Developing a patient safety incident classification system for primary care. A literature review and Delphi-survey 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: Despite awareness that comparative analysis of patient safety data from several data sources would promote risk reduction, there has been little effort to establish an incident classification system that is generally applicable to patient safety data in European primary care. OBJECTIVE: To describe the development of a patient safety incident classification system for primary care. METHODS: A systematic review was followed by an expert group discussion and a modified Delphi survey, to provide consensus statements. RESULTS: We developed a classification system providing a mechanism for classifying patient safety incidents across Europe, taking into account the varying organizational arrangements that exist for primary care. It takes into account organizational processes and outcomes related to patient safety incidents and can supplement existing classification systems. CONCLUSION: Classification systems are key tools in the analysis of patient safety incidents. A system that has relevance for primary care is now available.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

Interactions between downslope flows and a developing cold-air pool

A numerical model has been used to characterize the development of a region of enhanced cooling in an alpine valley with a width of order (Formula presented.) km, under decoupled stable conditions. The region of enhanced cooling develops largely as a region of relatively dry air which partitions the valley atmosphere dynamics into two volumes, with airflow partially trapped within the valley by a developing elevated inversion. Complex interactions between the region of enhanced cooling and the downslope flows are quantified. The cooling within the region of enhanced cooling and the elevated inversion is almost equally partitioned between radiative and dynamic effects. By the end of the simulation, the different valley atmospheric regions approach a state of thermal equilibrium with one another, though this cannot be said of the valley atmosphere and its external environment.Peer reviewe

Cln5 represents a new type of cysteine-basedS-depalmitoylase linked to neurodegeneration

Genetic CLN5 variants are associated with childhood neurodegeneration and Alzheimer’s disease; however, the molecular function of ceroid lipofuscinosis neuronal protein 5 (Cln5) is unknown. We solved the Cln5 crystal structure and identified a region homologous to the catalytic domain of members of the N1pC/P60 superfamily of papain-like enzymes. However, we observed no protease activity for Cln5; and instead, we discovered that Cln5 and structurally related PPPDE1 and PPPDE2 have efficient cysteine palmitoyl thioesterase (S-depalmitoylation) activity using fluorescent substrates. Mutational analysis revealed that the predicted catalytic residues histidine-166 and cysteine-280 are critical for Cln5 thioesterase activity, uncovering a new cysteine-based catalytic mechanism for S-depalmitoylation enzymes. Last, we found that Cln5-deficient neuronal progenitor cells showed reduced thioesterase activity, confirming live cell function of Cln5 in setting S-depalmitoylation levels. Our results provide new insight into the function of Cln5, emphasize the importance of S-depalmitoylation in neuronal homeostasis, and disclose a new, unexpected enzymatic function for the N1pC/P60 superfamily of proteins

A modified atmospheric non-hydrostatic model on low aspect ratio grids

© The Author(s), 2012. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Tellus A 64 (2012): 17516, doi:10.3402/tellusa.v64i0.17516.It is popular to use a horizontal explicit and a vertical implicit (HE-VI) scheme in the compressible nonhydrostatic (NH) model. However, when the aspect ratio becomes small, a small time-interval is required in HE-VI, because the Courant-Fredrich-Lewy (CFL) criterion is determined by the horizontal grid spacing. Furthermore, simulations from HE-VI can depart from the forward–backward (FB) scheme in NH even when the time interval is less than the CFL criterion allowed. Hence, a modified non-hydrostatic (MNH) model is proposed, in which the left-hand side of the continuity equation is multiplied by a parameter d (45d516, in this study). When the linearized MNH is solved by FB (can be other schemes), the eigenvalue shows that MNH can suppress the frequency of acoustic waves very effectively but does not have a significant impact on the gravity waves. Hence, MNH enables to use a longer time step than that allowed in the original NH. When the aspect ratio is small, MNH solved by FB can be more accurate and efficient than the NH solved by HE-VI. Therefore, MNH can be very useful to study cloud, Large Eddy Simulation (LES), turbulence, flow over complex terrains, etc., which require fine resolution in both horizontal and vertical directions

DCMIP2016: a review of non-hydrostatic dynamical core design and intercomparison of participating models

