest increase in UACR

Full pressure suit heat balance studies

Thermal balance between heat removal and metabolic rate in pressurized Gemini G2-C full pressure suit at two barometric pressure

Burst detection in water networks using principal component anlysis

The following work presents a multivariate statistical technique applied to the control of water inflows into district metering areas (DMAs) of urban networks. This technique, called principal-component analysis (PCA), allows for a sensitive and quick analysis of the inflows into a DMA without hassling mathematical algorithms. The PCA technique simplifies the original set of flow rate data recorded by the supervisory control and data acquisition (SCADA) system, synthesizing the most significant information into a statistical model that is able to explain most of the behavior of the water distribution network. The PCA technique also allows for the establishment of control charts that help system operators in the identification of anomalous behaviors regarding water use, bursts, or illegal connections. The described technique has been proven to offer high detection sensitivity to bursts or other unexpected consumptions.Palau Estevan, CV.; Arregui De La Cruz, F.; Carlos Alberola, MDM. (2012). Burst detection in water networks using principal component anlysis. Journal of Water Resources Planning and Management. 138(1):47-54. doi:10.1061/(ASCE)WR.1943-5452.0000147S4754138

Gas Accretion and Giant Lyman-alpha Nebulae

Several decades of observations and discoveries have shown that high-redshift AGN and massive galaxies are often surrounded by giant Lyman-alpha nebulae extending in some cases up to 500 kpc in size. In this review, I discuss the properties of the such nebulae discovered at z>2 and their connection with gas flows in and around the galaxies and their halos. In particular, I show how current observations are used to constrain the physical properties and origin of the emitting gas in terms of the Lyman-alpha photon production processes and kinematical signatures. These studies suggest that recombination radiation is the most viable scenario to explain the observed Lyman-alpha luminosities and Surface Brightness for the large majority of the nebulae and imply that a significant amount of dense, ionized and cold clumps should be present within and around the halos of massive galaxies. Spectroscopic studies suggest that, among the giant Lyman-alpha nebulae, the one associated with radio-loud AGN should have kinematics dominated by strong, ionized outflows within at least the inner 30-50 kpc. Radio-quiet nebulae instead present more quiescent kinematics compatible with stationary situation and, in some cases, suggestive of rotating structures. However, definitive evidences for accretion onto galaxies of the gas associated with the giant Lyman-alpha emission are not unambiguously detected yet. Deep surveys currently ongoing using other bright, non-resonant lines such as Hydrogen H-alpha and HeII1640 will be crucial to search for clearer signatures of cosmological gas accretion onto galaxies and AGN.Comment: Invited review to appear in Gas Accretion onto Galaxies, Astrophysics and Space Science Library, eds. A. J. Fox & R. Dave', to be published by Springe

The Calibration of Mid-Infrared Star Formation Rate Indicators

With the goal of investigating the degree to which the mid-infrared emission traces the star formation rate (SFR), we analyze Spitzer 8 um and 24 um data of star-forming regions in a sample of 33 nearby galaxies with available HST/NICMOS images in the Paschen-alpha (1.8756 um) emission line. The galaxies are drawn from the Spitzer Infrared Nearby Galaxies Survey (SINGS) sample, and cover a range of morphologies and a factor ~10 in oxygen abundance. Published data on local low-metallicity starburst galaxies and Luminous Infrared Galaxies are also included in the analysis. Both the stellar-continuum-subtracted 8 um emission and the 24 um emission correlate with the extinction-corrected Pa-alpha line emission, although neither relationship is linear. Simple models of stellar populations and dust extinction and emission are able to reproduce the observed non-linear trend of the 24 um emission versus number of ionizing photons, including the modest deficiency of 24 um emission in the low metallicity regions, which results from a combination of decreasing dust opacity and dust temperature at low luminosities. Conversely, the trend of the 8 um emission as a function of the number of ionizing photons is not well reproduced by the same models. The 8 um emission is contributed, in larger measure than the 24 um emission, by dust heated by non-ionizing stellar populations, in agreement with previous findings. Two SFR calibrations, one using the 24 um emission and the other using a combination of the 24 um and H-alpha luminosities (Kennicutt et al. 2007), are presented. No calibration is presented for the 8 um emission, because of its significant dependence on both metallicity and environment. The calibrations presented here should be directly applicable to systems dominated by on-going star formation.Comment: 67 pages, 15 figures, accepted for publication on the Astrophysical Journal; replacement contains: correction to equation 8; important tweaks to equation 9; various typos correcte

An efficient semiparametric maxima estimator of the extremal index

The extremal index $\theta$, a measure of the degree of local dependence in the extremes of a stationary process, plays an important role in extreme value analyses. We estimate $\theta$ semiparametrically, using the relationship between the distribution of block maxima and the marginal distribution of a process to define a semiparametric model. We show that these semiparametric estimators are simpler and substantially more efficient than their parametric counterparts. We seek to improve efficiency further using maxima over sliding blocks. A simulation study shows that the semiparametric estimators are competitive with the leading estimators. An application to sea-surge heights combines inferences about $\theta$ with a standard extreme value analysis of block maxima to estimate marginal quantiles.Comment: 17 pages, 7 figures. Minor edits made to version 1 prior to journal publication. The final publication is available at Springer via http://dx.doi.org/10.1007/s10687-015-0221-

Mobility of thorium ions in liquid xenon

We present a measurement of the $^{226}$Th ion mobility in LXe at 163.0 K and 0.9 bar. The result obtained, 0.240$\pm$0.011 (stat) $\pm$0.011 (syst) cm$^{2}$/(kV-s), is compared with a popular model of ion transport.Comment: 6.5 pages,

Information and Discrimination from b Quark Production on Z Resonance

We introduce and define operatively in a model independent way a new ``heavy" b-vertexparameter, $\eta_b$, that can be derived from the measurement of a special polarization asymmetry for production of b-quarks on Z resonance. We show that the combination of the measurement of $\eta_b$ with that of a second and previously defined ``heavy" b-vertex parameter $\delta_{bV}$ can discriminate a number of models of New Physics that remain associated to different ``trajectories" in the plane of the variations of the two parameters. This is shown in particular for some popular SUSY and technicolor-type models. In general, this discrimination is possible if a measurement of \underline{both} parameters is performed.Comment: 22 pages, 6 figures available by air mail upon request, (e-mail [email protected] PM/94-04, UTS-DFT-94-02 .( revised version with corrected references