We Want to Know: Eliciting Hospitalized Patients' Perspectives on Breakdowns in Care

BACKGROUND: There is increasing recognition that patients have critical insights into care experiences, including breakdowns in care. Harnessing patient perspectives for hospital improvement requires an in-depth understanding of the types of breakdowns patients identify and the impact of these events. METHODS: We interviewed a broad sample of patients during hospitalization and post discharge to elicit patient perspectives on breakdowns in care. Through an iterative process, we developed a categorization of patient-perceived breakdowns called the Patient Experience Coding Tool. RESULTS: Of 979 interviewees, 386 (39.4%) believed they had experienced at least one breakdown in care. The most common reported breakdowns involved information exchange (n = 158, 16.1%), medications (n = 120, 12.3%), delays in admission (n = 90, 9.2%), team communication (n = 65, 6.6%), providers’ manner (n = 62, 6.3%), and discharge (n = 56, 5.7%). Of the 386 interviewees who reported a breakdown, 140 (36.3%) perceived associated harm. Patient-perceived harms included physical (eg, pain), emotional (eg, distress, worry), damage to relationship with providers, need for additional care or prolonged hospital stay, and life disruption. We found higher rates of reporting breakdowns among younger (<60 years old) patients (45.4% vs 34.5%, P < 0.001), those with at least some college education (46.8% vs 32.7%, P < 0.001), and those with another person (family or friend) present during the interview or interviewed in lieu of the patient (53.4% vs 37.8%, P = 0.002). CONCLUSIONS: When asked directly, almost 4 out of 10 hospitalized patients reported a breakdown in their care. Patient-perceived breakdowns in care are frequently associated with perceived harm, illustrating the importance of detecting and addressing these events. Journal of Hospital Medicine 2017;12:603-609. © 2017 Society of Hospital Medicin

Search for the Proton Decay Mode proton to neutrino K+ in Soudan 2

We have searched for the proton decay mode proton to neutrino K+ using the one-kiloton Soudan 2 high resolution calorimeter. Contained events obtained from a 3.56 kiloton-year fiducial exposure through June 1997 are examined for occurrence of a visible K+ track which decays at rest into mu+ nu or pi+ pi0. We found one candidate event consistent with background, yielding a limit, tau/B > 4.3 10^{31} years at 90% CL with no background subtraction.Comment: 13 pages, Latex, 3 tables and 3 figures, Accepted by Physics Letters

An overview of the MHONGOOSE survey: Observing nearby galaxies with MeerKAT

MHONGOOSE is a deep survey of the neutral hydrogen distribution in a representative sample of 30 nearby disk and dwarf galaxies with HI masses from 10^6 to ~10^{11} M_sun, and luminosities from M_R ~ -12 to M_R ~ -22. The sample is selected to uniformly cover the available range in log(M_HI). Our extremely deep observations, down to HI column density limits of well below 10^{18} cm^{-2} - or a few hundred times fainter than the typical HI disks in galaxies - will directly detect the effects of cold accretion from the intergalactic medium and the links with the cosmic web. These observations will be the first ever to probe the very low-column density neutral gas in galaxies at these high resolutions. Combination with data at other wavelengths, most of it already available, will enable accurate modelling of the properties and evolution of the mass components in these galaxies and link these with the effects of environment, dark matter distribution, and other fundamental properties such as halo mass and angular momentum. MHONGOOSE can already start addressing some of the SKA-1 science goals and will provide a comprehensive inventory of the processes driving the transformation and evolution of galaxies in the nearby universe at high resolution and over 5 orders of magnitude in column density. It will be a Nearby Galaxies Legacy Survey that will be unsurpassed until the advent of the SKA, and can serve as a highly visible, lasting statement of MeerKAT's capabilities

Diving into the vertical dimension of elasmobranch movement ecology

Knowledge of the three-dimensional movement patterns of elasmobranchs is vital to understand their ecological roles and exposure to anthropogenic pressures. To date, comparative studies among species at global scales have mostly focused on horizontal movements. Our study addresses the knowledge gap of vertical movements by compiling the first global synthesis of vertical habitat use by elasmobranchs from data obtained by deployment of 989 biotelemetry tags on 38 elasmobranch species. Elasmobranchs displayed high intra- and interspecific variability in vertical movement patterns. Substantial vertical overlap was observed for many epipelagic elasmobranchs, indicating an increased likelihood to display spatial overlap, biologically interact, and share similar risk to anthropogenic threats that vary on a vertical gradient. We highlight the critical next steps toward incorporating vertical movement into global management and monitoring strategies for elasmobranchs, emphasizing the need to address geographic and taxonomic biases in deployments and to concurrently consider both horizontal and vertical movements

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Identification of the Paleocene-Eocene boundary in coastal strata in the Otway Basin, Victoria, Australia