Atmospheric dynamical cores are a fundamental component of global atmospheric modeling systems and are responsible for capturing the dynamical behavior of the Earth's atmosphere via numerical integration of the Navier-Stokes equations. These systems have existed in one form or another for over half of a century, with the earliest discretizations having now evolved into a complex ecosystem of algorithms and computational strategies. In essence, no two dynamical cores are alike, and their individual successes suggest that no perfect model exists. To better understand modern dynamical cores, this paper aims to provide a comprehensive review of 11 non-hydrostatic dynamical cores, drawn from modeling centers and groups that participated in the 2016 Dynamical Core Model Intercomparison Project (DCMIP) workshop and summer school. This review includes a choice of model grid, variable placement, vertical coordinate, prognostic equations, temporal discretization, and the diffusion, stabilization, filters, and fixers employed by each syste

Identifying risks for male street gang affiliation: a systematic review and narrative synthesis

Gang violence has increased in recent years. Individuals are becoming gang affiliated younger, and many have suffered historic maltreatment. Subsequent exposure to violence can result in profound consequences, including acute psychological harm. This review aims to identify predictive risk factors for male street gang affiliation. A systematic literature search was conducted utilising PsycINFO, PsycARTICLES, Medline, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews and the Social Policy and Practice databases (from the databases’ inception to 03/04/15). From this search, n=244 peer-reviewed papers were included in an initial scoping review, and n=102 thereafter met criteria for a systematic review; a narrative synthesis follows. Gang members have typically faced numerous historic adversities across multiple domains; individual, family, peers, school and community. Cumulative factors generated an independent risk. The meta-narrative described an overarching failure to safeguard vulnerable individuals, with the motivation for gang affiliation hypothetically arising from an attempt to have their basic needs met. Clinical and research recommendations were made to inform early intervention policy and practice

The influence of learning styles on knowledge acquisition in public sector management

This research note outlines a project designed to investigate the role of training institutions in providing effective training and development programmes for managers. The investigation is being carried out in the light of recent criticisms levelled against the nature of formal learning environments prevalent in most institutional settings. The traditional role of trainers and developers as the providers of knowledge and skills for the development of competent managers runs contrary to recent findings, which suggest that managers learn more effectively in informal settings, rather than the formal settings evident in many development programmes. The idea that explicitly extracted competencies are the target every manager should aim for to improve their effectiveness is also challenged because competencies alone are no longer regarded as a sufficient criterion for success. Recent research has attached greater importance to the need for helping managers to see knowledge as a social phenomenon, and one factor that might distinguish successful managers from others is tacit knowledge (Wagner & Sternberg, 1987; Argyris, 1999). A major focus of this study is to explore the possibility that the level and content of tacit knowledge acquired by managers may be influenced by their individual learning styles, and the degree to which their dominant styles are matched with the context of their work environment

The Implementation of Managed Entry Agreements in Central and Eastern Europe : Findings and Implications

