Improving the patient discharge process: Implementing actions derived from a Soft Systems Methodology Study

In the period from January 2013 to July 2014, three process change initiatives were undertaken at a major UK hospital to improve the patient discharge process. These initiatives were inspired by the findings of a study of the discharge process using Soft Systems Methodology. The first initiative simplified time-consuming paperwork and the second introduced more regular reviews of patient progress through daily multi-disciplinary “Situation Reports”. These two initiatives were undertaken in parallel across the hospital, and for the average patient they jointly led to a 41% reduction between a patient being declared medically stable and their being discharged from the hospital. The third initiative implemented more proactive alerting of Social Care Practitioners to patients with probable social care needs at the front door, and simplified capture of important patient information (using a “SPRING” form). This initiative saw a 20% reduction in total length of stay for 88 patients on three wards where the SPRING form was used, whilst 248 patients on five control wards saw no significant change in total length of stay in the same period. Taken together, these initiatives have reduced total length of stay by 67% from 55.8 days to 18.6 days for the patients studied

The Evolution of the Hastings Coastline: Discussion

n/

Balancing charge-transfer strength and triplet states for deep-blue thermally activated delayed fluorescence with an unconventional electron rich dibenzothiophene acceptor

Manipulation of the emission properties of deep-blue emitters exhibiting thermally activated delayed fluorescence (TADF) through molecular design is challenging. We present an effective strategy to probe deeper into the role of localized (LE) and charge transfer (CT) states in the reverse intersystem crossing (RISC) mechanism. In a series of donor–acceptor–donor (D–A–D) blue emitters the dibenzothiophene functionality is used as an unconventional acceptor, while derivatives of 9,10-dihydro-9,9-dimethylacridine are used as electron-donors. tert-Butyl and methoxy substituents in the para-positions of the donor greatly enhance the donor strength, which allows exploration of different energy alignments among CT and LE triplet states. In the tert-butyl substituted compound the low energy triplet is localized on the acceptor unit, with the RISC mechanism (kRISC = 0.17 × 105 s−1) likely involving the mixture of CT and LE triplet states that are separated by less than 0.09 eV. An optimized organic light-emitting diode (OLED) based on the tBu-compound presents a maximum external quantum efficiency of 10.5% and deep-blue emission with Commission Internationale de l'Eclairage coordinates of (0.133, 0.129). However, when methoxy substituents are used, the low-energy triplet state moves away from the emissive 1CT singlet increasing the energy gap to 0.24 eV. Despite a larger ΔEST, a faster RISC rate (kRISC = 2.28 × 105 s−1) is observed due to the upper-state RISC occurring from the high-energy triplet state localized on the D (or A) units. This work shows the importance of fine-tuning the electronic interactions of the donor and acceptor units to control the TADF mechanism and achieve a deep-blue TADF OLED

Both cis and trans Activities of Foot-and-Mouth Disease Virus 3D Polymerase Are Essential for Viral RNA Replication

The Picornaviridae is a large family of positive-sense RNA viruses that contains numerous human and animal pathogens, including foot-and-mouth disease virus (FMDV). The picornavirus replication complex comprises a co-ordinated network of protein-protein and protein-RNA interactions involving multiple viral and host-cellular factors. Many of the proteins within the complex possess multiple roles in viral RNA replication, some of which can be provided in trans (i.e. via expression from a separate RNA molecule), whilst other are required in cis (i.e. expressed from the template RNA molecule). In vitro studies have suggested that multiple copies of the RNA-dependent RNA-polymerase (RdRp), 3D, are involved in the viral replication complex. However, it is not clear whether all these molecules are catalytically active or what other function(s) they provide. In this study, we aimed to distinguish between catalytically-active 3D molecules and those which build a replication complex. We report a novel non-enzymatic cis-acting function of 3D that is essential for viral genome replication. Using a FMDV replicon in complementation experiments, our data demonstrate that this cis-acting role of 3D is distinct from the catalytic activity, which is predominantly trans-acting. Immunofluorescence studies suggest that both cis- and trans acting 3D molecules localise to the same cellular compartment. However, our genetic and structural data suggest that 3D interacts in cis with RNA stem-loops that are essential for viral RNA replication. Together, this study identifies a previously undescribed aspect of picornavirus replication complex structure-function and an important methodology for probing such interactions further