Detailed, stratigraphically well-constrained environmental reconstructions are available for Paleocene and Eocene strata at a range of sites in the southwest Pacific Ocean (New Zealand and East Tasman Plateau; ETP) and Integrated Ocean Discovery Program (IODP) Site U1356 in the south of the Australo-Antarctic Gulf (AAG). These reconstructions have revealed a large discrepancy between temperature proxy data and climate models in this region, suggesting a crucial error in model, proxy data or both. To resolve the origin of this discrepancy, detailed reconstructions are needed from both sides of the Tasmanian Gateway. Paleocene-Eocene sedimentary archives from the west of the Tasmanian Gateway have unfortunately remained scarce (only IODP Site U1356), and no well-dated successions are available for the northern sector of the AAG. Here we present new stratigraphic data for upper Paleocene and lower Eocene strata from the Otway Basin, southeast Australia, on the (north)west side of the Tasmanian Gateway. We analyzed sediments recovered from exploration drilling (Latrobe-1 drill core) and outcrop sampling (Point Margaret) and performed high-resolution carbon isotope geochemistry of bulk organic matter and dinoflagellate cyst (dinocyst) and pollen biostratigraphy on sediments from the regional lithostratigraphic units, including the Pebble Point Formation, Pember Mudstone and Dilwyn Formation. Pollen and dinocyst assemblages are assigned to previously established Australian pollen and dinocyst zonations and tied to available zonations for the SW Pacific. Based on our dinocyst stratigraphy and previously published planktic foraminifer biostratigraphy, the Pebble Point Formation at Point Margaret is dated to the latest Paleocene. The globally synchronous negative carbon isotope excursion that marks the Paleocene-Eocene boundary is identified within the top part of the Pember Mudstone in the Latrobe-1 borehole and at Point Margaret. However, the high abundances of the dinocyst Apectodinium prior to this negative carbon isotope excursion prohibit a direct correlation of this regional bio-event with the quasi-global Apectodinium acme at the Paleocene-Eocene Thermal Maximum (PETM; 56Ma). Therefore, the first occurrence of the pollen species Spinizonocolpites prominatus and the dinocyst species Florentinia reichartii are here designated as regional markers for the PETM. In the Latrobe-1 drill core, dinocyst biostratigraphy further indicates that the early Eocene (∼56-51Ma) sediments are truncated by ∼ 10Myr long hiatus overlain by middle Eocene (∼ 40Ma) strata. These sedimentary archives from southeast Australia may prove key in resolving the model-data discrepancy in this region, and the new stratigraphic data presented here allow for detailed comparisons between paleoclimate records on both sides of the Tasmanian Gateway

Identification of the Paleocene-Eocene boundary in coastal strata in the Otway Basin, Victoria, Australia

Detailed, stratigraphically well-constrained environmental reconstructions are available for Paleocene and Eocene strata at a range of sites in the southwest Pacific Ocean (New Zealand and East Tasman Plateau; ETP) and Integrated Ocean Discovery Program (IODP) Site U1356 in the south of the Australo-Antarctic Gulf (AAG). These reconstructions have revealed a large discrepancy between temperature proxy data and climate models in this region, suggesting a crucial error in model, proxy data or both. To resolve the origin of this discrepancy, detailed reconstructions are needed from both sides of the Tasmanian Gateway. Paleocene-Eocene sedimentary archives from the west of the Tasmanian Gateway have unfortunately remained scarce (only IODP Site U1356), and no well-dated successions are available for the northern sector of the AAG. Here we present new stratigraphic data for upper Paleocene and lower Eocene strata from the Otway Basin, southeast Australia, on the (north)west side of the Tasmanian Gateway. We analyzed sediments recovered from exploration drilling (Latrobe-1 drill core) and outcrop sampling (Point Margaret) and performed high-resolution carbon isotope geochemistry of bulk organic matter and dinoflagellate cyst (dinocyst) and pollen biostratigraphy on sediments from the regional lithostratigraphic units, including the Pebble Point Formation, Pember Mudstone and Dilwyn Formation. Pollen and dinocyst assemblages are assigned to previously established Australian pollen and dinocyst zonations and tied to available zonations for the SW Pacific. Based on our dinocyst stratigraphy and previously published planktic foraminifer biostratigraphy, the Pebble Point Formation at Point Margaret is dated to the latest Paleocene. The globally synchronous negative carbon isotope excursion that marks the Paleocene-Eocene boundary is identified within the top part of the Pember Mudstone in the Latrobe-1 borehole and at Point Margaret. However, the high abundances of the dinocyst Apectodinium prior to this negative carbon isotope excursion prohibit a direct correlation of this regional bio-event with the quasi-global Apectodinium acme at the Paleocene-Eocene Thermal Maximum (PETM; 56Ma). Therefore, the first occurrence of the pollen species Spinizonocolpites prominatus and the dinocyst species Florentinia reichartii are here designated as regional markers for the PETM. In the Latrobe-1 drill core, dinocyst biostratigraphy further indicates that the early Eocene (∼56-51Ma) sediments are truncated by ∼ 10Myr long hiatus overlain by middle Eocene (∼ 40Ma) strata. These sedimentary archives from southeast Australia may prove key in resolving the model-data discrepancy in this region, and the new stratigraphic data presented here allow for detailed comparisons between paleoclimate records on both sides of the Tasmanian Gateway