Does longer roster lead-time reduce temporary staff usage? A regression analysis of e-rostering data from 77 hospital units

Aims Utilisation of temporary nursing staff is contentious and expensive. Using e-rostering data from 77 hospital units, this research investigates whether longer roster lead-times reduce temporary staff usage. Background It is commonly assumed that longer roster approval lead-times, the time from when a roster is approved, to when it is worked, result in better, more cost-effective rosters. Consequently, many hospitals target lead-times of six weeks, a figure recommended for the UK National Health Service (NHS) in a recent governmental review. This contrasts with the minimum lead-time advocated by New South Wales Ministry of Health, which advises a shorter lead-time of two weeks. Using data from 77 hospital units, this paper explores this assumed relationship. Design Using data extracted from the e-rostering system of an NHS Acute Foundation Trust, this study uses linear regression analysis to explore the relationship between roster approval lead-time and temporary staff usage. The data were captured over a period of nine months from 15th February 2016 to 23rd October 2016, a total of 693 rosters. Results/Findings This research suggests that late roster approval may contribute to as much as 37% of temporary staff usage, while approval 4-6 weeks prior to the roster being worked reduces this to approximately 15%. However, this is only relevant under specific conditions. Importantly, this should be considered before mandating lead times across all units. Conclusions This research implies that the optimum approval lead-time lies between four to six weeks, however, given other challenges, achieving this in practice may prove difficult

Multi-Site Harmonization of 7 Tesla MRI Neuroimaging Protocols

Increasing numbers of 7 tesla (7T) magnetic resonance imaging (MRI) scanners are in research and clinical use. 7T MRI can increase the scanning speed, spatial resolution and contrast-to-noise-ratio of many neuroimaging protocols, but technical challenges in implementation have been addressed in a variety of ways across sites. In order to facilitate multi-centre studies and ensure consistency of findings across sites, it is desirable that 7T MRI sites implement common high-quality neuroimaging protocols that can accommodate different scanner models and software versions. With the installation of several new 7T MRI scanners in the United Kingdom, the UK7T Network was established with an aim to create a set of harmonized structural and functional neuroimaging sequences and protocols. The Network currently includes five sites, which use three different scanner platforms, provided by two different vendors. Here we describe the harmonization of functional and anatomical imaging protocols across the three different scanner models, detailing the necessary changes to pulse sequences and reconstruction methods. The harmonized sequences are fully described, along with implementation details. Example datasets acquired from the same subject on all Network scanners are made available. Based on these data, an evaluation of the harmonization is provided. In addition, the implementation and validation of a common system calibration process is described. Keywords 7 tesla; MRI; Harmonization; anatomical; functional; Scanner calibration;The UK7T Network and this work was funded by the UK's Medical Research Council (MRC). [MR/N008537/1]. Centre funding The Wellcome Centre for Integrative Neuroimaging is supported by core funding from the Wellcome Trust (203139/Z/16/Z). Cardiff University Brain Research Imaging Centre is supported by the UK Medical Research Council (MR/M008932/1) and the Wellcome Trust (WT104943). This research was co-funded by the NIHR Cambridge Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Individual funding CTR is funded by a Sir Henry Dale Fellowship from the Wellcome Trust and the Royal Society [098436/Z/12/B]