Implementation of Triple P-Positive Parenting Program in Hong Kong: Predictors of programme completion and clinical outcomes

This study examined the effectiveness of the Triple P-Positive Parenting Program in a government child health service delivery context with Chinese parents in Hong Kong. Specifically, the study sought to identify pre-intervention variables that might predict programme outcomes such as, level of clinical improvement and programme completion. Participants were 661 parents of pre-school and primary aged children participating in a group version of the Triple P-Positive Parenting Program. There were significant decreases in disruptive child behaviours, levels of parenting stress, general stress and anxiety and an increase in parenting sense of competence. Greater change in reports of child behaviour problems was related to lower levels of family income, new immigrant family status, and higher pre-intervention levels of parenting stress. The present study provides a profile of parents who are most likely to benefit from parent training programmes

A combined experimental and computational study on the reaction of fluoroarenes with Mg–Mg, Mg–Zn, Mg–Al and Al–Zn bonds

Through a combined experimental and computational (DFT) approach, the reaction mechanism of the addition of fluoroarenes to Mg–Mg bonds has been determined as a concerted S_{N}Ar-like pathway in which one Mg centre acts as a nucleophile and the other an electrophile. The experimentally determined Gibbs activation energy for the addition of C₆F₆ to a Mg–Mg bond of a molecular complex, ΔG‡_{₂₉₈K}(experiment) = 21.3 kcal mol⁻¹ is modelled by DFT with the ωB97X functional, ΔG‡₂₉₈ {K}_(DFT) = 25.7 kcal mol⁻¹. The transition state for C–F activation involves a polarisation of the Mg–Mg bond and significant negative charge localisation on the fluoroarene moiety. This transition state is augmented by stabilising closed-shell Mg⋯F_{ortho} interactions that, in combination with the known trends in C–F and C–M bond strengths in fluoroarenes, provide an explanation for the experimentally determined preference for C–F bond activation to occur at sites flanked by ortho-fluorine atoms. The effect of modification of both the ligand coordination sphere and the nature and polarity of the M–M bond (M = Mg, Zn, Al) on C–F activation has been investigated. A series of highly novel β-diketiminate stabilised complexes containing Zn–Mg, Zn–Zn–Zn, Zn–Al and Mg–Al bonds has been prepared, including the first crystallographic characterisation of a Mg–Al bond. Reactions of these new M–M containing complexes with perfluoroarenes were conducted and modelled by DFT. C–F bond activation is dictated by the steric accessibility, and not the polarity, of the M–M bond. The more open coordination complexes lead to enhanced Mg⋯F_{ortho} interactions which in turn lower the energy of the transition states for C–F bond activation

Ward's Hierarchical Clustering Method: Clustering Criterion and Agglomerative Algorithm

The Ward error sum of squares hierarchical clustering method has been very widely used since its first description by Ward in a 1963 publication. It has also been generalized in various ways. However there are different interpretations in the literature and there are different implementations of the Ward agglomerative algorithm in commonly used software systems, including differing expressions of the agglomerative criterion. Our survey work and case studies will be useful for all those involved in developing software for data analysis using Ward's hierarchical clustering method.Comment: 20 pages, 21 citations, 4 figure

Submillimeter Studies of Prestellar Cores and Protostars: Probing the Initial Conditions for Protostellar Collapse

Improving our understanding of the initial conditions and earliest stages of protostellar collapse is crucial to gain insight into the origin of stellar masses, multiple systems, and protoplanetary disks. Observationally, there are two complementary approaches to this problem: (1) studying the structure and kinematics of prestellar cores observed prior to protostar formation, and (2) studying the structure of young (e.g. Class 0) accreting protostars observed soon after point mass formation. We discuss recent advances made in this area thanks to (sub)millimeter mapping observations with large single-dish telescopes and interferometers. In particular, we argue that the beginning of protostellar collapse is much more violent in cluster-forming clouds than in regions of distributed star formation. Major breakthroughs are expected in this field from future large submillimeter instruments such as Herschel and ALMA.Comment: 12 pages, 9 figures, to appear in the proceedings of the conference "Chemistry as a Diagnostic of Star Formation" (C.L. Curry & M. Fich eds.