On partial well-order for monotone grid classes of permutations

A monotone grid class is a permutation class (i.e., a downset of permutations under the containment order) defined by local monotonicity conditions. We give a simplified proof of a result of Murphy and Vatter that monotone grid classes of forests are partially well-ordered

Education Human Excellence

In line with the logic of ecology and the philosophy of Existentialism, the existence of one thing is always in the company of one or more of other things. This, to give a correct idea or to avoid misunderstandings of the use of the predicate ahead as in terms like seeds, superior schools, excellent products of education, and others, it is morally imperative for the users of such terms to provide the terms with Reviews their Contexts to Determine Whether a superior means \u27prime\u27, \u27superior\u27, \u27competitive\u27, or any other. Instances of such Contexts can be of appearance or performance, of a long or short term, of the current objectives or future goals, of individuals or the community, of individual or social needs, of national or International needs, of inclusive or exclusive purposes, and others. Even now, the writer is still of the belief that the USAge of the aforementioned Reviews those terms in the field of education in Indonesia is still more as jargon rather than basic concepts. Indeed very rarely or even never does the public, particularly subject to Reviews those who are very much concerned with the development of education in Indonesia, to get a thorough explanation of Reviews those terms Mentioned. This article tries to build a kind of "second opinion" as a balance to the existence of that jargon Mentioned

Wall slip, shear banding, and instability in the flow of a triblock copolymer micellar solution

The shear flow of a triblock copolymer micellar solution (PEO--PPO--PEO Pluronic P84 in brine) is investigated using simultaneous rheological and velocity profile measurements in the concentric cylinder geometry. We focus on two different temperatures below and above the transition temperature $T_c$ which was previously associated with the apparition of a stress plateau in the flow curve. (i) At $T=37.0^\circ$C $<T_c$, the bulk flow remains homogeneous and Newtonian-like, although significant wall slip is measured at the rotor that can be linked to an inflexion point in the flow curve. (ii) At $T=39.4^\circ$C $>T_c$, the stress plateau is shown to correspond to stationary shear-banded states characterized by two high shear rate bands close to the walls and a very weakly sheared central band, together with large slip velocities at the rotor. In both cases, the high shear branch of the flow curve is characterized by flow instability. Interpretations of wall slip, three-band structure, and instability are proposed in light of recent theoretical models and experiments.Comment: 13 pages, 13 figure

National Vascular Registry: 2014 Progress Report.

The National Vascular Registry is commissioned by the Healthcare Quality Improvement Partnership (HQIP) to measure the quality and outcomes of care for patients who undergo major vascular surgery in NHS hospitals in England and Wales. It aims to provide comparative information on the performance of NHS hospitals and thereby support local quality improvement as well as inform patients about the care delivered in the NHS. As such, all NHS hospitals in England, Wales, Scotland and Northern Ireland are encouraged to participate in the Registry. The measures used to describe the patterns and outcomes of care are drawn from various national guidelines including: the “2014 The Provision of Services for Patients with Vascular Disease” and the Quality Improvement Frameworks published by the Vascular Society, and the National Institute for Health and Care Excellence (NICE) guidelines on stroke and peripheral arterial disease. In 2014, the Registry published NHS trust and surgeon-level information for elective infrarenal Abdominal Aortic Aneurysm (AAA) repair and carotid endarterectomy on the Registry website. From 28 October, information on both procedures has been available on the www.vsqip.org.uk website for all UK NHS trusts that currently perform them. For English NHS trusts, the same information was published for individual consultants, as part of NHS England’s “Everyone Counts: Planning for Patients 2013/4” initiative. Consultant-level information was also published for NHS hospitals in Wales, Scotland and Northern Ireland for consenting surgeons. This progress report aims to complement that information by (1) providing an overview of care delivered by the NHS at a national level, and (2) describing various developments within the National Vascular Registry. The Registry will publish its next annual report on major vascular surgery in November 2015

