Understanding the models of community hospital rehabilitation activity (MoCHA): a mixed method study

Introduction To understand the variation in performance between community hospitals, our objectives are: to measure the relative performance (cost efficiency) of rehabilitation services in community hospitals; to identify the characteristics of community hospital rehabilitation that optimise performance; to investigate the current impact of community hospital in-patient rehabilitation for older people on secondary care and the potential impact if community hospital rehabilitation was optimised to best practice nationally; to examine the relationship between the configuration of intermediate care and secondary care bed use; and to develop toolkits for commissioners and community hospital providers to optimise performance. Methods and analysis Four linked studies will be performed. Study 1: Cost efficiency modelling will apply econometric techniques to datasets from the NHS Benchmarking Network surveys of community hospital and intermediate care. This will identify community hospitals’ performance and estimate the gap between high and low performers. Analyses will determine the potential impact if the performance of all community hospitals nationally was optimised to best performance, and examine the association between community hospital configuration and secondary care bed use. Study 2: A national community hospital survey gathering detailed cost data and efficiency variables will be performed. Study 3: In-depth case studies of three community hospitals, two high and one low performing, will be undertaken. Case studies will gather routine hospital and local health economy data. Ward culture will be surveyed. Content and delivery of treatment will be observed. Patients and staff will be interviewed. Study 4: Co-designed web-based quality improvement toolkits for commissioners and providers will be developed, including indicators of performance and the gap between local and best community hospitals performance. Ethics and dissemination Publications will be in peer reviewed journals, reports will be distributed through stakeholder organisations. Ethical approval was obtained from the Bradford Research Ethics committee (reference: 15/YH/0062)

Critical fluctuation conductivity in layered superconductors in strong electric field

The paraconductivity, originating from critical superconducting order-parameter fluctuations in the vicinity of the critical temperature in a layered superconductor is calculated in the frame of the self-consistent Hartree approximation, for an arbitrarily strong electric field and zero magnetic field. The paraconductivity diverges less steep towards the critical temperature in the Hartree approximation than in the Gaussian one and it shows a distinctly enhanced variation with the electric field. Our results indicate that high electric fields can be effectively used to suppress order-parameter fluctuations in high-temperature superconductors.Comment: 11 pages, 2 figures, to be published in Phys. Rev.

Physics with the KLOE-2 experiment at the upgraded DAϕ\phiNE

Investigation at a $\phi$--factory can shed light on several debated issues in particle physics. We discuss: i) recent theoretical development and experimental progress in kaon physics relevant for the Standard Model tests in the flavor sector, ii) the sensitivity we can reach in probing CPT and Quantum Mechanics from time evolution of entangled kaon states, iii) the interest for improving on the present measurements of non-leptonic and radiative decays of kaons and eta/eta$^\prime$ mesons, iv) the contribution to understand the nature of light scalar mesons, and v) the opportunity to search for narrow di-lepton resonances suggested by recent models proposing a hidden dark-matter sector. We also report on the $e^+ e^-$ physics in the continuum with the measurements of (multi)hadronic cross sections and the study of gamma gamma processes.Comment: 60 pages, 41 figures; added affiliation for one of the authors; added reference to section

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Purification of β-1, 4-glucanase from ethylene-treated abscission zones of Sambucus nigra

Leaflet abscission in Sambucus nigra is the result of cell wall breakdown at the site of separation. Associated with wall degradation is an increase in the activity of the enzyme β1,4 glucanase (E.C.3.1.2.4) in the cells that comprise the abscission zone. The enzyme has been extracted from abscission zone tissue and purified using a substrate affinity column. A qualitative enzyme assay procedure has been developed and this has facilitated the purification process. The β1,4 glucanase enzyme has a pH optimum of 7 and a molecular mass of 54kDa. Antibodies have been raised to the purified protein. The role of the enzyme in the abscission process is discussed