Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study

Objective To identify the primary reasons for term admissions to neonatal units in England, to determine risk factors for admissions for jaundice and to estimate the proportion who can be cared for in a transitional setting without separation of mother and baby. Design Retrospective observational study using neonatal unit admission data from the National Neonatal Research Database and data of live births in England from the Office for National Statistics. Setting All 163 neonatal units in England 2011–2013. Participants 133 691 term babies born ≥37 weeks gestational age and admitted to neonatal units in England. Primary and secondary outcomes Primary reasons for admission, term babies admitted for the primary reason of jaundice, patient characteristics, postnatal age at admission, total length of stay, phototherapy, intravenous fluids, exchange transfusion and kernicterus. Results Respiratory disease was the most common reason for admission overall, although jaundice was the most common reason for admission from home (22% home vs 5% hospital). Risk factors for admission for jaundice include male, born at 37 weeks gestation, Asian ethnicity and multiple birth. The majority of babies received only a brief period of phototherapy, and only a third received intravenous fluids, suggesting that some may be appropriately managed without separation of mother and baby. Admission from home was significantly later (3.9 days) compared with those admitted from elsewhere in the hospital (1.7 days) (p<0.001). Conclusion Around two-thirds of term admissions for jaundice may be appropriately managed in a transitional care setting, avoiding separation of mother and baby. Babies with risk factors may benefit from a community midwife postnatal visit around the third day of life to enable early referral if necessary. We recommend further work at the national level to examine provision and barriers to transitional care, referral pathways between primary and secondary care, and community postnatal care

Magnetic Flux Transport at the Solar Surface

After emerging to the solar surface, the Sun's magnetic field displays a complex and intricate evolution. The evolution of the surface field is important for several reasons. One is that the surface field, and its dynamics, sets the boundary condition for the coronal and heliospheric magnetic fields. Another is that the surface evolution gives us insight into the dynamo process. In particular, it plays an essential role in the Babcock-Leighton model of the solar dynamo. Describing this evolution is the aim of the surface flux transport model. The model starts from the emergence of magnetic bipoles. Thereafter, the model is based on the induction equation and the fact that after emergence the magnetic field is observed to evolve as if it were purely radial. The induction equation then describes how the surface flows -- differential rotation, meridional circulation, granular, supergranular flows, and active region inflows -- determine the evolution of the field (now taken to be purely radial). In this paper, we review the modeling of the various processes that determine the evolution of the surface field. We restrict our attention to their role in the surface flux transport model. We also discuss the success of the model and some of the results that have been obtained using this model.Comment: 39 pages, 15 figures, accepted for publication in Space Sci. Re

Surface effects on the orbital order in the single layered manganite La0.5Sr1.5MnO4

We report the first observation of `orbital truncation rods' -- the scattering arising from the termination of bulk orbital order at the surface of a crystal. The x-ray measurements, performed on a cleaved, single-layered perovskite, La0.5Sr1.5MnO4, reveal that while the crystallographic surface is atomically smooth, the orbital `surface' is much rougher, with an r.m.s. deviation from the average `surface' of ~0.7nm. The temperature dependence of this scattering shows evidence of a surface-induced second order transition.Comment: 13 pages, 4 figure

Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study

Objective To identify the primary reasons for term admissions to neonatal units in England, to determine risk factors for admissions for jaundice and to estimate the proportion who can be cared for in a transitional setting without separation of mother and baby. Design Retrospective observational study using neonatal unit admission data from the National Neonatal Research Database and data of live births in England from the Office for National Statistics. Setting All 163 neonatal units in England 2011–2013. Participants 133 691 term babies born ≥37 weeks gestational age and admitted to neonatal units in England. Primary and secondary outcomes Primary reasons for admission, term babies admitted for the primary reason of jaundice, patient characteristics, postnatal age at admission, total length of stay, phototherapy, intravenous fluids, exchange transfusion and kernicterus. Results Respiratory disease was the most common reason for admission overall, although jaundice was the most common reason for admission from home (22% home vs 5% hospital). Risk factors for admission for jaundice include male, born at 37 weeks gestation, Asian ethnicity and multiple birth. The majority of babies received only a brief period of phototherapy, and only a third received intravenous fluids, suggesting that some may be appropriately managed without separation of mother and baby. Admission from home was significantly later (3.9 days) compared with those admitted from elsewhere in the hospital (1.7 days) (p<0.001). Conclusion Around two-thirds of term admissions for jaundice may be appropriately managed in a transitional care setting, avoiding separation of mother and baby. Babies with risk factors may benefit from a community midwife postnatal visit around the third day of life to enable early referral if necessary. We recommend further work at the national level to examine provision and barriers to transitional care, referral pathways between primary and secondary care, and community postnatal care

