The suitability of care pathways for integrating processes and information systems in healthcare

Purpose: This paper examines the suitability of current care pathway modelling techniques for supporting business improvement and the development of information systems. This is in the light of current UK government policies advocating the use of care pathways as part of the £12.4 billion programme for IT and as a key strategy to reducing waiting times. Approach: We conducted a qualitative analysis of the variety in purpose, syntax and semantics in a selection of existing care pathways. Findings: Care pathways are typically modelled in an ad-hoc manner with little reference to formal syntax or semantics. Research limits: The research reviews a small selection of existing pathways. The feature set used for evaluation could be further refined. Future research should examine the suitability of applying existing process modelling techniques to care pathways and explore the motivations for modelling care pathways in an ad-hoc manner. Practical implications: The development of care pathways can aid process improvement and the integration of information systems. However, while syntax and semantics are not standardised the impact of care pathways in the work of Department of Health agencies, in particular Connecting for Health, is likely to be limited. Value: The results provide insight into the limitations of the state of the art in care pathway models. This highlights a significant omission in the Department of Health’s approach and identifies an important direction for further development that will aid Connecting for Health, healthcare organisations and healthcare professionals to deliver more effective services

Swyer syndrome.

PURPOSE OF REVIEW: This review focuses on the pathogenesis, diagnosis, management and long-term outcomes of disorders of sex development, specifically women with Swyer syndrome (46,XY complete gonadal dysgenesis). RECENT FINDINGS: Recent discoveries have broadened our understanding of the complex pathways involved in normal and abnormal sex development. In 46,XY gonadal dysgenesis, lack of testis development may be triggered by sex determining region Y, NR5A1, DHH or testis-determining gene loss-of-function mutations, DAX1 or WNT4 duplication or MAP3K1 gain-of-function mutations. The diagnosis and management of patients with Swyer syndrome is complex, and optimal care requires an experienced multidisciplinary team. Early diagnosis is vital because of the significant risk of germ cell tumour, and bilateral gonadectomy should be performed. Furthermore, early sex hormone treatment is necessary to induce and maintain typical pubertal development and to achieve optimal bone mineral accumulation. Pregnancy is possible via ova donation, and outcomes are similar to women with 46,XX ovarian failure. SUMMARY: Further pathogenic gene mutations are likely to be identified, and the function, interaction and phenotypic effects of new and existing mutations will be further defined. Patients require long-term follow-up in specialist centres

High-pitch versus conventional cardiovascular CT in patients being assessed for transcatheter aortic valve implantation: A real-world appraisal

Objective High-pitch protocols are increasingly used in cardiovascular CT assessment for transcatheter aortic valve implantation (TAVI), but the impact on diagnostic image quality is not known. Methods We reviewed 95 consecutive TAVI studies: 44 (46%) high-pitch and 51 (54%) standard-pitch. Single high-pitch scans were performed regardless of heart rate. For standard-pitch acquisitions, a separate CT-aortogram and CT-coronary angiogram were performed with prospective gating, unless heart rate was ≥70 beats/min, when retrospective gating was used. The aortic root and coronary arteries were assessed for artefact (significant artefact=1; artefact not limiting diagnosis=2; no artefact=3). Aortic scans were considered diagnostic if the score was > 1; the coronaries, if all three epicardial arteries scored > 1. Results There was no significant difference in diagnostic image quality for either the aorta (artefact-free high-pitch: 31 (73%) scans vs standard-pitch: 40 (79%), p=0.340) or the coronary tree as a whole (10 (23%) vs 15 (29%), p=0.493). However, proximal coronary arteries were less well visualised using high-pitch acquisitions (16 (36%) vs 30 (59%), p=0.04). The median (IQR) radiation dose was significantly lower in the high-pitch cohort (dose-length product: 347 (318-476) vs 1227 (1150-1474) mGy cm, respectively, p < 0.001), and the protocol required almost half the amount of contrast. Conclusions The high-pitch protocol significantly reduces radiation and contrast doses and is non-inferior to standard-pitch acquisitions for aortic assessment. For aortic root assessment, the high-pitch protocol is recommended. However, if coronary assessment is critical, this should be followed by a conventional standard-pitch, low-dose, prospectively gated CT-coronary angiogram if the high-pitch scan is non-diagnostic

Highly Stable Molybdenum Disulfide Protected Silicon Photocathodes for Photoelectrochemical Water Splitting

© 2017 American Chemical Society. Developing materials, interfaces, and devices with improved stability remains one of the key challenges in the field of photoelectrochemical water splitting. As a barrier to corrosion, molybdenum disulfide is a particularly attractive protection layer for photocathodes due to its inherent stability in acid, the low permeability of its basal planes, and the excellent hydrogen evolution reaction (HER) activity the MoS2 edge. Here, we demonstrate a stable silicon photocathode containing a protecting layer consisting of molybdenum disulfide, molybdenum silicide, and silicon oxide which operates continuously for two months. We make comparisons between this system and another molybdenum sulfide-silicon photocathode embodiment, taking both systems to catastrophic failure during photoelectrochemical stability measurements and exploring mechanisms of degradation. X-ray photoelectron spectroscopy and transmission electron microscopy provide key insights into the origins of stability

Differences in the processing of anaphoric reference between closely related languages: neurophysiological evidence

Contains fulltext : 67857.pdf ( ) (Open Access)1 p

Investigating Catalyst–Support Interactions To Improve the Hydrogen Evolution Reaction Activity of Thiomolybdate [Mo3S13]2– Nanoclusters

