A person-time analysis of hospital activity among cancer survivors in England.

BACKGROUND: There are around 2 million cancer survivors in the UK. This study describes the inpatient and day case hospital activity among the population of cancer survivors in England. This is one measure of the burden of cancer on the individual and the health service. METHODS: The national cancer registry data set for England (1990-2006) is linked to the NHS Hospital Episode Statistics (HES) database. Cohorts of survivors were defined as those people recorded in the cancer registry data with a diagnosis of breast, colorectal, lung or prostate cancer before 2007. The person-time of prevalence in 2006 for each cohort of survivors was calculated according to the cancer type, sex, age and time since diagnosis. The corresponding HES episodes of care in 2006 were used to calculate the person-time of admitted hospital care for each cohort of survivors. The average proportion of time spent in hospital by survivors in each cohort was calculated as the summed person-time of hospital activity divided by the summed person-time of prevalence. The analysis was conducted separately for cancer-related episodes and non-cancer-related episodes. RESULTS: Lung cancer survivors had the highest intensity of cancer-related hospital activity. For all cancers, cancer-related hospital activity was highest in the first year following diagnosis. Breast and prostate cancer survivors had peaks of cancer-related hospital activity in the relatively young and relatively old age groups. The proportion of time spent in hospital for non-cancer-related care was much lower than that for cancer-related care and increased gradually with age but was generally constant regardless of time since diagnosis. CONCLUSION: The person-time approach used in this study is more revealing than a simple enumeration of cancer survivors and hospital admissions. Hospital activity among cancer survivors is highest soon after diagnosis. The effect of age on the amount of hospital activity is different for each type of cancer

Measuring Confidentiality with Multiple Observables

Measuring the confidentiality of programs that need to interact with the outside world can prevent leakages and is important to protect against dangerous attacks. However, information propagation is difficult to follow through a large program with implicit information flow, tricky loops, and complicated instructions. Previous works have tackled this problem in several ways but often measure leakage a program has on average rather than the leakage produced by a set of particularly compromising interactions. We introduce new methods that target a specific set of observables revealed throughout execution to cut down on the resources needed for analysis. Our implementation examines Python bytecode and we compare its results with Meta\u27s Pyre, a static taint analysis engine

A Study of Knowledge and Practical Skill Performance in University Students: A Comparison of Technology Enriched versus Traditional Classroom Instruction

Context: Technology is increasingly utilized in the delivery of athletic training education. Hand-held technology affords continued education outside the classroom. Purpose: To determine the effect of mobile technology on the acquisition of knowledge and practical skills in a university upper extremity evaluation course. Design and Setting: A cohort retrospective archival assessment in a university office environment of grades and performance on written and practical examinations in an upper extremity evaluation course. Participants: Sixty-four college age participants (male n=35, 54.69%, female n=29, 45.31%) previously enrolled in an undergraduate or graduate athletic training program who completed the upper extremity evaluation course between Spring 2009 and Spring 2012. Main Outcome Measures: Dependent variables included final written examination score, final oral practical examination score, and final grade. The independent variable was the technology-enriched instruction provided using the Flashcards Deluxe application available on Android, Apple iPod Touch, iPhone, or iPad devices. This application allows participants to study electronic flashcards with text, pictures, and sound on a mobile device. The control group did not receive the technology-enriched instruction. Results: A one-way between subjects ANOVA was conducted to compare the effect of technology on final written examination, final oral practical examination, and overall grade. There was a significant effect on the final written examination [F (1,63)= 11.621, p = .001,η²=.158]; however, oral practical examination [F(1,63)=0.348, p=.557,η²=.006] and overall grade [F(1,63)=0.695, p=.408,η²=.011] were not significant. Conclusion: Participants with technology-enriched instruction performed significantly better on their final written examination. Based on the findings, technology-enriched instruction improves a student’s knowledge comprehension of orthopedic principles of evaluation. Student performance was improved on written examinations following the use of electronic flashcards. Based on the findings in this study, technology-enriched instruction improves a student’s comprehension of upper extremity evaluation knowledge. It is reasonable to believe the use of flashcards would assist in student comprehension in other learning areas as well