Assessing the effect of dynamics on the closed-loop protein-folding hypothesis

The closed-loop (loop-n-lock) hypothesis of protein folding suggests that loops of about 25 residues, closed through interactions between the loop ends (locks), play an important role in protein structure. Coarse-grain elastic network simulations, and examination of loop lengths in a diverse set of proteins, each supports a bias towards loops of close to 25 residues in length between residues of high stability. Previous studies have established a correlation between total contact distance (TCD), a metric of sequence distances between contacting residues (cf. contact order), and the log-folding rate of a protein. In a set of 43 proteins, we identify an improved correlation ( r 2 = 0.76), when the metric is restricted to residues contacting the locks, compared to the equivalent result when all residues are considered ( r 2 = 0.65). This provides qualified support for the hypothesis, albeit with an increased emphasis upon the importance of a much larger set of residues surrounding the locks. Evidence of a similar-sized protein core/extended nucleus (with significant overlap) was obtained from TCD calculations in which residues were successively eliminated according to their hydrophobicity and connectivity, and from molecular dynamics simulations. Our results suggest that while folding is determined by a subset of residues that can be predicted by application of the closed-loop hypothesis, the original hypothesis is too simplistic; efficient protein folding is dependent on a considerably larger subset of residues than those involved in lock formation. </jats:p

History on trial: evaluating learning outcomes through audit and accreditation in a national standards environment

This paper uses a trial audit of history programs undertaken in 2011-2012 to explore issues surrounding the attainment of Threshold Learning Outcomes (TLOs) in an emerging Australian national standards environment for the discipline of history. The audit sought to ascertain whether an accreditation process managed by the discipline under the auspices of the Australian Historical Association (AHA) could be based on a limited-intervention, “light-touch” approach to assessing attainment of the TLOs. The results of the audit show that successful proof of TLO attainment would only be possible with more active intervention into existing history majors and courses. Assessments across all levels of history teaching would have to be designed, undertaken, and marked using a rubric matched to the TLOs. It proved unrealistic to expect students to demonstrate acquisition of the TLOs from existing teaching and assessment practices. The failure of the “light-touch” audit process indicates that demonstrating student attainment under a national standards regime would require fundamental redevelopment of the curriculum. With standards-based approaches to teaching and learning emerging as international phenomena, this case study resonates beyond Australia and the discipline under investigation.Sean Brawley, Jennifer Clark, Chris Dixon, Lisa Ford, Erik Nielsen, Shawn Ross, Stuart Upto

A method for assessing liner performance during the peak milk flow period

peer-reviewedThe objective of this study was to develop a method to quantify the milking conditions under which circulatory impairment of teat tissues occurs during the peak flow period of milking. A secondary objective was to quantify the effect of the same milking conditions on milk flow rate during the peak flow rate period of milking. Additionally, the observed milk flow rate was a necessary input to the calculation of canal area, our quantitative measure of circulatory impairment. A central composite experimental design was used with 5 levels of each of 2 explanatory variables (system vacuum and pulsator ratio), creating 9 treatments including the center point. Ten liners, representing a wide range of liner compression (as indicated by overpressure), were assessed, with treatments applied using a novel quarter-milking device. Eight cows (32 cow-quarters) were used across 10 separate evening milkings, with quarter being the experimental unit. The 9 treatments, with the exception of a repeated center point, were randomly applied to all quarters within each individual milking. Analysis was confined to the peak milk flow period. Milk flow rate (MFR) and teat canal cross sectional area (CA) were normalized by dividing individual MFR, or CA, values by their within-quarter average value across all treatments. A multiple explanatory variable regression model was developed for normalized MFR and normalized CA. The methods presented in this paper provided sufficient precision to estimate the effects of vacuum (both at teat-end and in the liner mouthpiece), pulsation, and liner compression on CA, as an indicator of teat-end congestion, during the peak flow period of milking. Liner compression (as indicated by overpressure), teat-end vacuum, vacuum in the liner mouthpiece, milk-phase time, and their interactions are all important predictors of MFR and teat-end congestion during the peak milk flow period of milking. Increasing teat-end vacuum and milk-phase time increases MFR and reduces CA (indicative of increased teat-end congestion). Increasing vacuum in the liner mouthpiece also acts to reduce CA and MFR. Increasing liner compression reduces the effects of teat-end congestion, resulting in increased MFR and increased CA at high levels of teat-end vacuum and milk-phase time. These results provide a better understanding of the balance between milking speed and milking gentleness