Durrington Walls to West Amesbury by way of Stonehenge: a major transformation of the Holocene landscape

A new sequence of Holocene landscape change has been discovered through an investigation of sediment sequences, palaeosols, pollen and molluscan data discovered during the Stonehenge Riverside Project. The early post-glacial vegetational succession in the Avon valley at Durrington Walls was apparently slow and partial, with intermittent woodland modification and the opening-up of this landscape in the later Mesolithic and earlier Neolithic, though a strong element of pine lingered into the third millennium BC. There appears to have been a major hiatus around 2900 cal BC, coincident with the beginnings of demonstrable human activities at Durrington Walls, but slightly after activity started at Stonehenge. This was reflected in episodic increases in channel sedimentation and tree and shrub clearance, leading to a more open downland, with greater indications of anthropogenic activity, and an increasingly wet floodplain with sedges and alder along the river’s edge. Nonetheless, a localized woodland cover remained in the vicinity of DurringtonWalls throughout the third and second millennia BC, perhaps on the higher parts of the downs, while stable grassland, with rendzina soils, predominated on the downland slopes, and alder–hazel carr woodland and sedges continued to fringe the wet floodplain. This evidence is strongly indicative of a stable and managed landscape in Neolithic and Bronze Age times. It is not until c 800–500 cal BC that this landscape was completely cleared, except for the marshy-sedge fringe of the floodplain, and that colluvial sedimentation began in earnest associated with increased arable agriculture, a situation that continued through Roman and historic times

Editor's Choice - Delays to Surgery and Procedural Risks Following Carotid Endarterectomy in the UK National Vascular Registry.

OBJECTIVE: Guidelines recommend that patients suffering an ischaemic transient ischaemic attack (TIA) or stroke caused by carotid artery stenosis should undergo carotid endarterectomy (CEA) within 14 days. METHOD: The degree to which UK vascular units met this standard was examined and whether rapid interventions were associated with procedural risks. The study analysed patients undergoing CEA between January 2009 and December 2014 from 100 UK NHS hospitals. Data were collected on patient characteristics, intervals of time from symptoms to surgery, and 30-day postoperative outcomes. The relationship between outcomes and time from symptom to surgery was evaluated using multilevel multivariable logistic regression. RESULTS: In 23,235 patients, the median time from TIA/stroke to CEA decreased over time, from 22 days (IQR 10-56) in 2009 to 12 days (IQR 7-26) in 2014. The proportion of patients treated within 14 days increased from 37% to 58%. This improvement was produced by shorter times across the care pathway: symptoms to referral, from medical review to being seen by a vascular surgeon, and then to surgery. The spread of the median time from symptom to surgery among NHS hospitals shrank between 2009 and 2013 but then grew slightly. Low-, medium-, and high-volume NHS hospitals all improved their performance similarly. Performing CEA within 48 h of symptom onset was associated with a small increase in the 30-day stroke and death rate: 3.1% (0-2 days) compared with 2.0% (3-7 days); adjusted odds ratio 1.64 (95% CI 1.04-2.59) but not with longer delays. CONCLUSIONS: The delay from symptom to CEA in symptomatic patients with ipsilateral 50-99% carotid stenoses has reduced substantially, although 42% of patients underwent CEA after the recommended 14 days. The risk of stroke after CEA was low, but there may be a small increase in risk during the first 48 h after symptoms

National Vascular Registry: 2015 Annual Report.

