Harmonious Healthcare Teams: What Healthcare Professionals Can and Cannot Learn from Chamber Musicians

Background: As healthcare becomes increasingly team based, we need new ways of educating trainees to be collaborative team members. One approach is to look to other professions that have developed highly effective ways of collaborating. Doctors have already turned to musicians for specific lessons; however, as of yet, there has been little empirical study of the ways that musicians interact in ensembles, or analysis of how this might provide insights for healthcare. Our hypothesis is that healthcare teams might learn from understanding collaborative practices of chamber musicians.Methods and Findings: We undertook an exploratory study of professional musicians playing in non-conducted ensembles. We used semi-structured interviews to explore factors the musicians considered important for effective group function. The interviews were transcribed and coded thematically. We identified three prominent themes that have relevance for healthcare teams.Conclusions: The highly individual nature of each musical group’s identity suggests that a focus on generic interprofessional education skills development may be insufficient. Furthermore, musicians’ understanding of the fundamental role of non-melodic parts provides the possibility of more nuanced leadership models. Finally, essential differences between musicians’ interactions in rehearsals and performances highlight the importance of varied forms of group interactions

Health status and healthcare trends of individuals accessing Australian aged care programmes over a decade: the Registry of Senior Australians historical cohort

BACKGROUND:Understanding the health profile, service, and medicine use of Australians in the aged care sector will help inform appropriate service provision for our ageing population. AIMS:To examine the 2006-2015 trends in (1) co-morbidities and frailty of individuals accessing aged care and (2) health services, medicine use, and mortality after entry into long term care. METHODS:A cross-sectional and population-based trend analysis were conducted using the Registry of Senior Australians. RESULTS:From 2006-2015, 509,944 individuals accessed permanent residential care, 206,394 home care, 283,014 respite, and 124,943 transition care. Over this time, the proportion of individuals accessing permanent residential care with high frailty scores (≥0.3) increased (19.7% to 49.7%), as did the proportion with 5-9 co-morbidities (46.4% to 54.5%), with similar trends observed for those accessing other services. The median number of medicines dispensed in the year after entering permanent residential care increased from 9 (interquartile range (IQR) 6-12) to 10 (IQR 7-14), while remaining stable in home care (2006:9 IQR 5-12, 2015:9, IQR 6-13). Short-term (within 100 days) mortality in those accessing permanent care was higher in 2006 (15.6%, 95%CI 15.2-16.0%) than 2015 (14.6%, 95%CI 14.3-14.9%), while longer term (101-1095 days, 2006: 44.3%, 95%CI 43.7-45.0%, 2015: 46.4%, 95%CI 45.8-46.9%) mortality was higher. Mortality in individuals accessing home care did not change. CONCLUSION:The health of older Australians accessing aged care programs has declined while frailty increased, with an increasing use of medicine and worse long-term mortality in some. Funding and care models need to adapt to this changing profile.Maria C. Inacio, Catherine Lang, Sarah C. E. Bray, Renuka Visvanathan, Craig Whitehead, Elizabeth C. Griffith, Keith Evans, Megan Corlis and Steve Wesseling

The risk of fall-related hospitalisations at entry into permanent residential aged care

Background: Entering permanent residential aged care (PRAC) is a vulnerable time for individuals. While falls risk assessment tools exist, these have not leveraged routinely collected and integrated information from the Australian aged and health care sectors. Our study examined individual, system, medication, and health care related factors at PRAC entry that are predictors of fall-related hospitalisations and developed a risk assessment tool using integrated aged and health care data. Methods: A retrospective cohort study was conducted on N=32,316 individuals ≥65 years old who entered a PRAC facility (01/01/2009-31/12/2016). Fall-related hospitalisations within 90 or 365days were the outcomes of interest. Individual, system, medication, and health care-related factors were examined as predictors. Risk prediction models were developed using elastic nets penalised regression and Fine and Gray models. Area under the receiver operating characteristics curve (AUC) assessed model discrimination. Results: 64.2% (N =20,757) of the cohort were women and the median age was 85 years old (interquartile range 80-89). After PRAC entry, 3.7% (N =1209) had a fall-related hospitalisation within 90days and 9.8% (N =3156) within 365days. Twenty variables contributed to fall-related hospitalisation prediction within 90days and the strongest predictors included fracture history (sub-distribution hazard ratio (sHR)=1.87, 95% confdence interval (CI) 1.63-2.15), falls history (sHR=1.41, 95%CI 1.21-2.15), and dementia (sHR=1.39, 95%CI 1.22-1.57). Twenty-seven predictors of fallrelated hospitalisation within 365days were identifed, the strongest predictors included dementia (sHR=1.36, 95%CI 1.24-1.50), history of falls (sHR=1.30, 95%CI 1.20-1.42) and fractures (sHR=1.28, 95%CI 1.15-1.41). The risk prediction models had an AUC of 0.71 (95%CI 0.68-0.74) for fall-related hospitalisations within 90days and 0.64 (95%CI 0.62-0.67) for within 365days. Conclusion: Routinely collected aged and health care data, when integrated at a clear point of action such as entry into PRAC, can identify residents at risk of fall-related hospitalisations, providing an opportunity for better targeting risk mitigation strategies.Maria C. Inacio, Max Moldovan, Craig Whitehead, Janet K. Sluggett, Maria Crotty, Megan Corlis, Renuka Visvanathan, Steve Wesselingh, and Gillian E. Caughe

