Falls after discharge from hospital : is there a gap between older peoples' knowledge about falls prevention strategies and the research evidence?

Purpose: The aim of this study was to examine whether older people are prepared to engage in appropriate falls prevention strategies after discharge from hospital. Design and Methods We used a semi-structured interview to survey older patients about to be discharged from hospital and examined their knowledge regarding falls prevention strategies to utilize in the post-discharge period. The study was part of a prospective cohort study, nested within a larger, randomized controlled trial. Participants (n = 333) were asked to suggest strategies to reduce their falls risk at home after discharge, and their responses were compared with current reported research evidence for falls prevention interventions.  Results Participants’ strategies (n = 629) were classified into 7 categories: behavioral, support while mobilizing, approach to movement, physical environment, visual, medical, and activities or exercise. Although exercise has been identified as an effective falls risk reduction strategy, only 2.9% of participants suggested engaging in exercises. Falls prevention was most often conceptualized by participants as requiring 1 (35.4%) or 2 (40.8%) strategies for avoiding an accidental event, rather than engaging in sustained multiple risk reduction behaviors.  Implications Results demonstrate that older patients have low levels of knowledge about appropriate falls prevention strategies that could be used after discharge in spite of their increased falls risk during this period. Findings suggest that health care workers should design and deliver falls prevention education programs specifically targeted to older people who are to be discharged from hospital.

Patients undergoing subacute rehabilitation have accurate expectations of their health-related quality of life at discharge

Background Expectations held by patients and health professionals may affect treatment choices and participation (by both patients and health professionals) in therapeutic interventions in contemporary patient-centered healthcare environments. If patients in rehabilitation settings overestimate their discharge health-related quality of life, they may become despondent as their progress falls short of their expectations. On the other hand, underestimating their discharge health-related quality of life may lead to a lack of motivation to participate in therapies if they do not perceive likely benefit. There is a scarcity of empirical evidence evaluating whether patients' expectations of future health states are accurate. The purpose of this study is to evaluate the accuracy with which older patients admitted for subacute in-hospital rehabilitation can anticipate their discharge health-related quality of life. Methods A prospective longitudinal cohort investigation of agreement between patients' anticipated discharge health-related quality of life (as reported on the EQ-5D instrument at admission to a rehabilitation unit) and their actual self-reported health-related quality of life at the time of discharge from this unit was undertaken. The mini-mental state examination was used as an indicator of patients' cognitive ability. Results Overall, 232(85%) patients had all assessment data completed and were included in analysis. Kappa scores ranged from 0.42-0.68 across the five EQ-5D domains and two patient cognition groups. The percentage of exact correct matches within each domain ranged from 69% to 85% across domains and cognition groups. Overall 40% of participants in each cognition group correctly anticipated all of their self-reported discharge EQ-5D domain responses. Conclusions Patients admitted for subacute in-hospital rehabilitation were able to anticipate the discharge health-related quality of life on the EQ-5D instrument with a moderate level of accuracy. This finding adds to the foundational empirical work supporting joint treatment decision making and patient-centered models of care during rehabilitation following acute illness or injury. Accurate patient expectations of the impact of treatment (or disease progression) on future health-related related quality of life is likely to allow patients and health professionals to successfully target interventions to priority areas where meaningful gains can be achieved.

Reliability of partial ambiguity fixing with multiple GNSS constellations

Reliable ambiguity resolution (AR) is essential to Real-Time Kinematic (RTK) positioning and its applications, since incorrect ambiguity fixing can lead to largely biased positioning solutions. A partial ambiguity fixing technique is developed to improve the reliability of AR, involving partial ambiguity decorrelation (PAD) and partial ambiguity resolution (PAR). Decorrelation transformation could substantially amplify the biases in the phase measurements. The purpose of PAD is to find the optimum trade-off between decorrelation and worst-case bias amplification. The concept of PAR refers to the case where only a subset of the ambiguities can be fixed correctly to their integers in the integer least-squares (ILS) estimation system at high success rates. As a result, RTK solutions can be derived from these integer-fixed phase measurements. This is meaningful provided that the number of reliably resolved phase measurements is sufficiently large for least-square estimation of RTK solutions as well. Considering the GPS constellation alone, partially fixed measurements are often insufficient for positioning. The AR reliability is usually characterised by the AR success rate. In this contribution an AR validation decision matrix is firstly introduced to understand the impact of success rate. Moreover the AR risk probability is included into a more complete evaluation of the AR reliability. We use 16 ambiguity variance-covariance matrices with different levels of success rate to analyse the relation between success rate and AR risk probability. Next, the paper examines during the PAD process, how a bias in one measurement is propagated and amplified onto many others, leading to more than one wrong integer and to affect the success probability. Furthermore, the paper proposes a partial ambiguity fixing procedure with a predefined success rate criterion and ratio-test in the ambiguity validation process. In this paper, the Galileo constellation data is tested with simulated observations. Numerical results from our experiment clearly demonstrate that only when the computed success rate is very high, the AR validation can provide decisions about the correctness of AR which are close to real world, with both low AR risk and false alarm probabilities. The results also indicate that the PAR procedure can automatically chose adequate number of ambiguities to fix at given high-success rate from the multiple constellations instead of fixing all the ambiguities. This is a benefit that multiple GNSS constellations can offer.