The National Vascular Registry is commissioned by the Healthcare Quality Improvement Partnership (HQIP) to measure the quality and outcomes of care for patients who undergo major vascular surgery in NHS hospitals in England and Wales. It aims to provide comparative information on the performance of NHS vascular units and thereby support local quality improvement as well as inform patients about major vascular interventions delivered in the NHS. As such, all NHS hospitals in England, Wales, Scotland and Northern Ireland are encouraged to participate in the Registry. The measures used to describe the patterns and outcomes of care are drawn from various national guidelines including: the “Provision of Services for Patients with Vascular Disease” document and the Quality Improvement Frameworks published by the Vascular Society, and the National Institute for Health and Care Excellence (NICE) guidelines on stroke and peripheral arterial disease. This report provides a description of the care provided by NHS vascular units, and contains information on the process and outcomes of care for: (i) patients undergoing abdominal aortic aneurysm (AAA) repair, (ii) patients undergoing carotid endarterectomy, (iii) patients undergoing a revascularisation procedure (angioplasty/stent or bypass) or major amputation for lower-limb peripheral arterial disease (PAD). In addition, the report presents the findings of an organisational audit conducted in August 2015

Improving 1-Year Outcomes of Infrainguinal Limb Revascularization: Population-Based Cohort Study of 104 000 Patients in England.

BACKGROUND: The availability and diversity of lower limb revascularization procedures have increased in England in the past decade. We investigated whether these developments in care have translated to improvements in patient pathways and outcomes. METHODS: Individual-patient records from Hospital Episode Statistics were used to identify 103 934 patients who underwent endovascular (angioplasty) or surgical (endarterectomy, profundaplasty, or bypass) lower limb revascularization for infrainguinal peripheral artery disease in England between January 2006 and December 2015. Major lower limb amputations and deaths within 1 year after revascularization were ascertained from Hospital Episode Statistics and Office for National Statistics mortality records. Competing risks regression was used to estimate the cumulative incidence of major amputation and death, adjusted for patient age, sex, comorbidity score, indication for the intervention (intermittent claudication, severe limb ischemia without record of tissue loss, severe limb ischemia with a record of ulceration, severe limb ischemia with a record of gangrene/osteomyelitis), and comorbid diabetes mellitus. RESULTS: The estimated 1-year risk of major amputation decreased from 5.7% (in 2006-2007) to 3.9% (in 2014-2015) following endovascular revascularization, and from 11.2% (2006-2007) to 6.6% (2014-2015) following surgical procedures. The risk of death after both types of revascularization also decreased. These trends were observed for all indication categories, with the largest reductions found in patients with severe limb ischemia with ulceration or gangrene. Overall, morbidity increased over the study period, and a larger proportion of patients was treated for the severe end of the peripheral artery disease spectrum using less invasive procedures. CONCLUSIONS: Our findings show that from 2006 to 2015, the overall survival increased and the risk of major lower limb amputation decreased following revascularization. These observations suggest that patient outcomes after lower limb revascularization have improved during a period of centralization and specialization of vascular services in the United Kingdom

Patient-Reported Outcome Measures for Abdominal Aortic Aneurysm: A systematic review and qualitative evidence synthesis

Background: The aim was to identify and evaluate existing patient reported outcome measures (PROMs) for use in patients with an abdominal aortic aneurysm (AAA) to inform the selection for use in surgical practice. Methods: Two systematic reviews were conducted: a systematic review to identify valid, reliable and acceptable PROMs for patients with AAA and a qualitative evidence synthesis to assess the relevance to patients of the identified PROMs items. PROMs studies were evaluated for their psychometric properties using established assessment criteria and their methodological quality using the COSMIN checklist. Qualitative studies were synthesised using framework analysis and identified concepts were then triangulated using a triangulation protocol with the item concepts of the identified PROMs. Results: Four PROMs from three studies were identified in the first review; the SF-36, the Australian Vascular Quality of Life Index, the AneurysmDQoL and AneurysmSRQ. None of the identified PROMs had undergone a rigorous psychometric evaluation within the AAA population. Four studies were included in the qualitative synthesis, from which 28 concepts important to patients with an AAA were identified. The AneurysmDQoL and the AneurysmSRQ together provided the most comprehensive assessment of these concepts. Fear of rupture, control, ability to forget about the condition and size of aneurysm were all concepts identified in the qualitative studies but not covered by items on the identified PROMs. Conclusion: Further research is needed to develop PROMs that are reliable, valid and acceptable to patients for use in surgical practice for AAA