Marble and Mosaic

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Factors associated with variation in hospital use at the end of life in England

Objective: To identify the relative importance of factors influencing hospital use at the end of life. Design: Retrospective cohort study of person and health system effects on hospital use in the past 12 months modelling differences in admissions, bed days and whether a person died in hospital. Setting: Residents in England for the period 2009/2010 to 2011/2012 using Hospital Episodes Statistics (HES) data from all acute care hospitals in England funded by the National Health Service (NHS). Participants: 1 223 859 people registered with a GP in England who died (decedents) in England (April 2009–March 2012) with a record of NHS hospital care. Main outcome measures: Hospital admissions, and hospital bed days and place of death (in or out of hospital) in the past 12 months of life. Results: The mean number of admissions in the past 12 months of life averaged 2.28 occupying 30.05 bed days—excluding 9.8% of patients with no hospital history. A total of 50.8% of people died in hospital. Difference in hospital use was associated with a range of patient descriptors (age, gender and ethnicity). The variables with the greatest ‘explanatory power’ were those that described the diagnoses and causes of death. So, for example, 65% of the variability in the model of hospital admissions was explained by diagnoses. Only moderate levels of variation were explained by the hospital provider variables for admissions and deaths in hospital, though the impacts on total bed days was large. Conclusions: Comparative analyses of hospital utilisation should standardise for a range of patient specific variables. Though the models indicated some degree of variability associated with individual providers, the scale of this was not great for admissions and death in hospital but the variability associated with length of stay differences suggests that attempts to optimise hospital use should look at differences in lengths of stay and bed use. This study adds important new information about variability in admissions by diagnostic group, and variability in bed days by diagnostic group and eventual cause of death

Inflatable holding fixture permits X-rays to be taken of inner weld areas

Inflatable rubber gland positions and holds X ray film in positive contact with inner weld areas of mainfold torus assemblies for verifying the weld quality. The gland is constructed to conform to the inside diameter of the manifold torus

The discovery of trapped energetic electrons in the outer cusp

We report on the POLAR/CEPPAD discovery of a trapped, 60°\u3cθ\u3c120° pitch angle electron population in the outer cusp (7−9+ Re), whose energetic electron component extends from below 30 keV to ∼2 MeV. Because the time variability in the outer cusp precludes mapping with POLAR, we have carried out test particle simulations using the Tsyganenko 1996 model (T96) to demonstrate the trapping of these energy electrons in the outer cusp region and the resonant frequencies of its trapped motion. We discuss the boundaries and regions of the cusp trap and show that it is analogous to the dipole trap. We show that the phase space densities observed there are equal or greater than the phase space densities observed in the radiation belts at constant magnetic moment, thus allowing the possibility of diffusive filling of the radiation belts from the cus

Making it in academic psychology: Demographic and personality correlates of eminence

Citations to published work, personality, and demographic characteristics were examined in a sample of male and female academic psychologists. A large sex difference was found in citations with men receiving significantly more recognition. Reputational rankings of graduate school and current institution were significantly related to citations, as were components of achievement motivation. Mastery and work needs were positively related to citations while competitiveness was negatively associated with the criterion. A model of attainment in psychology is proposed and possible explanations for the differential recognition of women are explored

COPe-support - a multi-component digital intervention for family carers for people affected by psychosis: study protocol for a randomized controlled trial.

BACKGROUND: Psychosis often causes significant distress and impacts not only in the individuals, but also those close to them. Many relatives and friends ('carers') provide long-term support and need resources to assist them. We have co-produced a digital mental health intervention called COPe-support (Carers fOr People with Psychosis e-support) to provide carers with flexible access to high quality psychoeducation and interactive support from experts and peers. This study evaluates the effectiveness of COPe-support to promote mental wellbeing and caregiving experiences in carers. METHODS: This study is a single-blind, parallel arm, individually randomized controlled trial (RCT) comparing COPe-support, with attention control. Both groups continue to receive usual care. COPe-support provides interactive web-based psychoeducation on psychosis-related issues, wellbeing-promotion and network support through forums. The attention-control is a non-interactive online information resource pack. Carers living in England are eligible if they provide at least weekly support to a family member or close friend affected by psychosis, and use internet communication (including emails) daily. All trial procedures are run online, including collection of outcome measurements which participants will directly input into our secure platform. Following baseline assessment, a web-based randomization system will be used to allocate 360 carers to either arm. Participants have unlimited access to the allocated condition for 40 weeks. Data collection is at three time points (10, 20, and 40 weeks after randomization). Analyses will be conducted by trial statisticians blinded to allocation. The primary outcome is mental wellbeing measured by Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), at 20 weeks. As well as an intention-to-treat analysis, a complier average causal effect (CACE) analysis will be conducted to estimate the intervention effect in participants who have accessed COPe-support content twice or more. The secondary objectives and analysis will examine other health and caregiving-related outcomes and explore mechanisms. In a process evaluation, we will interview 20% of the intervention arm participants regarding the acceptability of COPe-support. We will explore in detail participants' usage patterns. DISCUSSION: The results of this trial will provide valuable information about the effectiveness of COPe-support in promoting wellbeing and caregiving experiences in carers. TRIAL REGISTRATION: The RCT is registered with the Current Controlled Trials registration (ISRCTN 89563420, registration date: 02/03/2018)

Simulations of inner magnetosphere dynamics with an expanded RAM-SCB model and comparisons with Van Allen Probes observations

Abstract Simulations from our newly expanded ring current-atmosphere interactions model with self-consistent magnetic field (RAM-SCB), now valid out to 9 R E, are compared for the first time with Van Allen Probes observations. The expanded model reproduces the storm time ring current buildup due to the increased convection and inflow of plasma from the magnetotail. It matches Magnetic Electron Ion Spectrometer (MagEIS) observations of the trapped high-energy (\u3e50 keV) ion flux; however, it underestimates the low-energy (\u3c10 keV) Helium, Oxygen, Proton, and Electron (HOPE) observations. The dispersed injections of ring current ions observed with the Energetic particle, Composition, and Thermal plasma (ECT) suite at high (\u3e20 keV) energy are better reproduced using a high-resolution convection model. In agreement with Electric and Magnetic Field Instrument Suite and Integrated Science (EMFISIS) observations, RAM-SCB indicates that the large-scale magnetic field is depressed as close as ∼4.5 RE during even a moderate storm. Regions of electromagnetic ion cyclotron instability are predicted on the duskside from ∼6 to ∼9 RE, indicating that previous studies confined to geosynchronous orbit may have underestimated their scattering effect on the energetic particles. Key Points Expanded RAM-SCB model reproduces well high-energy (\u3e50 keV) MagEIS observations The magnetic field is depressed as close as ∼4.5 RE during even a moderate storm EMIC wave growth extends on duskside from ∼6 to ∼9 RE during storm main phase