Evaluation of demand in a rural English hospital emergency department

The purpose of this article is to analyse the patient demand placed on a rural district general hospital (DGH) emergency department within the context of the Purpose, Process, People (PPP) framework used in the private sector. This analysis was undertaken to inform wider evaluation of the implementation of the enterprise culture—the NHS policy to adopt private sector best practice to produce resource use, quality and efficiency improvements. The article concludes with a view that the PPP framework provides methods of calculating the level of discharge necessary to meet the four-hour wait target. Data describing the characteristics and patterns of attending patients can be used to develop an emergency department’s processes and people to achieve its time-based target

Conducting rigorous research with subgroups of at-risk youth: lessons learned from a teen pregnancy prevention project in Alaska

In 2010, Alaska Department of Health and Social Services (DHSS) received federal funding to test an evidence-based teen pregnancy prevention program. The grant required a major modification to an existing program and a randomized control trial (RCT) to test its effectiveness. As the major modifications, Alaska used peer educators instead of adults to deliver the program to youth aged 1419 instead of the original curriculum intended age range of 1214. Cultural and approach adaptations were included as well. After 4 years of implementation and data collection, the sample was too small to provide statistically significant results. The lack of findings gave no information about the modification, nor any explanation of how the curriculum was received, or reasons for the small sample. This paper reports on a case study follow-up to the RCT to better understand outcome and implementation results. For this study, researchers reviewed project documents and interviewed peer educators, state and local staff, and evaluators. Three themes emerged from the data: (a) the professional growth of peer educators and development of peer education, (b) difficulties resulting from curriculum content, especially for subpopulations of sexually active youth, youth identified as lesbian, gay, bisexual, transgender, queer, intersex and/or asexual, pregnant, and parenting youth and (c) the appropriateness of an RCT with subpopulations of at-risk youth. Three recommendations emerged from the case study. First, including as many stakeholders as possible in the program and evaluation design phases is essential, and must be supported by appropriate funding streams and training. Second, there must be recognition of the multiple small subpopulations found in Alaska when adapting programs designed for a larger and more homogeneous population. Third, RCTs may not be appropriate for all population subgroups.Ye

Interaction between genetic factors, Porphyromonas gingivalis and microglia to promote Alzheimer’s disease

In late onset Alzheimer disease (AD) pathogenesis, genes, infections and immunity could be significant factors. We have reviewed if the keystone periodontal pathogen Porphyromonas gingivalis may affect genes and microglia (primary immune cells in the brain) to promote AD development. Genes for apolipoprotein, clusterin, CD33, triggering receptor expressed on myeloid cells-2 (TREM-2), tyrosine kinase binding protein (TYR-OBP), and complement receptors can affect microglia. Most of these genes can also be affected by P. gingivalis via its mastering of immune suppression. Besides, P. gingivalis can affect microglia directly in several ways. Taken together, genetic predisposition, P. gingivalis infection and microglia could promote neurodegeneration typical of that reported for AD

Development of a Simple Method for Labeling and Identification of Protein Binders in Art

Easel paintings are assets with an important historic and cultural value. They usually possess a multi-tiered structure, composed of di erent layers some of which may present protein binders, making it important to identify these materials for restoration and conservation purposes. We propose the identification of di erent protein binders by a new fluorescent labeling method employing a coumarin based chromophore, C392STP (sodium(E/Z)-4-(4-(2-(6,7-dimethoxycoumarin-3-yl)vinyl)benzoyl)-2,3,5,6-tetrafluorobenzenesulfo-nate). The method was optimized using commercial proteins and was further tested on proteins extracted from hen’s egg yolk, white bovine milk, and rabbit skin glue. To model more realistic conditions, paint models of easel paintings were prepared. The paint models were made with hen’s egg yolk, white bovine milk, and rabbit skin glue, mixed with di erent pigments and submitted to artificial aging. Then the extracted proteins from the paint models were labeled with C392 which allowed a sensitive and selective identification by polyacrylamide gel electrophoresis (PAGE) of the di erent protein binders used. As a final test, three 19th century easel paintings, from the Italian painter Giorgio Marini, were analyzed. The results show the potential of the proposed method for the identification of protein binders present in easel paintings

Dynamics of a self-propelled capsule robot in contact with different folds in the small intestine

