The use of patient feedback by hospital boards of directors: a qualitative study of two NHS hospitals in England

BACKGROUND: Although previous research suggests that different kinds of patient feedback are used in different ways to help improve the quality of hospital care, there have been no studies of the ways in which hospital boards of directors use feedback for this purpose. OBJECTIVES: To examine whether and how boards of directors of hospitals use feedback from patients to formulate strategy and to assure and improve the quality of care. METHODS: We undertook an in-depth qualitative study in two acute hospital National Health Service foundation trusts in England, purposively selected as contrasting examples of the collection of different kinds of patient feedback. We collected and analysed data from interviews with directors and other managers, from observation of board meetings, and from board papers and other documents. RESULTS: The two boards used in-depth qualitative feedback and quantitative feedback from surveys in different ways to help develop strategies, set targets for quality improvement and design specific quality improvement initiatives; but both boards made less subsequent use of any kinds of feedback to monitor their strategies or explicitly to assure the quality of services. DISCUSSION AND CONCLUSIONS: We have identified limitations in the uses of patient feedback by hospital boards that suggest that boards should review their current practice to ensure that they use the different kinds of patient feedback that are available to them more effectively to improve, monitor and assure the quality of care

GraCT: A Grammar based Compressed representation of Trajectories

We present a compressed data structure to store free trajectories of moving objects (ships over the sea, for example) allowing spatio-temporal queries. Our method, GraCT, uses a $k^2$-tree to store the absolute positions of all objects at regular time intervals (snapshots), whereas the positions between snapshots are represented as logs of relative movements compressed with Re-Pair. Our experimental evaluation shows important savings in space and time with respect to a fair baseline.Comment: This research has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sk{\l}odowska-Curie Actions H2020-MSCA-RISE-2015 BIRDS GA No. 69094

PERFORMANCE EVALUATION OF A COMPOSITE-PADDED EVAPORATIVE COOLING STORAGE BIN

In tropical regions, postharvest losses of fruits and vegetables induced by high temperatures is a major challenge to agriculture, especially in places with poor or no electric power supply. The present study is on the comparative performance evaluation of a 92kg capacity storage bin for the preservation of fruits and vegetables, operating on the principle of evaporative cooling. A 24V DC, 0.37kW fan attached to the back of the cooler serves to blow in cooling air. The average temperature drop and saturation efficiency in the evaporative cooler during the no-load test were 5°C and 42%, respectively. The facility was able to sustain tomatoes, garden eggs and carrots stored in it for ten days. The weight losses at ambient temperature were found to be 70%, 30%and 45% for tomatoes, garden eggs and carrots, respectively; while those stored at cooler temperature were10%, 25%, and 40% for tomatoes, garden eggs and carrots respectively. The evaporative cooler performed best for storage of tomatoes. http://dx.doi.org/10.4314/njt.v36i1.3

Tree Compression with Top Trees Revisited

We revisit tree compression with top trees (Bille et al, ICALP'13) and present several improvements to the compressor and its analysis. By significantly reducing the amount of information stored and guiding the compression step using a RePair-inspired heuristic, we obtain a fast compressor achieving good compression ratios, addressing an open problem posed by Bille et al. We show how, with relatively small overhead, the compressed file can be converted into an in-memory representation that supports basic navigation operations in worst-case logarithmic time without decompression. We also show a much improved worst-case bound on the size of the output of top-tree compression (answering an open question posed in a talk on this algorithm by Weimann in 2012).Comment: SEA 201

The Simplex Algorithm for the Rapid Identification of Operating Conditions During Early Bioprocess Development: Case Studies in FAb' Precipitation and Multimodal Chromatography

This study describes a data-driven algorithm as a rapid alternative to conventional Design of Experiments (DoE) approaches for identifying feasible operating conditions during early bioprocess development. In general, DoE methods involve fitting regression models to experimental data, but if model fitness is inadequate then further experimentation is required to gain more confidence in the location of an optimum. This can be undesirable during very early process development when feedstock is in limited supply and especially if a significant percentage of the tested conditions are ultimately found to be sub-optimal. An alternative approach involves focusing solely upon the feasible regions by using the knowledge gained from each condition to direct the choice of subsequent test locations that lead towards an optimum. To illustrate the principle, this study describes the application of the Simplex algorithm which uses accumulated knowledge from previous test points to direct the choice of successive conditions towards better regions. The method is illustrated by two case studies; a two variable precipitation example investigating how salt concentration and pH affect FAb' recovery from E. coli homogenate and a three-variable chromatography example identifying the optimal pH and concentrations of two salts in an elution buffer used to recover ovine antibody bound to a multimodal cation exchange matrix. Two-level and face-centered central composite regression models were constructed for each study and statistical analysis showed that they provided a poor fit to the data, necessitating additional experimentation to confirm the robust regions of the search space. By comparison, the Simplex algorithm identified a good operating point using 50% and 70% fewer conditions for the precipitation and chromatography studies, respectively. Hence, data-driven approaches have significant potential for early process development when material supply is at a premium

T-cell reconstitution after thymus xenotransplantation induces hair depigmentation and loss