Probing the Origins of the CIV and Fe Kalpha Baldwin Effect

We use UV/optical and X-ray observations of 272 radio-quiet Type 1 AGNs and quasars to investigate the CIV Baldwin Effect (BEff). The UV/optical spectra are drawn from the Hubble Space Telescope, International Ultraviolet Explorer and Sloan Digital Sky Survey archives. The X-ray spectra are from the Chandra and XMM-Newton archives. We apply correlation and partial-correlation analyses to the equivalent widths, continuum monochromatic luminosities, and alpha_ox, which characterizes the relative X-ray to UV brightness. The equivalent width of the CIV 1549 emission line is correlated with both alpha_ox and luminosity. We find that by regressing l_UV with EW(CIV) and alpha_ox, we can obtain tighter correlations than by regressing l_UV with only EW(CIV). Both correlation and regression analyses imply that l_UV is not the only factor controlling the changes of EW(CIV); alpha_ox (or, equivalently, the soft X-ray emission) plays a fundamental role in the formation and variation of CIV. Variability contributes at least 60% of the scatter of the EW(CIV)-l_UV relation and at least 75% of the scatter of the of the EW(CIV)-alpha_ox relation. In our sample, narrow Fe Kalpha 6.4 keV emission lines are detected in 50 objects. Although narrow Fe Kalpha exhibits a BEff similar to that of CIV, its equivalent width has almost no dependence on either alpha_ox or EW(CIV). This suggests that the majority of narrow Fe Kalpha emission is unlikely to be produced in the broad emission-line region. We do find suggestive correlations between the emission-line luminosities of CIV and Fe Kalpha, which could be potentially used to estimate the detectability of the Fe Kalpha line of quasars from rest-frame UV spectroscopic observations

Vitamin D3 regulates cell viability in gastric cancer and cholangiocarcinoma

A low serum level of vitamin D has been associated with an increased incidence of gastrointestinal tract cancers. However, the effects of vitamin D3 have not been investigated in gastric cancer and cholangiocarcinoma. In the present study, we found that vitamin D3 treatment significantly suppressed the viability of gastric cancer and cholangiocarcinoma cells. Moreover, vitamin D3 had a synergistic effect with other anti-cancer drugs, such as paclitaxel, adriamycin, and vinblastine, for suppressing cell viability. To determine the underlying mechanism involved in the regulation of viability by vitamin D3, we examined the effects of vitamin D3 on expression of hedgehog signaling target genes, which has been associated with gastric cancer and cholangiocarcinoma. Vitamin D3 treatment decreased the level of mRNA expression of patched1, Gli1, cyclin D1, and Bcl2, suggesting the possibility that vitamin D3 may act through regulation of hedgehog signaling. From the above results, we conclude that vitamin D3 regulates cell viability in gastric cancer and cholangiocarcinoma

Multi-site harmonization of 7 Tesla MRI neuroimaging protocols

Increasing numbers of 7 T (7 T) magnetic resonance imaging (MRI) scanners are in research and clinical use. 7 T MRI can increase the scanning speed, spatial resolution and contrast-to-noise-ratio of many neuroimaging protocols, but technical challenges in implementation have been addressed in a variety of ways across sites. In order to facilitate multi-centre studies and ensure consistency of findings across sites, it is desirable that 7 T MRI sites implement common high-quality neuroimaging protocols that can accommodate different scanner models and software versions. With the installation of several new 7 T MRI scanners in the United Kingdom, the UK7T Network was established with an aim to create a set of harmonized structural and functional neuroimaging sequences and protocols. The Network currently includes five sites, which use three different scanner platforms, provided by two different vendors. Here we describe the harmonization of functional and anatomical imaging protocols across the three different scanner models, detailing the necessary changes to pulse sequences and reconstruction methods. The harmonized sequences are fully described, along with implementation details. Example datasets acquired from the same subject on all Network scanners are made available. Based on these data, an evaluation of the harmonization is provided. In addition, the implementation and validation of a common system calibration process is described

Integrated policy assessment and optimisation over multiple sustainable development goals in Eastern Africa