Sequential slotted amplify-and-forward with partial relay isolation

In this paper, we propose a novel relay ordering and scheduling strategy for the sequential slotted amplify-and-forward (SAF) protocol and evaluate its performance in terms of diversity-multiplexing trade-off (DMT). The relays between the source and destination are grouped into two relay clusters based on their respective locations. The proposed strategy achieves partial relay isolation and decreases the decoding complexity at the destination. We show that the DMT upper bound of sequential-SAF with the proposed strategy outperforms other amplify and forward protocols and is more practical compared to the relay isolation assumption made in the original paper [1]. Simulation result shows that the sequential-SAF protocol with the proposed strategy has better outage performance compared to the existing AF and non-cooperative protocols in high SNR regime.

Post-discharge surveillance : can patients reliably diagnose surgical wound infections?

Post-discharge surgical wound infection surveillance is an important part of many infection control programs. It is frequently undertaken by patient self-assessment, prompted either by a telephone or postal questionnaire. To assess the reliability of this method, 290 patients were followed for six weeks postoperatively. Their wounds were photographed and also covertly assessed for signs of infection by two experienced infection control nurses (ICNs). Patients also responded to a postal questionnaire seeking evidence of infection at both week four and week six post-surgery. Correlation between the patient's assessment of their wound and the ICNs diagnosis was poor (r=0.37) with a low positive predictive value (28.7%), although negative predictive value was high (98.2%). Assessment of photos for signs of infection by two experienced clinicians also correlated poorly with the ICNs diagnosis of infection (r=0.54). The patient's recall of prescription of an antibiotic by their general practitioner (GP) for wound infection during the postoperative period correlated best with the ICNs diagnosis (r=0.76). This latter measure, particularly when confirmed by the GP in those patients reporting an infection, appears to provide the most valid and resource efficient marker of post-discharge surgical wound infection.

Residence time investigation in a co-axial dielectric barrier discharge reactor

The residence time distribution (RTD) is a crucial parameter when treating engine exhaust emissions with a Dielectric Barrier Discharge (DBD) reactor. In this paper, the residence time of such a reactor is investigated using a finite element based software: COMSOL Multiphysics 4.3. Non-thermal plasma (NTP) discharge is being introduced as a promising method for pollutant emission reduction. DBD is one of the most advantageous of NTP technologies. In a two cylinder co-axial DBD reactor, tubes are placed between two electrodes and flow passes through the annuals between these barrier tubes. If the mean residence time increases in a DBD reactor, there will be a corresponding increase in reaction time and consequently, the pollutant removal efficiency can increase. However, pollutant formation can occur during increased mean residence time and so the proportion of fluid that may remain for periods significantly longer than the mean residence time is of great importance. In this study, first, the residence time distribution is calculated based on the standard reactor used by the authors for ultrafine particle (10-500 nm) removal. Then, different geometrics and various inlet velocities are considered. Finally, for selected cases, some roughness elements added inside the reactor and the residence time is calculated. These results will form the basis for a COMSOL plasma and CFD module investigation.

The effect of Yb addition in bi2sr2ca 1-xybxcu2oy partial melted thick films

To study the phase relations in the Bi-2212 and Yb2O3 system, Bi2Sr2Ca1-xYbxCu 2Oy thick films are prepared by partial melt processing via an intermediate reaction between Bi-2212 and Yb2O3. When Bi-2212 and Yb2O3 are partially melted and then slowly cooled, solid solutions of Bi2Sr2Ca 1-xYbxCu2Oy, form by reactions between liquid and solid phases which contain Yb. Following these reactions, Ca is partially replaced in Bi-2212 matrix and participates in the formation of secondary phases, such as Bi-free, (Ca, Sr)Ox and CaO. Variation of the Bi-2212-Yb2O3 ratios and processing parameters changes the balance between the phases and leads to different Yb:Ca ratios in the Bi-2212 matrix of processed thick films. When the partial melting process is optimized for each sample to minimize the growth of secondary phases, x = 0.42-0.46 for the samples prepared at pO2 = 0.01 atm, x = 0.24-0.29 for the samples prepared at pO2 = 0.21 atm, x = 0.18-0.23 for the samples prepared at pO2 = 0.99 atm are obtained regardless to the starting compositions. It is found that superconducting properties of Bi 2Sr2Ca1-xYbxCu2O y thick films strongly depend on the processing conditions, because the conditions result in different Yb content in the Bi-2212 matrix and the volume fraction of the secondary phases. The highest Tc(0) of 77, 90 and 91 K were obtained for the samples processed at 0.01, 0.21 and 0.99 atm of O2, respectively.