Funding Information: In Bosnia and Herzegovina, both The Federation of Bosnia and Herzegovina and the Republic of Srpska, also have special funds and budgets in place for the financing of expensive medicines, which are innovative and under patent. Similar earmarked funds are available in Scotland (the New Medicines Fund funded by the Pharmaceutical Price Regulation Scheme [PPRS] rebates) [35] and England (the Cancer Drugs Fund) [36]. However, support for such earmarked funds is mixed. While they facilitate access, critics raised issues about fairness towards other disease areas and patient groups that are not eligible for special funding [3, 39]. Further, the views of a Patient and Clinician Engagement meeting in Scotland [37] and the end-of-life criteria in England [38] offer opportunities for special considerations affecting medicines for end-of-life and very rare conditions to be taken into account in the health technology assessment process. Funding Information: The authors would like to acknowledge Dr. Jan Jones from the Scottish Medicines Consortium, Scotland, for contributing to the discussion with information on Scotland, Drs. Lyudmila Bezmelnitsyna and Anastasia Isaeva for contributing to data collection in Russia and Dr. Kate?ina Podrazilov? from SZP ?R for providing information on the Czech Republic. Alessandra Ferrario was a Research Officer at the LSE Health at the time this research was conducted. She is now a postdoctoral Research Fellow at the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA. Email: [email protected] No sources of funding were used for this study. The authors declare they have no conflicts of interest. However, Di?na Ar?ja, Maria Dimitrova, Jurij F?rst, Ieva Grei?i?t?-Kuprijanov, Iris Hoxha, Arianit Jakupi, Erki Laidm?e, Vanda Markovic-Pekovic, Dmitry Meshkov, Guenka Petrova, Maciej Pomorski and Patricia Vella Bonanno work directly for national health authorities or are advisers to them. Alessandra Ferrario, Tomasz Bochenek, Ileana Mardare, Dominik Tomek, Luka Voncina, Alan Haycox, Panos Kanavos,?Olga L?blov?, and Brian Godman are academics and independent researchers also working with national and regional health authorities and others to improve the quality and efficiency of prescribing, and Tarik Catic, D?vid Dank?,and Tanja Novakovic are involved with pharmaceutical, pharmacoeconomics and outcomes research groups in their countries. Olga L?blov? has also carried out remunerated consultancy activities for A&R Partners, Baxter AG and Instytut Arcana and Ileana Mardare has signed a consulting contract with Ewopharma A.G. Romania. The content of the paper and the conclusions are those of each author and may not necessarily reflect those of any organisation that employs them. Publisher Copyright: © 2017, The Author(s).Background: Managed entry agreements (MEAs) are a set of instruments to facilitate access to new medicines. This study surveyed the implementation of MEAs in Central and Eastern Europe (CEE) where limited comparative information is currently available. Method: We conducted a survey on the implementation of MEAs in CEE between January and March 2017. Results: Sixteen countries participated in this study. Across five countries with available data on the number of different MEA instruments implemented, the most common MEAs implemented were confidential discounts (n = 495, 73%), followed by paybacks (n = 92, 14%), price-volume agreements (n = 37, 5%), free doses (n = 25, 4%), bundle and other agreements (n = 19, 3%), and payment by result (n = 10, >1%). Across seven countries with data on MEAs by therapeutic group, the highest number of brand names associated with one or more MEA instruments belonged to the Anatomical Therapeutic Chemical (ATC)-L group, antineoplastic and immunomodulating agents (n = 201, 31%). The second most frequent therapeutic group for MEA implementation was ATC-A, alimentary tract and metabolism (n = 87, 13%), followed by medicines for neurological conditions (n = 83, 13%). Conclusions: Experience in implementing MEAs varied substantially across the region and there is considerable scope for greater transparency, sharing experiences and mutual learning. European citizens, authorities and industry should ask themselves whether, within publicly funded health systems, confidential discounts can still be tolerated, particularly when it is not clear which country and party they are really benefiting. Furthermore, if MEAs are to improve access, countries should establish clear objectives for their implementation and a monitoring framework to measure their performance, as well as the burden of implementation.publishersversionPeer reviewe

Interactions between the night time valley-wind system and a developing cold-air pool

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Boundary-Layer Meteorology following peer review. The version of record [Arduini, G., Staquet, C & Chemel, C., ‘Interactions between the night time valley-wind system and a developing cold-air pool’, Boundary-Layer Meteorol (2016) 161:1 (49-72), first published online June 2, 2016, is available at Springer online at doi: 10.1007/s10546-016-0155-8The Weather Research and Forecast (WRF) numerical model is used to characterize the influence of a thermally-driven down-valley flow on a developing cold-air pool in an idealized alpine valley decoupled from the atmosphere above. Results for a three-dimensional (3D) valley, which allows for the formation of a down-valley flow, and for a two-dimensional (2D) valley, where the formation of a down-valley flow is inhibited, are analyzed and compared. A key result is that advection leads to a net cooling in the 2D valley and to a warming in the 3D valley, once the down-valley flow is fully developed. This difference stems from the suppression of the slope-flow induced upward motions over the valley centre in the 3D valley. As a result, the downslope flows develop a cross-valley circulation within the cold-air pool, the growth of the cold-air pool is reduced and the valley atmosphere is generally warmer than in the 2D valley. A quasi-steady state is reached for which the divergence of the down-valley flow along the valley is balanced by the convergence of the downslope flows at the top of the cold-air pool, with no net contribution of subsiding motions far from the slope layer. More precisely, the inflow of air at the top of the cold-air pool is found to be driven by an interplay between the return flow from the plain region and subsidence over the plateaux. Finally, the mechanisms that control the structure of the cold-air pool and its evolution are found to be independent of the valley length as soon as the quasi-steady state is reached and the down-valley flow is fully developed.Peer reviewedFinal Accepted Versio

Efficacy of Neoadjuvant Carboplatin plus Docetaxel in Triple-Negative Breast Cancer: Combined Analysis of Two Cohorts

Recent studies demonstrate that addition of neoadjuvant (NA) carboplatin (Cb) to anthracycline/taxane chemotherapy improves pathological complete response (pCR) in triple negative breast cancer (TNBC). Effectiveness of anthracycline-free, platinum combinations in TNBC is not well known. Here we report efficacy of NA carboplatin + docetaxel (CbD) in TNBC