Nature and type of patient-reported safety incidents in primary care: Cross-sectional survey of patients from Australia and England

Background Patient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement. Objective The aim of this study was to characterise the nature of patient-reported safety incidents in primary care. Design Secondary analysis of two cross sectional studies. Participants Adult patients from Australian and English primary care settings. Measures Patients’ self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented. Results A total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent. Conclusions The nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement

Transplant Experiments Point to Fire Regime as Limiting Savanna Tree Distribution

Plant species range shifts are predicted to occur in response to climate change. The predictions are often based on the assumption that climate is the primary factor limiting the distribution of species. However the distribution of grassy biomes in Africa cannot be predicted by climate alone, instead interactions between vegetation, climate and disturbance structure the ecosystems. To test if climatic variables, as predicted by an environmental niche model, determine the distribution limits of two common savanna tree species we established a transplant experiment at a range of latitudes and altitudes much broader than the distribution limits of our study species. We planted seedlings of two common savanna trees, Senegalia nigrescens and Colophospermum mopane, at eight paired high and low elevation sites across an 850 km latitudinal gradient in South African savannas. At each site seedlings were planted in both grassy and cleared plots. After 2 years of growth, rainfall, temperature and location inside or outside their distribution range did not explain species success. Grass competition was the only variable that significantly affected plant growth rates across all sites, but grass competition alone could not explain the distribution limit. Species distributions were best predicted when maximum tree growth rates were considered in relation to local fire return intervals. The probability of sapling escape from the fire trap was the most likely determinant of distribution limits of these two species. As trees grew and survived 100 s of kilometers south of their current range limits we conclude that climate alone does not explain the current distribution of these trees, and that climate change adaptation strategies for savanna environments based only on climatic envelope modeling will be inappropriate

A 1D RCE study of factors affecting the tropical tropopause layer and surface climate

There are discrepancies between global climate models regarding the evolution of the tropical tropopause layer (TTL) and also whether changes in ozone impact the surface under climate change. We use a 1D clear-sky radiative–convective equilibrium model to determine how a variety of factors can affect the TTL and how they influence surface climate. We develop a new method of convective adjustment, which relaxes the temperature profile toward the moist adiabat and allows for cooling above the level of neutral buoyancy. The TTL temperatures in our model are sensitive to CO2 concentration, ozone profile, the method of convective adjustment, and the upwelling velocity, which is used to calculate a dynamical cooling rate in the stratosphere. Moreover, the temperature response of the TTL to changes in each of the above factors sometimes depends on the others. The surface temperature response to changes in ozone and upwelling at and above the TTL is also strongly amplified by both stratospheric and tropospheric water vapor changes. With all these influencing factors, it is not surprising that global models disagree with regard to TTL structure and evolution and the influence of ozone changes on surface temperatures. On the other hand, the effect of doubling CO2 on the surface, including just radiative, water vapor, and lapse-rate feedbacks, is relatively robust to changes in convection, upwelling, or the applied ozone profile

Asymptotics and local constancy of characters of p-adic groups

In this paper we study quantitative aspects of trace characters $\Theta_\pi$ of reductive $p$-adic groups when the representation $\pi$ varies. Our approach is based on the local constancy of characters and we survey some other related results. We formulate a conjecture on the behavior of $\Theta_\pi$ relative to the formal degree of $\pi$, which we are able to prove in the case where $\pi$ is a tame supercuspidal. The proof builds on J.-K.~Yu's construction and the structure of Moy-Prasad subgroups.Comment: Proceedings of Simons symposium on the trace formul

The combined influence of distance and neighbourhood deprivation on Emergency Department attendance in a large English population: a retrospective database study