Heavy reliance on traditional biomass for household energy in eastern Africa has significant negative health and environmental impacts. The African context for energy access is rather different from historical experiences elsewhere as challenges in achieving energy access have coincided with major climate ambitions. Policies focusing on household energy needs in eastern Africa contribute to at least three sustainable development goals (SDGs): climate action, good health, and improved energy access. This study uses an integrated assessment model to simulate the impact of land policies and technology subsidies, as well as the interaction of both, on greenhouse gas (GHG) emissions, exposure to air pollution and energy access in eastern Africa under a range of socioeconomic pathways. We find that land policies focusing on increasing the sustainable output of biomass resources can reduce GHG emissions in the region by about 10%, but also slightly delay progress in health and energy access goals. An optimised portfolio of energy technology subsidies consistent with a global Green Climate Funds budget of 30-35 billion dollar, can yield another 10% savings in GHG emissions, while decreasing mortality related to air pollution by 20%, and improving energy access by up to 15%. After 2030, both land and technology policies become less effective, and more dependent on the overall development path of the region. The analysis shows that support for biogas technology should be prioritised in both the short and long term, while financing liquefied petroleum gas and ethanol technologies also has synergetic climate, health and energy access benefits. Instead, financing PV technologies is mostly relevant for improving energy access, while charcoal and to a lesser extend fuelwood technologies are relevant for curbing GHG emissions if their finance is linked to land policies. We suggest that integrated policy analysis is needed in the African context for simultaneously reaching progress in multiple SDGs.The authors thank Francesco Dalla Longa for his comments, and Brennan Bowman and Sebastien Huclin for their help with regard to data and methodology. This research is supported by the European Union's Horizon 2020 research and innovation program under Grant Agreements No. 642260 (TRANSrisk project) and No. 820846 (Paris Reinforce), and by the Spanish Ministry of Economy and Competitiveness MINECO through BC3 Maria de Maeztu excellence accreditation MDM-2017-0714. Dirk-Jan van de Ven and Jon Sampedro acknowledge financial support from the Ministry of the Economy and Competitiveness of Spain (ECO2015-68023). Jon Sampedro also acknowledges financial support from the Basque Government (PRE_2018_2_0076). Sha Yu was supported by the Global Technology Strategy Project (GTSP). The views and opinions expressed in this paper are those of the authors alone

Guidelines on the management of acute respiratory distress syndrome.

The Faculty of Intensive Care Medicine and Intensive Care Society Guideline Development Group have used GRADE methodology to make the following recommendations for the management of adult patients with acute respiratory distress syndrome (ARDS). The British Thoracic Society supports the recommendations in this guideline. Where mechanical ventilation is required, the use of low tidal volumes (<6 ml/kg ideal body weight) and airway pressures (plateau pressure <30 cmH2O) was recommended. For patients with moderate/severe ARDS (PF ratio<20 kPa), prone positioning was recommended for at least 12 hours per day. By contrast, high frequency oscillation was not recommended and it was suggested that inhaled nitric oxide is not used. The use of a conservative fluid management strategy was suggested for all patients, whereas mechanical ventilation with high positive end-expiratory pressure and the use of the neuromuscular blocking agent cisatracurium for 48 hours was suggested for patients with ARDS with ratio of arterial oxygen partial pressure to fractional inspired oxygen (PF) ratios less than or equal to 27 and 20 kPa, respectively. Extracorporeal membrane oxygenation was suggested as an adjunct to protective mechanical ventilation for patients with very severe ARDS. In the absence of adequate evidence, research recommendations were made for the use of corticosteroids and extracorporeal carbon dioxide removal

Field strength dependence of grey matter R2* on venous oxygenation

The relationship between venous blood oxygenation and change in transverse relaxation rate (ΔR2 *) plays a key role in calibrated BOLD fMRI. This relationship, defined by the parameter β, has previously been determined using theoretical simulations and experimental measures. However, these earlier studies have been confounded by the change in venous cerebral blood volume (CBV) in response to functional tasks. This study used a double-echo gradient echo EPI scheme in conjunction with a graded isocapnic hyperoxic sequence to assess quantitatively the relationship between the fractional venous blood oxygenation (1-Yv) and transverse relaxation rate of grey matter (ΔR2 * GM), without inducing a change in vCBV. The results demonstrate that the relationship between ΔR2 * and fractional venous oxygenation at all magnet field strengths studied was adequately described by a linear relationship. The gradient of this relationship did not increase monotonically with field strength, which may be attributed to the relative contributions of intravascular and extravascular signals which will vary with both field strength and blood oxygenation