Sedimentary controls on modern sand grain coat formation

Clay coated quartz grains can influence reservoir quality evolution during sandstone diagenesis. Porosity can be reduced and fluid flow restricted where grain coats encroach into pore space. Conversely pore-lining grain coats can restrict the growth of pore-filling quartz cement in deeply buried sandstones, and thus can result in unusually high porosity in deeply buried sandstones. Being able to predict the distribution of clay coated sand grains within petroleum reservoirs is thus important to help find good reservoir quality. Here we report a modern analogue study of 12 sediment cores from the Anllóns Estuary, Galicia, NW Spain, collected from a range of sub-environments, to help develop an understanding of the occurrence and distribution of clay coated grains. The cores were described for grain size, bioturbation and sedimentary structures, and then sub-sampled for electron and light microscopy, laser granulometry, and X-ray diffraction analysis. The Anllóns Estuary is sand-dominated with intertidal sand flats and saltmarsh environments at the margins; there is a shallowing/fining-upwards trend in the estuary-fill succession. Grain coats are present in nearly every sample analysed; they are between 1 μm and 100 μm thick and typically lack internal organisation. The extent of grain coat coverage can exceed 25% in some samples with coverage highest in the top 20 cm of cores. Samples from muddy intertidal flat and the muddy saltmarsh environments, close to the margins of the estuary, have the highest coat coverage (mean coat coverage of 20.2% and 21.3%, respectively). The lowest mean coat coverage occurs in the sandy saltmarsh (10.4%), beyond the upper tidal limit and sandy intertidal flat environments (8.4%), close to the main estuary channel. Mean coat coverage correlates with the concentration of clay fraction. The primary controls on the distribution of fine-grained sediment, and therefore grain coat distribution, are primary sediment transport and deposition processes that concentrate the clay fraction in the sediment towards the margins of the estuary. Bioturbation and clay illuviation/mechanical infiltration are secondary processes that may redistribute fine-grained sediment and produce grain coats. Here we have shown that detrital grain coats are more likely in marginal environments of ancient estuary-fills, which are typically found in the fining-upward part of progradational successions

Erlang could have told you so—A case study of health policy without maths

Little consideration is given to the operational reality of implementing national policy at local scale. Using a case study from Norway, we examine how simple mathematical models may offer powerful insights to policy makers when planning policies. Our case study refers to a national initiative requiring Norwegian municipalities to establish acute community beds (municipal acute units or MAUs) to avoid hospital admissions. We use Erlang loss queueing models to estimate the total number of MAU beds required nationally to achieve the original policy aim. We demonstrate the effect of unit size and patient demand on anticipated utilisation. The results of our model imply that both the average demand for beds and the current number of MAU beds would have to be increased by 34% to achieve the original policy goal of transferring 240 000 patient days to MAUs. Increasing average demand or bed capacity alone would be insufficient to reach the policy goal. Day-to-day variation and uncertainty in the numbers of patients arriving or leaving the system can profoundly affect health service delivery at the local level. Health policy makers need to account for these effects when estimating capacity implications of policy. We demonstrate how a simple, easily reproducible, mathematical model could assist policy makers in understanding the impact of national policy implemented at the local level

Trombe walls with nanoporous aerogel insulation applied to UK housing refurbishments

There is an opportunity to improve the efficiency of passive Trombe walls and active solar air collectors by replacing their conventional glass covers with lightweight polycarbonate panels filled with nanoporous aerogel insulation. This study investigates the thermal performance, energy savings, and financial payback period of passive Aerogel Trombe walls applied to the existing UK housing stock. Using parametric modeling, a series of design guidance tables have been generated, providing estimates of the energy savings and overheating risk associated with applying areas of Trombe wall to four different house types across the UK built to six notional construction standards. Calculated energy savings range from 183 kWh/m2/year for an 8 m2 system retrofitted to a solid walled detached house to 62 kWh/m2/year for a 32 m2 system retrofitted to a super insulated flat. Predicted energy savings from Trombe walls up to 24 m2 are found to exceed the energy savings from external insulation across all house types and constructions. Small areas of Trombe wall can provide a useful energy contribution without creating a significant overheating risk. If larger areas are to be installed, then detailed calculations would be recommended to assess and mitigate potential overheating issues.The EPSRC, Brunel University, and Buro Happold Lt