This is the final version. Available on open access from Elsevier via the DOI in this recordData availability: Data will be made available on request.Considering the anatomy of small intestine involving lesions, circular folds and tumours are the major sources resisting the locomotion of capsule robots. By mimicking the small-bowel tumours as cone folds, this paper presents a comparative study on the dynamics of a vibro-impact capsule robot in contact with different circular and cone folds. With the aid of GPU parallel computing and path-following techniques, extensive bifurcation and basin stability analyses are performed to identify different capsule-fold interactions and unravel the parametric influences on the robot, such as fold shape, Young’s modulus and robot’s control parameters (e.g., excitation period and amplitude). It is found that fold shape and Young’s modulus may only affect capsule’s dynamics significantly when robot’s excitation period is large. Two essential locomotion modes, a period-one motion with capsule-fold contact in the small region of excitation amplitude and a fold crossing motion in the large region of excitation amplitude, dominating the dynamics of the robot regardless of fold shape and Young’s modulus are observed. In addition, the instability mechanism of this period-one motion is revealed in detail. The numerical study presented in this work will provide a solid basis for the locomotion control of the robot when encountering different types of circular folds and small-bowel tumours. It also offers the potential of utilising robot’s dynamics for bowel cancer detection.European Union Horizon 2020National Natural Science Foundation of Chin

A perspective from extinct radionuclides on a Young Stellar Object: The Sun and its accretion disk

Meteorites, which are remnants of solar system formation, provide a direct glimpse into the dynamics and evolution of a young stellar object (YSO), namely our Sun. Much of our knowledge about the astrophysical context of the birth of the Sun, the chronology of planetary growth from micrometer-sized dust to terrestrial planets, and the activity of the young Sun comes from the study of extinct radionuclides such as 26Al (t1/2 = 0.717 Myr). Here we review how the signatures of extinct radionuclides (short-lived isotopes that were present when the solar system formed and that have now decayed below detection level) in planetary materials influence the current paradigm of solar system formation. Particular attention is given to tying meteorite measurements to remote astronomical observations of YSOs and modeling efforts. Some extinct radionuclides were inherited from the long-term chemical evolution of the Galaxy, others were injected into the solar system by a nearby supernova, and some were produced by particle irradiation from the T-Tauri Sun. The chronology inferred from extinct radionuclides reveals that dust agglomeration to form centimeter-sized particles in the inner part of the disk was very rapid (<50 kyr), planetesimal formation started early and spanned several million years, planetary embryos (possibly like Mars) were formed in a few million years, and terrestrial planets (like Earth) completed their growths several tens of million years after the birth of the Sun.Comment: 49 pages, 9 figures, 1 table. Uncorrected preprin

Black Hole Deconstruction

A D4-D0 black hole can be deconstructed into a bound state of D0 branes with a D6-anti-D6 pair containing worldvolume fluxes. The exact spacetime solution is known and resembles a D0 accretion disk surrounding a D6-anti-D6 core. We find a scaling limit in which the disk and core drop inside an AdS_2 throat. Crossing this AdS_2 throat and the D0 accretion disk into the core, we find a second scaling region describing the D6-anti-D6 pair. It is shown that the M-theory lift of this region is AdS_3 x S^2. Surprisingly, time translations in the far asymptotic region reduce to global, rather than Poincare, time translations in this core AdS_3. We further find that the quantum mechanical ground state degeneracy reproduces the Bekenstein-Hawking entropy-area law.Comment: 11 page

Engaging national organizations for knowledge translation: Comparative case studies in knowledge value mapping

<p>Abstract</p> <p>Background</p> <p>Government sponsors of research and development, along with their funded investigators, are increasingly tasked with demonstrating evidence of knowledge use by nontraditional audiences. This requires efforts to translate their findings for effective communication. For technology-related knowledge, these audiences include clinicians, consumers, manufacturers, public policy agencies, and knowledge brokers. One potentially efficient approach is to communicate research findings through relevant national organizations. However, this requires an understanding of how such organizations view and treat research knowledge, which can be determined through knowledge-value mapping. Do knowledge values differ between national organizations representing different audiences? Can a deeper understanding of knowledge values help sponsors, investigators, and organizations better communicate research findings to stakeholders?</p> <p>Methods</p> <p>A series of comparative case studies on knowledge-value mapping were derived through interviews with spokespersons for six national organizations. The semi-structured interviews followed a 10-item questionnaire to characterize different ways in which each organization engages with research-based knowledge. Each participating organization represents a particular stakeholder group, while all share a common interest in the research subject matter.</p> <p>Results</p> <p>Each national organization considers the value of the research knowledge in the context of their organization's mission and the interests of their members. All are interested in collaborating with researchers to share relevant findings, while they vary along the following dimensions of knowledge engagement: create, identify, translate, adapt, communicate, use, promote, absorptive capacity, and recommendations for facilitation.</p> <p>Conclusions</p> <p>The principles of knowledge translation suggest that investigators can increase use by tailoring the format and context of their findings to the absorptive capacity of nonscholars. Greater absorption should result in higher levels of knowledge awareness, interest, and use, which can then be documented. National organizations and their members, in turn, can strive to optimize their absorptive capacities regarding the state of the sciences. This combination will ensure the highest possible return on public investment in research activities. This knowledge-value mapping study concludes that national organizations are appropriate channels for communicating research findings and for meeting statutory requirements and general expectations for generating and documenting knowledge use.</p