Here we present a mouse model for T-cell targeting of hair follicles, linking the pathogenesis of alopecia to that of depigmentation disorders. Clinically, thymus transplantation has been successfully used to treat T-cell immunodeficiency in congenital athymia, but is associated with autoimmunity. We established a mouse model of thymus transplantation by subcutaneously implanting human thymus tissue into athymic C57BL/6 nude mice. These xenografts supported mouse T-cell development. Surprisingly, we did not detect multiorgan autoimmune disease. However, in all transplanted mice, we noted a striking depigmentation and loss of hair follicles. Transfer of T cells from transplanted nudes to syngeneic black-coated RAG(-/-) recipients caused progressive, persistent coat-hair whitening, which preceded patchy hair loss in depigmented areas. Further transfer experiments revealed that these phenomena could be induced by CD4+ T cells alone. Immunofluorescent analysis suggested that Trp2+ melanocyte-lineage cells were decreased in depigmented hair follicles, and pathogenic T cells upregulated activation markers when exposed to C57BL/6 melanocytes in vitro, suggesting that these T cells are not tolerant to self-melanocyte antigens. Our data raise interesting questions about the mechanisms underlying tissue-specific tolerance to skin antigens

Accessibility-based reranking in multimedia search engines

Traditional multimedia search engines retrieve results based mostly on the query submitted by the user, or using a log of previous searches to provide personalized results, while not considering the accessibility of the results for users with vision or other types of impairments. In this paper, a novel approach is presented which incorporates the accessibility of images for users with various vision impairments, such as color blindness, cataract and glaucoma, in order to rerank the results of an image search engine. The accessibility of individual images is measured through the use of vision simulation filters. Multi-objective optimization techniques utilizing the image accessibility scores are used to handle users with multiple vision impairments, while the impairment profile of a specific user is used to select one from the Pareto-optimal solutions. The proposed approach has been tested with two image datasets, using both simulated and real impaired users, and the results verify its applicability. Although the proposed method has been used for vision accessibility-based reranking, it can also be extended for other types of personalization context

Quantum Simulation of Tunneling in Small Systems

A number of quantum algorithms have been performed on small quantum computers; these include Shor's prime factorization algorithm, error correction, Grover's search algorithm and a number of analog and digital quantum simulations. Because of the number of gates and qubits necessary, however, digital quantum particle simulations remain untested. A contributing factor to the system size required is the number of ancillary qubits needed to implement matrix exponentials of the potential operator. Here, we show that a set of tunneling problems may be investigated with no ancillary qubits and a cost of one single-qubit operator per time step for the potential evolution. We show that physically interesting simulations of tunneling using 2 qubits (i.e. on 4 lattice point grids) may be performed with 40 single and two-qubit gates. Approximately 70 to 140 gates are needed to see interesting tunneling dynamics in three-qubit (8 lattice point) simulations.Comment: 4 pages, 2 figure

A new age model for the middle Eocene deep-marine Ainsa Basin, Spanish Pyrenees

The middle Eocene Ainsa Basin, Spanish Pyrenees, comprises ~. 4. km of deep-marine sedimentary rocks belonging to the Hecho Group. Despite extensive study of these exemplary deep-marine clastic successions, there has been no comprehensive chronostratigraphic framework that provides primary ages for the submarine fan and related deposits. Here, we present a new composite basin stratigraphy based upon biostratigraphic analyses of the Upper Hecho Group submarine-fan and interfan deposits. Calcareous nannofossil data suggest that deposition of the Gerbe through to Guaso systems occurred during biozones NP14-16 (42.6 and 48.9. Ma based on our age model). Additional biostratigraphic ages from the Lower Hecho Group suggest that the entire Hecho Group no older than biozone NP13 (~. 51. Ma). The improved chronostratigraphic control enables correlations between submarine canyons and submarine-fans of the Ainsa and Jaca basins to be assessed. Our new age model provides a means of comparison of stratigraphic events with regional sections allowing a better understanding of the lateral and temporal evolution of these depositional systems from source-to-sink

Polymorphisms in the WNK1 gene are asociated with blood pressure variation and urinary potassium excretion

WNK1 - a serine/threonine kinase involved in electrolyte homeostasis and blood pressure (BP) control - is an excellent candidate gene for essential hypertension (EH). We and others have previously reported association between WNK1 and BP variation. Using tag SNPs (tSNPs) that capture 100% of common WNK1 variation in HapMap, we aimed to replicate our findings with BP and to test for association with phenotypes relating to WNK1 function in the British Genetics of Hypertension (BRIGHT) study case-control resource (1700 hypertensive cases and 1700 normotensive controls). We found multiple variants to be associated with systolic blood pressure, SBP (7/28 tSNPs min-p = 0.0005), diastolic blood pressure, DBP (7/28 tSNPs min-p = 0.002) and 24 hour urinary potassium excretion (10/28 tSNPs min-p = 0.0004). Associations with SBP and urine potassium remained significant after correction for multiple testing (p = 0.02 and p = 0.01 respectively). The major allele (A) of rs765250, located in intron 1, demonstrated the strongest evidence for association with SBP, effect size 3.14 mmHg (95%CI:1.23–4.9), DBP 1.9 mmHg (95%CI:0.7–3.2) and hypertension, odds ratio (OR: 1.3 [95%CI: 1.0–1.7]).We genotyped this variant in six independent populations (n = 14,451) and replicated the association between rs765250 and SBP in a meta-analysis (p = 7×10−3, combined with BRIGHT data-set p = 2×10−4, n = 17,851). The associations of WNK1 with DBP and EH were not confirmed. Haplotype analysis revealed striking associations with hypertension and BP variation (global permutation p10 mmHg reduction) and risk for hypertension (OR<0.60). Our data indicates that multiple rare and common WNK1 variants contribute to BP variation and hypertension, and provide compelling evidence to initiate further genetic and functional studies to explore the role of WNK1 in BP regulation and EH