The Perioperative Surgical Home: A New Paradigm in a Surgical Episode of Care

An overview and review of a Perioperative Surgical Home (PSH) pilot developed using hte guiding principles of the patient-centered medical home. The PSH coordinates care and decisions from the decision to operate through return to primary care. The pilot demonstrated that a PSH improves efficiencies, decreases waste, improves patient and physician satisfaction and decreases care costs

Primary Care and the Perioperative Surgical Home

Our team partnered with UMass Memorial Medical Center’s Urology and Anesthesiology departments on a pilot patient-centered, physician-led, multidisciplinary team-based system of coordinated care for the surgical patient. The goals were to improve the patient experience, improve health care and reduce costs. Primary care physicians were surveyed to understand how surgical teams can better coordinate care with primary care. The results of the survey show that concise, useful communication about mutual patients is important to primary care physicians; there is no need for immediate follow-up appointments with primary care physicians unless necessary – appointments are recommended for two to four weeks after discharge; and defining the roles of primary care physicians and the surgeon is important

The impact of changing guidelines on prostate cancer screening in a population-based setting, 2000-2014

Introduction: This study evaluates the potential impact of the publication of conflicting prostate cancer (PCa) screening trial results in 2009 and changes to the US Preventive Services Task Force (USPSTF) guidelines to recommend against screening in 2012 on temporal trends in PSA testing at two participating sites in the NCI-funded Cancer Research Network. Methods: Study participants were men aged 40-80 without a history of PCa who sought care at Fallon Health (Worcester, MA) or Henry Ford Health System (Detroit, MI) between 2000-2014. We used health claims and electronic health record data to identify men who underwent PSA testing per calendar year. We also examined trends in PSA testing among high-risk men (African-American, family history of PCa). Testing rates were compared between 2000-2008, 2009-2012, and 2013-2014. Results: From a population of 279,350 eligible men, 133,038 (48%) had at least one PSA test during the study period. Mean age at PSA test was 57 years, which increased over time at both sites. Overall, PSA testing rates rose between 2000-2008 (27-32% of eligible men per year), but declined between 2009-2012 (25% of eligible men). Testing rates declined further in 2013-2014 (23% of eligible men). We observed similar rates of decline in testing for men aged 55-69 and those aged ≥70. High-risk men were less likely to be screened across all time periods, although data was limited. Conclusions: This analysis of two population-based electronic health datasets provides evidence of a recent decrease in PSA testing, following an increase in the early 2000s. Although we are unable to determine causality, it is plausible that results of recent screening trials and/or changes to the USPSTF guidelines have impacted PSA testing practices over the past 14 years

Predicting the 10-year risk of death from other causes in men with localized prostate cancer using patient-reported factors: Development of a tool

OBJECTIVE: To develop a tool for estimating the 10-year risk of death from other causes in men with localized prostate cancer. SUBJECTS AND METHODS: We identified 2,425 patients from the Surveillance Epidemiology and End Results-Medicare Health Outcomes Survey database, age \u3c 80, newly diagnosed with clinical stage T1-T3a prostate cancer from 1/1/1998-12/31/2009, with follow-up through 2/28/2013. We developed a Fine and Gray competing-risks model for 10-year other cause mortality considering age, patient-reported comorbid medical conditions, component scores and items of the SF-36 Health Survey, activities of daily living, and sociodemographic characteristics. Model discrimination and calibration were compared to predictions from Social Security life table mortality risk estimates. RESULTS: Over a median follow-up of 7.7 years, 76 men died of prostate-specific causes and 465 died of other causes. The strongest predictors of 10-year other cause mortality risk included increasing age at diagnosis, higher approximated Charlson Comorbidity Index score, worse patient-reported general health (fair or poor vs. excellent-good), smoking at diagnosis, and marital status (all other vs. married) (all p \u3c 0.05). Model discrimination improved over Social Security life tables (c-index of 0.70 vs. 0.59, respectively). Predictions were more accurate than predictions from the Social Security life tables, which overestimated risk in our population. CONCLUSIONS: We provide a tool for estimating the 10-year risk of dying from other causes when making decisions about treating prostate cancer using pre-treatment patient-reported characteristics

Patents and Industrialisation. An Historical Overview of the British Case, 1624-1907

A Report to the Strategic Advisory Board on Intellectual Property Policy (SABIP), U

Observation of the Decay Λ0b→Λ+cτ−¯ν

The first observation of the semileptonic b-baryon decay Λb0→Λc+τ-ν¯τ, with a significance of 6.1σ, is reported using a data sample corresponding to 3 fb-1 of integrated luminosity, collected by the LHCb experiment at center-of-mass energies of 7 and 8 TeV at the LHC. The τ- lepton is reconstructed in the hadronic decay to three charged pions. The ratio K=B(Λb0→Λc+τ-ν¯τ)/B(Λb0→Λc+π-π+π-) is measured to be 2.46±0.27±0.40, where the first uncertainty is statistical and the second systematic. The branching fraction B(Λb0→Λc+τ-ν¯τ)=(1.50±0.16±0.25±0.23)% is obtained, where the third uncertainty is from the external branching fraction of the normalization channel Λb0→Λc+π-π+π-. The ratio of semileptonic branching fractions R(Λc+)B(Λb0→Λc+τ-ν¯τ)/B(Λb0→Λc+μ-ν¯μ) is derived to be 0.242±0.026±0.040±0.059, where the external branching fraction uncertainty from the channel Λb0→Λc+μ-ν¯μ contributes to the last term. This result is in agreement with the standard model prediction