Protocol for a randomised controlled trial to evaluate the effectiveness of improving tuberculosis patients’ treatment adherence via electronic monitors and an app versus usual care in Tibet

Background Treatment non-adherence is a serious challenge to effective tuberculosis (TB) control in Tibet. In this study we will pilot and evaluate the effectiveness of using new electronic monitors (e-monitors) and a smartphone app to improve treatment adherence among new pulmonary TB patients in Tibet. Methods We will use a multicentre, parallel-group, individually randomised controlled, superiority trial with blinded outcome evaluation and unblinded treatment. We will randomise new pulmonary TB outpatients (aged ≥ 15 years old and free from communication impairment) from Shigatse, Tibet to either the intervention or control arm in a 1:1 ratio at the time of their diagnosis. All patients will be treated according to the World Health Organisation standard 6-month TB treatment regimen and the China National TB programme guidelines. Intervention arm patients will be given their medication via e-monitors that have automatic voice reminders, and record medication adherence data and share it with health staff via Cloud connection. Intervention patients will also be encouraged to receive smartphone-based video-observed treatment if their adherence is problematic. Control arm patients will receive their medication in e-monitors that will collect medication adherence history, but will have their reminder function deactivated and are not linked to the app. The primary outcome is the rate of poor adherence, measured monthly during treatment as a binary indicator where poor adherence means missing ≥ 20% of doses in a month. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and an analysis of the long-term effects of the intervention on TB control. Discussion Our study is one of the first trials to evaluate the use of e-monitors and smartphone apps for customised treatment support in low- and middle-income countries (LMICs). All intervention activities are designed to be embedded into routine TB care with strong local ownership. Through the trial we intend to understand the feasibility of our intervention, its effectiveness, its cost-effectiveness and its long-term impacts to inform future scale-up in remote areas of China and other LMICs. Trial registration Current Controlled Trials, ID: ISRCTN52132803. Registered on 9 November 2018

Successful new product development by optimizing development process effectiveness in highly regulated sectors: the case of the Spanish medical devices sector

Rapid development and commercialization of new products is of vital importance for small and medium sized enterprises (SME) in regulated sectors. Due to strict regulations, competitive advantage can hardly be achieved through the effectiveness of product concepts only. If an SME in a highly regulated sector wants to excell in new product development (NPD) performance, the company should focus on the flexibility, speed, and productivity of its NPD function: i.e. the development process effectiveness. Our main research goals are first to explore if SMEs should focus on their their development process effectiveness rather than on their product concept effectiveness to achieve high NPD performance; and second, to explore whether a shared pattern in the organization of the NPD function can be recognized to affect NPD performance positively. The medical devices sector in Spain is used as an example of a\ud highly regulated sector. A structured survey among 11 SMEs, of which 2 were studied also as in in-depth case studies, led to the following results. First of all, indeed the companies in the dataset which focused on the effectiveness of their development process, stood out in NPD performance. Further, the higher performing companies did have a number of commonalities in the organisation of their NPD function: 1) The majority of the higher performing firms had an NPD strategy characterized by a predominantly incremental project portfolio.\ud 2) a) Successful firms with an incremental project portfolio combined this with a functional team structure b) Successful firms with a radical project portfolio combined this with a heavyweight or autonomous team structure.\ud 3) A negative reciprocal relationship exists between formalization of the NPD processes and the climate of the NPD function, in that a formalized NPD process and an innovative climate do not seem to reinforce each other. Innovative climate combined with an informal NPD process does however contribute positively to NPD performance. This effect was stronger in combination with a radical project portfolio. The highest NPD performance was measured for companies focusing mainly on incremental innovation. It is argued that in highly regulated sectors, companies with an incremental product portfolio would benefit from employing a functional structure. Those companies who choose for a more radical project portfolio in highly regulated sectors should be aware\ud that they are likely to excell only in the longer term by focusing on strategic flexibility. In their NPD organization, they might be well advised to combine informal innovation processes with an innovative climate