Empirical assessment of beta dose heterogeneity in sediments:Implications for luminescence dating

Optically stimulated luminescence (OSL) dating of single grains is often required to determine an accurate age for partially-bleached sediment by identifying those grains with OSL signals that were well bleached prior to burial. However, single-grain De distributions are typically characterised by greater amounts of scatter in comparison to multiple grains. Here we investigate the scatter in single-grain De distributions of quartz from 56 proglacial samples associated with the retreat of the last British-Irish Ice Sheet. Our findings provide the first empirical dataset showing that beta-dose heterogeneity can impact the extrinsic scatter in single-grain De distributions, in addition to partial bleaching in nature. The additional scatter in single-grain De distributions caused by beta-dose heterogeneity suggests that it is inappropriate to apply a fixed threshold to determine between well-bleached and partially-bleached De distributions, but the skewness of the De distributions could alternatively be used. Autoradiography and QEMSCAN analyses show that there was a negative relationship between the relative standard deviation (RSD) of the beta-dose heterogeneity and the beta dose-rate. This relationship offers the opportunity to infer the RSD of the beta-dose heterogeneity for each sample using just the beta dose-rate, instead of acquiring empirical data for every sample. For this large suite of sedimentary samples, we observe a minimum OD of 20 % arising from the effects of beta-dose heterogeneity (Fig. 3e), which should be added (in quadrature) to the intrinsic OD to determine σb for the minimum age model (MAM) to calculate accurate OSL ages and prevent underestimation of the burial age

Combining qualitative and quantitative operational research methods to inform quality improvement in pathways that span multiple settings

BACKGROUND: Improving integration and continuity of care across sectors within resource constraints is a priority in many health systems. Qualitative operational research methods of problem structuring have been used to address quality improvement in services involving multiple sectors but not in combination with quantitative operational research methods that enable targeting of interventions according to patient risk. We aimed to combine these methods to augment and inform an improvement initiative concerning infants with congenital heart disease (CHD) whose complex care pathway spans multiple sectors. METHODS: Soft systems methodology was used to consider systematically changes to services from the perspectives of community, primary, secondary and tertiary care professionals and a patient group, incorporating relevant evidence. Classification and regression tree (CART) analysis of national audit datasets was conducted along with data visualisation designed to inform service improvement within the context of limited resources. RESULTS: A 'Rich Picture' was developed capturing the main features of services for infants with CHD pertinent to service improvement. This was used, along with a graphical summary of the CART analysis, to guide discussions about targeting interventions at specific patient risk groups. Agreement was reached across representatives of relevant health professions and patients on a coherent set of targeted recommendations for quality improvement. These fed into national decisions about service provision and commissioning. CONCLUSIONS: When tackling complex problems in service provision across multiple settings, it is important to acknowledge and work with multiple perspectives systematically and to consider targeting service improvements in response to confined resources. Our research demonstrates that applying a combination of qualitative and quantitative operational research methods is one approach to doing so that warrants further consideration

Identifying improvements to complex pathways: evidence synthesis and stakeholder engagement in infant congenital heart disease

OBJECTIVES: Many infants die in the year following discharge from hospital after surgical or catheter intervention for congenital heart disease (3–5% of discharged infants). There is considerable variability in the provision of care and support in this period, and some families experience barriers to care. We aimed to identify ways to improve discharge and postdischarge care for this patient group. DESIGN: A systematic evidence synthesis aligned with a process of eliciting the perspectives of families and professionals from community, primary, secondary and tertiary care. SETTING: UK. RESULTS: A set of evidence-informed recommendations for improving the discharge and postdischarge care of infants following intervention for congenital heart disease was produced. These address known challenges with current care processes and, recognising current resource constraints, are targeted at patient groups based on the number of patients affected and the level and nature of their risk of adverse 1-year outcome. The recommendations include: structured discharge documentation, discharging certain high-risk patients via their local hospital, enhanced surveillance for patients with certain (high-risk) cardiac diagnoses and an early warning tool for parents and community health professionals. CONCLUSIONS: Our recommendations set out a comprehensive, system-wide approach for improving discharge and postdischarge services. This approach could be used to address challenges in delivering care for other patient populations that can fall through gaps between sectors and organisations