Quality and safety in residential aged care: an evaluation of a national quality indicator programme

OnlinePublBackground: In Australia, 243 000 individuals live in approximately 2700 residential aged care facilities yearly. In 2019, a National Aged Care Mandatory Quality Indicator programme (QI programme) was implemented to monitor the quality and safety of care in facilities. Aim: To examine the validity of the QI programme indicators using explicit measure review criteria. Methods: The QI programme manual and reports were reviewed. A modified American College of Physicians Measure Review Criteria was employed to examine the QI programme’s eight indicators. Five authors rated each indicator on importance, appropriateness, clinical evidence, specifications and feasibility using a nine-point scale. A median score of 1–3 was considered to not meet criteria, 4–6 to meet some criteria and 7–9 to meet criteria. Results: All indicators, except polypharmacy, met criteria (median scores = 7–9) for importance, appropriateness and clinical evidence. Polypharmacy met some criteria for importance (median = 6, range 2–8), appropriateness (median = 5, range 2–8) and clinical evidence (median = 6, range 3–8). Pressure injury, physical restraints, significant unplanned weight loss, consecutive unplanned weight loss, falls and polypharmacy indicators met some criteria for specifications validity (all median scores = 5) and feasibility and applicability (median scores = 4 to 6). Antipsychotic use and falls resulting in major injury met some criteria for specifications (median = 6–7, range 4–8) and met criteria for feasibility and applicability (median = 7, range 4–8). Conclusions: Australia’s National QI programme is a major stride towards a culture of quality promotion, improvement and transparency. Measures’ specifications, feasibility and applicability could be improved to ensure the programme delivers on its intended purposes.Maria C. Inacio, Tesfahun C. Eshetie, Gillian E. Caughey, Craig Whitehead, Johanna Westbrook, Len Gray, Peter Hibbert, Elizabeth Beattie, Jeffrey Braithwaite, Ian D. Cameron, Maria Crotty, and Steve Wesseling

Search for direct production of charginos and neutralinos in events with three leptons and missing transverse momentum in √s = 7 TeV pp collisions with the ATLAS detector

A search for the direct production of charginos and neutralinos in final states with three electrons or muons and missing transverse momentum is presented. The analysis is based on 4.7 fb−1 of proton–proton collision data delivered by the Large Hadron Collider and recorded with the ATLAS detector. Observations are consistent with Standard Model expectations in three signal regions that are either depleted or enriched in Z-boson decays. Upper limits at 95% confidence level are set in R-parity conserving phenomenological minimal supersymmetric models and in simplified models, significantly extending previous results

Jet size dependence of single jet suppression in lead-lead collisions at sqrt(s(NN)) = 2.76 TeV with the ATLAS detector at the LHC

Measurements of inclusive jet suppression in heavy ion collisions at the LHC provide direct sensitivity to the physics of jet quenching. In a sample of lead-lead collisions at sqrt(s) = 2.76 TeV corresponding to an integrated luminosity of approximately 7 inverse microbarns, ATLAS has measured jets with a calorimeter over the pseudorapidity interval |eta| < 2.1 and over the transverse momentum range 38 < pT < 210 GeV. Jets were reconstructed using the anti-kt algorithm with values for the distance parameter that determines the nominal jet radius of R = 0.2, 0.3, 0.4 and 0.5. The centrality dependence of the jet yield is characterized by the jet "central-to-peripheral ratio," Rcp. Jet production is found to be suppressed by approximately a factor of two in the 10% most central collisions relative to peripheral collisions. Rcp varies smoothly with centrality as characterized by the number of participating nucleons. The observed suppression is only weakly dependent on jet radius and transverse momentum. These results provide the first direct measurement of inclusive jet suppression in heavy ion collisions and complement previous measurements of dijet transverse energy imbalance at the LHC.Comment: 15 pages plus author list (30 pages total), 8 figures, 2 tables, submitted to Physics Letters B. All figures including auxiliary figures are available at http://atlas.web.cern.ch/Atlas/GROUPS/PHYSICS/PAPERS/HION-2011-02