Measurement of the photon polarization in Λb→Λγ\Lambda_b \to \Lambda \gamma decays

The photon polarization in $b \to s \gamma$ transitions is measured for the first time in radiative b-baryon decays exploiting the unique spin structure of $\Lambda_b \to \Lambda \gamma$ decays. A data sample corresponding to an integrated luminosity of $6\;fb^{-1}$ collected by the LHCb experiment in $pp$ collisions at a center-of-mass energy of $13\;TeV$ is used. The photon polarization is measured to be $\alpha_{\gamma}= 0.82^{\,+\,0.17\,+\,0.04}_{\,-\,0.26\,-\,0.13}$, where the first uncertainty is statistical and the second systematic. This result is in agreement with the Standard Model prediction and previous measurements in b-meson decays. Charge-parity breaking effects are studied for the first time in this observable and found to be consistent with $CP$ symmetry.Comment: All figures and tables, along with machine-readable versions and any supplementary material and additional information, are available at https://cern.ch/lhcbproject/Publications/p/LHCb-PAPER-2021-030.html (LHCb public pages

Searches for rare Bs0 and B 0 decays into four muons

Searches for rare Bs0 and B0 decays into four muons are performed using proton-proton collision data recorded by the LHCb experiment, corresponding to an integrated luminosity of 9 fb−1. Direct decays and decays via light scalar and J/ψ resonances are considered. No evidence for the six decays searched for is found and upper limits at the 95% confidence level on their branching fractions ranging between 1.8 × 10−10 and 2.6 × 10−9 are set. [Figure not available: see fulltext.

Observation of Two New Excited Ξb0 States Decaying to Λb0 K-π+

Two narrow resonant states are observed in the Λb0K-π+ mass spectrum using a data sample of proton-proton collisions at a center-of-mass energy of 13 TeV, collected by the LHCb experiment and corresponding to an integrated luminosity of 6 fb-1. The minimal quark content of the Λb0K-π+ system indicates that these are excited Ξb0 baryons. The masses of the Ξb(6327)0 and Ξb(6333)0 states are m[Ξb(6327)0]=6327.28-0.21+0.23±0.12±0.24 and m[Ξb(6333)0]=6332.69-0.18+0.17±0.03±0.22 MeV, respectively, with a mass splitting of Δm=5.41-0.27+0.26±0.12 MeV, where the uncertainties are statistical, systematic, and due to the Λb0 mass measurement. The measured natural widths of these states are consistent with zero, with upper limits of Γ[Ξb(6327)0]<2.20(2.56) and Γ[Ξb(6333)0]<1.60(1.92) MeV at a 90% (95%) credibility level. The significance of the two-peak hypothesis is larger than nine (five) Gaussian standard deviations compared to the no-peak (one-peak) hypothesis. The masses, widths, and resonant structure of the new states are in good agreement with the expectations for a doublet of 1D Ξb0 resonances

Study of the psi(2)(3823) and chi(c1)(3872) states in B+->(J/psi pi(+)pi(-))K(+)decays

The decays $B^+\rightarrow J/\psi \pi^+ \pi^- K^+$ are studied using a data set corresponding to an integrated luminosity of 9fb$^{-1}$ collected with the LHCb detector in proton-proton collisions between 2011 and 2018. Precise measurements of the ratios of branching fractions with the intermediate $\psi_2(3823)$, $\chi_{c1}(3872)$ and $\psi(2S)$ states are reported. The decay of $B^+\rightarrow \psi_2(3872)K^+$ with $\psi_2(3823)\rightarrow J\psi\pi^+\pi^-$ is observed for the first time with a significance of 5.1 standard deviations. The mass differences between the $\psi_2(3823)$, $\chi_{c1}(3872)$ and $\psi(2S)$ states are measured to be $$\begin{array}{rcl} m_{\chi_{c1(3872)}} - m_{\psi_2(3823)} &= & 47.50 \pm 0.53 \pm 0.13\,\mathrm{MeV/}c^2\,, \\ m_{\psi_2(3823)} - m_{\psi(2S)} &= & 137.98 \pm 0.53 \pm 0.14\,\mathrm{MeV/}c^2\,, \\ m_{\chi_{c1}(3872)} - m_{\psi(2S)} &= & 185.49 \pm 0.06 \pm 0.03\,\mathrm{MeV/}c^2\,, \end{array}$$ resulting in the most precise determination of the $\chi_{c1}(3782)$ mass. The width of the $\psi_2(3823)$ state is found to be below 5.2MeV at 90\% confidence level. The Breit-Wigner width of the $\chi_{c1}(3872)$ state is measured to be $$\Gamma^{\mathrm{BW}}_{\chi_{c1}(3872)} = 0.96^{+0.19}_{-0.18}\pm0.21 \mathrm{MeV},$$ which is inconsistent with zero by 5.5 standard deviations.Comment: 26 pages, 3 figures. All figures and tables, along with any supplementary material and additional information, are available at https://cern.ch/lhcbproject/Publications/p/LHCb-PAPER-2020-009.html (LHCb public pages