© 2017 American Chemical Society. Molybdenum sulfides have been identified as promising materials for catalyzing the hydrogen evolution reaction (HER) in acid, with active edge sites that exhibit some of the highest turnover frequencies among nonpreciousmetal catalysts. The thiomolybdate [Mo 3 S 13 ] 2- nanocluster catalyst contains a structural motif that resembles the active site of MoS2 and has been reported to be among the most active forms of molybdenum sulfide. Herein, we improve the activity of the [Mo 3 S 13 ] 2- catalysts through catalyst-support interactions. We synthesize [Mo 3 S 13 ] 2- on gold, silver, glassy carbon, and copper supports to demonstrate the ability to tune the hydrogen binding energy of [Mo 3 S 13 ] 2- using catalyst-support electronic interactions and optimize HER activity

Airborne measurements of western U.S. wildfire emissions: Comparison with prescribed burning and air quality implications

Wildfires emit significant amounts of pollutants that degrade air quality. Plumes from three wildfires in the western U.S. were measured from aircraft during the Studies of Emissions and Atmospheric Composition, Clouds and Climate Coupling by Regional Surveys (SEAC4RS) and the Biomass Burning Observation Project (BBOP), both in summer 2013. This study reports an extensive set of emission factors (EFs) for over 80 gases and 5 components of submicron particulate matter (PM1) from these temperate wildfires. These include rarely, or never before, measured oxygenated volatile organic compounds and multifunctional organic nitrates. The observed EFs are compared with previous measurements of temperate wildfires, boreal forest fires, and temperate prescribed fires. The wildfires emitted high amounts of PM1 (with organic aerosol (OA) dominating the mass) with an average EF that is more than 2 times the EFs for prescribed fires. The measured EFs were used to estimate the annual wildfire emissions of carbon monoxide, nitrogen oxides, total nonmethane organic compounds, and PM1 from 11 western U.S. states. The estimated gas emissions are generally comparable with the 2011 National Emissions Inventory (NEI). However, our PM1 emission estimate (1530 ± 570 Gg yr-1) is over 3 times that of the NEI PM2.5 estimate and is also higher thanthe PM2.5 emitted from all other sources in these states in the NEI. This study indicates that the source of OA from biomass burning in the western states is significantly underestimated. In addition, our results indicate that prescribed burning may be an effective method to reduce fine particle emissions

The burden and risks of pediatric pneumonia in Nigeria: A desk‐based review of existing literature and data

Background: Pneumonia is a leading killer of children under‐5 years, with a high burden in Nigeria. We aimed to quantify the regional burden and risks of pediatric pneumonia in Nigeria, and specifically the states of Lagos and Jigawa. / Methods: We conducted a scoping literature search for studies of pneumonia morbidity and mortality in under‐5 children in Nigeria from 10th December 2018 to 26th April 2019, searching: Cochrane, PubMed, and Web of Science. We included grey literature from stakeholders' websites and information shared by organizations working in Nigeria. We conducted multivariable logistic regression using the 2016 to 2017 Multiple Cluster Indicators Survey data set to explore factors associated with pneumonia. Descriptive analyses of datasets from 2010 to 2019 was done to estimate trends in mortality, morbidity, and vaccination coverage. / Results: We identified 25 relevant papers (10 from Jigawa, 8 from Lagos, and 14 national data). None included data on pneumonia or acute respiratory tract infection burden in the health system, inpatient case‐fatality rates, severity, or age‐specific pneumonia mortality rates at state level. Secondary data analysis found that no household or caregiver socioeconomic indicators were consistently associated with self‐reported symptoms of cough and/or difficulty breathing, and seasonality was inconsistently associated, dependant on region. / Conclusion: There is a clear evidence gap around the burden of pediatric pneumonia in Nigeria, and challenges with the interpretation of existing household survey data. Improved survey approaches are needed to understand the risks of pediatric pneumonia in Nigeria, alongside the need for investment in reliable routine data systems to provide data on the clinical pneumonia burden in Nigeria

Health system challenges for improved childhood pneumonia case management in Lagos and Jigawa, Nigeria

Background: Case fatality rates for childhood pneumonia in Nigeria remain high. There is a clear need for improved case management of pneumonia, through the sustainable implementation of the Integrated Management of Childhood Illnesses (IMCI) diagnostic and treatment algorithms. We explored barriers and opportunities for improved case management of childhood pneumonia in Lagos and Jigawa states, Nigeria. / Methods: A mixed‐method analysis was conducted to assess the current health system capacity to deliver quality care. This was done through audits of 16 facilities in Jigawa and 14 facilities in Lagos, questionnaires (n = 164) and 13 focus group discussions with providers. Field observations provided context for data analysis and triangulation. / Results: There were more private providers in Lagos (4/8 secondary facilities) and more government providers in Jigawa (4/8 primary, 3/3 secondary, and 1/1 tertiary facilities). Oxygen and pulse oximeters were available in two of three in Jigawa and six of eight in Lagos of the sampled secondary care facilities. None of the eight primary facilities surveyed in Jigawa had oxygen or pulse oximetry available while in Lagos two of three primary facilities had oxygen and one of three had pulse oximeters. Other IMCI and emergency equipment were also lacking including respiratory rate timers, particularly in Jigawa state. Health care providers scored poorly on knowledge of IMCI, though previous IMCI training was associated with better knowledge. Key enabling factors in delivering pediatric care highlighted by health care providers included accountability procedures and feedback loops, the provision of free medication for children, and philanthropic acts. Common barriers to provide care included the burden of out‐of‐pocket payments, challenges in effective communication with caregivers, delayed presentation, and lack of clear diagnosis, and case management guidelines. / Conclusion: There is an urgent need to improve how the prevention and treatment of pediatric pneumonia is directed in both Lagos and Jigawa. Priority areas for reducing pediatric pneumonia burden are training and mentoring of health care providers, community health education, and introduction of oximeters and oxygen supply