Measurement of the polarisation of W bosons produced with large transverse momentum in pp collisions at sqrt(s) = 7 TeV with the ATLAS experiment

This paper describes an analysis of the angular distribution of W->enu and W->munu decays, using data from pp collisions at sqrt(s) = 7 TeV recorded with the ATLAS detector at the LHC in 2010, corresponding to an integrated luminosity of about 35 pb^-1. Using the decay lepton transverse momentum and the missing transverse energy, the W decay angular distribution projected onto the transverse plane is obtained and analysed in terms of helicity fractions f0, fL and fR over two ranges of W transverse momentum (ptw): 35 < ptw < 50 GeV and ptw > 50 GeV. Good agreement is found with theoretical predictions. For ptw > 50 GeV, the values of f0 and fL-fR, averaged over charge and lepton flavour, are measured to be : f0 = 0.127 +/- 0.030 +/- 0.108 and fL-fR = 0.252 +/- 0.017 +/- 0.030, where the first uncertainties are statistical, and the second include all systematic effects.Comment: 19 pages plus author list (34 pages total), 9 figures, 11 tables, revised author list, matches European Journal of Physics C versio

Observation of a new chi_b state in radiative transitions to Upsilon(1S) and Upsilon(2S) at ATLAS

The chi_b(nP) quarkonium states are produced in proton-proton collisions at the Large Hadron Collider (LHC) at sqrt(s) = 7 TeV and recorded by the ATLAS detector. Using a data sample corresponding to an integrated luminosity of 4.4 fb^-1, these states are reconstructed through their radiative decays to Upsilon(1S,2S) with Upsilon->mu+mu-. In addition to the mass peaks corresponding to the decay modes chi_b(1P,2P)->Upsilon(1S)gamma, a new structure centered at a mass of 10.530+/-0.005 (stat.)+/-0.009 (syst.) GeV is also observed, in both the Upsilon(1S)gamma and Upsilon(2S)gamma decay modes. This is interpreted as the chi_b(3P) system.Comment: 5 pages plus author list (18 pages total), 2 figures, 1 table, corrected author list, matches final version in Physical Review Letter

Measurement of the inclusive isolated prompt photon cross-section in pp collisions at sqrt(s)= 7 TeV using 35 pb-1 of ATLAS data

A measurement of the differential cross-section for the inclusive production of isolated prompt photons in pp collisions at a center-of-mass energy sqrt(s) = 7 TeV is presented. The measurement covers the pseudorapidity ranges |eta|<1.37 and 1.52<=|eta|<2.37 in the transverse energy range 45<=E_T<400GeV. The results are based on an integrated luminosity of 35 pb-1, collected with the ATLAS detector at the LHC. The yields of the signal photons are measured using a data-driven technique, based on the observed distribution of the hadronic energy in a narrow cone around the photon candidate and the photon selection criteria. The results are compared with next-to-leading order perturbative QCD calculations and found to be in good agreement over four orders of magnitude in cross-section.Comment: 7 pages plus author list (18 pages total), 2 figures, 4 tables, final version published in Physics Letters

Measurement of D*+/- meson production in jets from pp collisions at sqrt(s) = 7 TeV with the ATLAS detector

This paper reports a measurement of D*+/- meson production in jets from proton-proton collisions at a center-of-mass energy of sqrt(s) = 7 TeV at the CERN Large Hadron Collider. The measurement is based on a data sample recorded with the ATLAS detector with an integrated luminosity of 0.30 pb^-1 for jets with transverse momentum between 25 and 70 GeV in the pseudorapidity range |eta| < 2.5. D*+/- mesons found in jets are fully reconstructed in the decay chain: D*+ -> D0pi+, D0 -> K-pi+, and its charge conjugate. The production rate is found to be N(D*+/-)/N(jet) = 0.025 +/- 0.001(stat.) +/- 0.004(syst.) for D*+/- mesons that carry a fraction z of the jet momentum in the range 0.3 < z < 1. Monte Carlo predictions fail to describe the data at small values of z, and this is most marked at low jet transverse momentum.Comment: 10 pages plus author list (22 pages total), 5 figures, 1 table, matches published version in Physical Review