YesThe frequency of visits to Emergency Departments (ED) varies greatly between populations. This may reflect variation in patient behaviour, need, accessibility, and service configuration as well as the complex interactions between these factors. This study investigates the relationship between distance, socio-economic deprivation, and proximity to an alternative care setting (a Minor Injuries Unit (MIU)), with particular attention to the interaction between distance and deprivation. It is set in a population of approximately 5.4 million living in central England, which is highly heterogeneous in terms of ethnicity, socio-economics, and distance to hospital. The study data set captured 1,413,363 ED visits made by residents of the region to National Health Service (NHS) hospitals during the financial year 2007/8. Our units of analysis were small units of census geography having an average population of 1,545. Separate regression models were made for children and adults. For each additional kilometre of distance from a hospital, predicted child attendances fell by 2.2% (1.7%-2.6% p<0.001) and predicted adult attendances fell by 1.5% (1.2% -1.8%, p<0.001). Compared to the least deprived quintile, attendances in the most deprived quintile more than doubled for children (incident rate ratio (IRR) = 2.19, (1.90-2.54, p<0.001)) and adults (IRR 2.26, (2.01-2.55, p<0.001)). Proximity of an MIU was significant and both adult and child attendances were greater in populations who lived further away from them, suggesting that MIUs may reduce ED demand. The interaction between distance and deprivation was significant. Attendance in deprived neighbourhoods reduces with distance to a greater degree than in less deprived ones for both adults and children. In conclusion, ED use is related to both deprivation and distance, but the effect of distance is modified by deprivation

Which older people decline participation in a primary care trial of physical activity and why: insights from a mixed methods approach

This article is available through the Brunel Open Access Publishing Fund. Copyright 2014 Rogers et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Physical activity is of vital importance to older peoples’ health. Physical activity intervention studies with older people often have low recruitment, yet little is known about non-participants. Methods: Patients aged 60–74 years from three UK general practices were invited to participate in a nurse-supported pedometer-based walking intervention. Demographic characteristics of 298 participants and 690 non-participants were compared. Health status and physical activity of 298 participants and 183 non-participants who completed a survey were compared using age, sex adjusted odds ratios (OR) (95% confidence intervals). 15 non-participants were interviewed to explore perceived barriers to participation. Results: Recruitment was 30% (298/988). Participants were more likely than non-participants to be female (54% v 47%; p = 0.04) and to live in affluent postcodes (73% v 62% in top quintile; p < 0.001). Participants were more likely than non-participants who completed the survey to have an occupational pension OR 2.06 (1.35-3.13), a limiting longstanding illness OR 1.72 (1.05-2.79) and less likely to report being active OR 0.55 (0.33-0.93) or walking fast OR 0.56 (0.37-0.84). Interviewees supported general practice-based physical activity studies, particularly walking, but barriers to participation included: already sufficiently active, reluctance to walk alone or at night, physical symptoms, depression, time constraints, trial equipment and duration. Conclusion: Gender and deprivation differences suggest some selection bias. However, trial participants reported more health problems and lower activity than non-participants who completed the survey, suggesting appropriate trial selection in a general practice population. Non-participant interviewees indicated that shorter interventions, addressing physical symptoms and promoting confidence in pursuing physical activity, might increase trial recruitment and uptake of practice-based physical activity endeavours.The National Institute for Health Research (NIHR) under its Research for Patient Benefit Programme (Grant Reference Number PB-PG-0909-20055)

Multiple introductions and human-aided dispersal of the UK’s most widespread non-native amphibian

The alpine newt Ichthyosaura alpestris has achieved a widespread distribution as a non-native (alien) species in Britain since its initial introduction over a century ago, but the patterns of its release and subsequent dispersal have never yet been collectively analysed. We employed a multi-disciplinary combination of methods, using geographic profiling to estimate the likely number and locations of introductions, and mitochondrial DNA polymorphisms to investigate the likely geographic source of primary introductions, including the potential role of the pet trade. In parallel we used population genetic analysis and coalescence-based modelling to infer the demographics and directionality of dispersal from founding populations. Our results show that alpine newts have been released at multiple sites. We found a close resemblance between patterns of mtDNA haplotypes in the pet trade and those of established alpine newt populations, suggesting a relationship between trade, releases, and dispersal. Results from demographic modelling using Approximate Bayesian Computation are also consistent with multiple independent introductions with limited local dispersal, and additionally suggest that releases may occur from intermediate sources, such as captive populations. Our results support the hypothesis that deliberate human activity is largely responsible for both introductions of alpine newts into the UK and their wider dispersal post-introduction. The likely involvement of the international pet trade highlights the risk that ongoing releases of I. alpestris may expose native species to pathogens, whether pre-existing or novel