Re-melting of Bi-2212/Ag laminated tapes by partial melting process

Bi-2212 tapes are prepared by a combination of dip-coating and partial melt processing. We investigate the effect of re-melting of those tapes by partial melting followed by slow cooling on the structure and superconducting properties. Microstructural studies of re-melted samples show that they have the same overall composition as partially melted tapes. However, the fractional volumes of the secondary phases differ and the amounts and distribution of the secondary phases have a significant effect on the critical current. Critical current of Bi-2212/Ag tapes strongly depends on the maximum processing temperature. Initial J(c)'s of the tapes, which are partially melted, then slowly solidified at optimum conditions and finally post-annealed in an inert atmosphere, are up to 10.4 x 10(3) A/cm(2). It is found that the maximum processing temperature at initial partial melting has an influence on the optimum re-heat treatment conditions for the tapes. Re-melted tapes processed at optimum conditions recover superconducting properties after post-annealing in an inert atmosphere: the J(c) values of the tapes are about 80-110% of initial J(c)'s of those tapes.

Partial melt processing and electrical properties of Bi-Sr-Ca-Cu-o superconducting thick films on (100) MgO substrates

Superconducting thick films of Bi2Sr2CaCu2Oy (Bi-2212) on single-crystalline (100) MgO substrates have been prepared using a doctor-blade technique and a partial-melt process. It is found that the phase composition and the amount of Ag addition to the paste affect the structure and superconducting properties of the partially melted thick films. The optimum heat treatment schedule for obtaining high Jc has been determined for each paste. The heat treatment ensures attainment of high purity for the crystalline Bi-2212 phase and high orientation of Bi-2212 crystals, in which the c-axis is perpendicular to the substrate. The highest Tc, obtained by resistivity measurement, is 92.2 K. The best value for Jct (transport) of these thick films, measured at 77 K in self-field, is 8 × 10 3 Acm -2.

Characterizing multi-agent team behavior from partial team tracings : evidence from the English Premier League

Real-world AI systems have been recently deployed which can automatically analyze the plan and tactics of tennis players. As the game-state is updated regularly at short intervals (i.e. point-level), a library of successful and unsuccessful plans of a player can be learnt over time. Given the relative strengths and weaknesses of a player’s plans, a set of proven plans or tactics from the library that characterize a player can be identified. For low-scoring, continuous team sports like soccer, such analysis for multi-agent teams does not exist as the game is not segmented into “discretized” plays (i.e. plans), making it difficult to obtain a library that characterizes a team’s behavior. Additionally, as player tracking data is costly and difficult to obtain, we only have partial team tracings in the form of ball actions which makes this problem even more difficult. In this paper, we propose a method to overcome these issues by representing team behavior via play-segments, which are spatio-temporal descriptions of ball movement over fixed windows of time. Using these representations we can characterize team behavior from entropy maps, which give a measure of predictability of team behaviors across the field. We show the efficacy and applicability of our method on the 2010-2011 English Premier League soccer data.

The decline in activities of daily living at discharge (DADLD) index : stratifying patients at lower and higher risk

Background: Decreased ability to perform Activities of Daily Living (ADLs) during hospitalisation has negative consequences for patients and health service delivery. Objective: To develop an Index to stratify patients at lower and higher risk of a significant decline in ability to perform ADLs at discharge. Design: Prospective two cohort study comprising a derivation (n=389; mean age 82.3 years; SD� 7.1) and a validation cohort (n=153; mean age 81.5 years; SD� 6.1). Patients and setting: General medical patients aged = 70 years admitted to three university-affiliated acute care hospitals in Brisbane, Australia. Measurement and main results: The short ADL Scale was used to identify a significant decline in ability to perform ADLs from premorbid to discharge. In the derivation cohort, 77 patients (19.8%) experienced a significant decline. Four significant factors were identified for patients independent at baseline: 'requiring moderate assistance to being totally dependent on others with bathing'; 'difficulty understanding others (frequently or all the time)'; 'requiring moderate assistance to being totally dependent on others with performing housework'; a 'history of experiencing at least one fall in the previous 90 days prior to hospital admission' in addition to 'independent at baseline', which was protective against decline at discharge. 'Difficulty understanding others (frequently or all the time)' and 'requiring moderate assistance to being totally dependent on others with performing housework' were also predictors for patients dependent in ADLs at baseline. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of the DADLD dichotomised risk scores were: 83.1% (95% CI 72.8; 90.7); 60.5% (95% CI 54.8; 65.9); 34.2% (95% CI 27.5; 41.5); 93.5% (95% CI 89.2; 96.5). In the validation cohort, 47 patients (30.7%) experienced a significant decline. Sensitivity, specificity, PPV and NPV of the DADLD were: 78.7% (95% CI 64.3; 89.3); 69.8% (95% CI 60.1, 78.3); 53.6% (95% CI 41.2; 65.7); 88.1% (95% CI 79.2; 94.1). Conclusions: The DADLD Index is a useful tool for identifying patients at higher risk of decline in ability to perform ADLs at discharge.