Aptamer-based multiplexed proteomic technology for biomarker discovery

Interrogation of the human proteome in a highly multiplexed and efficient manner remains a coveted and challenging goal in biology. We present a new aptamer-based proteomic technology for biomarker discovery capable of simultaneously measuring thousands of proteins from small sample volumes (15 [mu]L of serum or plasma). Our current assay allows us to measure ~800 proteins with very low limits of detection (1 pM average), 7 logs of overall dynamic range, and 5% average coefficient of variation. This technology is enabled by a new generation of aptamers that contain chemically modified nucleotides, which greatly expand the physicochemical diversity of the large randomized nucleic acid libraries from which the aptamers are selected. Proteins in complex matrices such as plasma are measured with a process that transforms a signature of protein concentrations into a corresponding DNA aptamer concentration signature, which is then quantified with a DNA microarray. In essence, our assay takes advantage of the dual nature of aptamers as both folded binding entities with defined shapes and unique sequences recognizable by specific hybridization probes. To demonstrate the utility of our proteomics biomarker discovery technology, we applied it to a clinical study of chronic kidney disease (CKD). We identified two well known CKD biomarkers as well as an additional 58 potential CKD biomarkers. These results demonstrate the potential utility of our technology to discover unique protein signatures characteristic of various disease states. More generally, we describe a versatile and powerful tool that allows large-scale comparison of proteome profiles among discrete populations. This unbiased and highly multiplexed search engine will enable the discovery of novel biomarkers in a manner that is unencumbered by our incomplete knowledge of biology, thereby helping to advance the next generation of evidence-based medicine

The 'Women's Lifestyle Study', 2-year randomized controlled trial of physical activity counselling in primary health care: rationale and study design

<p>Abstract</p> <p>Background</p> <p>Physical inactivity is an independent risk factor for diabetes and heart disease. There is evidence that increasing physical activity can reduce the risk of developing these chronic diseases, but less evidence about effective ways to increase adherence to physical activity. Interventions are therefore needed that produce sustained increases in adherence to physical activity, are cost-effective and improve clinical endpoints.</p> <p>Methods</p> <p>The Women's Lifestyle Study is a two year randomized controlled trial involving a nurse-led intervention to increase physical activity in 40–74 year old physically inactive women recruited from primary care. Baseline measures were assessed in a face-to-face interview with a primary care nurse. The intervention involved delivery of a 'Lifestyle script' by a primary care nurse followed by telephone counselling for nine months and a face-to-face nurse visit at six months. Outcome measurements are assessed at 12 and 24 months. The primary outcome is physical activity measured using a validated physical activity questionnaire. Secondary outcomes include blood pressure, weight, waist circumference, physical fitness (step test), serum HbA1c, fasting glucose, lipids, insulin, and quality of life (SF36). Costs were measured prospectively to allow a subsequent cost-effectiveness evaluation if the trial is positive.</p> <p>Discussion</p> <p>Due to report in 2008, the Women's Lifestyle Study tests the effectiveness of an enhanced low-cost, evidence-based intervention in increasing physical activity, and improving cardiovascular and diabetes risk indicators over two years. If successful in demonstrating improvements in health outcomes, this randomized controlled trial will be the first to demonstrate long-term cardiovascular and diabetes risk health benefit, in addition to improvements in physical activity, from a sustainable physical activity intervention based in primary care.</p> <p>Trial Registration</p> <p>Australian Clinical Trials Registry (ACTR), ACTRN012605000490673.</p