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OBJECTIVES/GOALS: METHODS/STUDY POPULATION: Utilized novel TS evaluation methods and tools: - Translational Science Case Study protocol adapted to examine translational support service practices, barriers and facilitators influencing translational movement. - Translational Science Benefits Model (TSBM) Checklist elements for translational/research impact analysis. Triangulated diverse data sources: - Primary data: semi-structured interviews with translational service stakeholders. - Secondary data: service’s applications, reports, and publications; public stories/news related to their research support; scientific publications; organizational/policy documents; and interviews with research stakeholders featured in published sources. RESULTS/ANTICIPATED RESULTS: Translational challenges include: complexity and constant change of health data; lack of data/informatics literacy amongst researchers; limited appreciation and funding for research data services; silos of functionality and data related to biomedical informatics. Translational facilitators are: the UMN CTSA support; available infrastructure and knowledge base; researchers as the best promoters for services; multidisciplinary collaborations with research/community/healthcare teams; best practice approaches; and learning by doing. The translational/research support service contributes to community and public health, clinical/medical benefits, data literacy, catalyzing data-rich research, and health equity. DISCUSSION/SIGNIFICANCE: The evaluation case study provides evidence and lessons learned related to translational benefits, challenges, and facilitators of a successful translational research support service integrating best informatics practices in clinical research and contributing to health equity improvement.
In England, a range of mental health crisis care models and approaches to organising crisis care systems have been implemented, but characteristics associated with their effectiveness are poorly understood.
Aims
To (a) develop a typology of catchment area mental health crisis care systems and (b) investigate how crisis care service models and system characteristics relate to psychiatric hospital admissions and detentions.
Method
Crisis systems data were obtained from a 2019 English national survey. Latent class analyses were conducted to identify discernible typologies, and mixed-effects negative binomial regression models were fitted to explore associations between crisis care models and admissions and detention rates, obtained from nationally reported data.
Results
No clear typology of catchment area crisis care systems emerged. Regression models suggested that provision of a crisis telephone service within the local crisis system was associated with a 11.6% lower admissions rate and 15.3% lower detention rate. Provision of a crisis cafe was associated with a 7.8% lower admission rates. The provision of a crisis assessment team separate from the crisis resolution and home treatment service was associated with a 12.8% higher admission rate.
Conclusions
The configuration of crisis care systems varies considerably in England, but we could not derive a typology that convincingly categorised crisis care systems. Our results suggest that a crisis phone line and a crisis cafe may be associated with lower admission rates. However, our findings suggest crisis assessment teams, separate from home treatment teams, may not be associated with reductions in admission and detentions.
To determine whether a multifaceted initiative resulted in maintained reduction in inappropriate treatment of asymptomatic pyuria (ASP) or bacteriuria (ASB) in the emergency department (ED).
Design:
Single-center, retrospective study.
Methods:
Beginning in December 2015, a series of interventions were implemented to decrease the inappropriate treatment of ASP or ASB in the ED. Patients discharged from the ED from August to October 2015 (preintervention period), from December 2016 to February 2017 (postintervention period 1), and from November 2019 to January 2020 (postintervention period 2) were included if they had pyuria and/or bacteriuria without urinary symptoms. The primary outcome was the proportion of patients prescribed antibiotics within 72 hours of discharge from the ED. The secondary outcome was the number of patients returning to the ED with symptomatic UTI within 30 days of discharge.
Results:
We detected a significant decrease in the proportion of patients with ASP or ASB who were inappropriately treated when comparing the preintervention group and post-intervention group 1 (100% vs 32.4%; P < .001). This reduced frequency of inappropriate treatment was noted 3 years after the intervention, with 28% of patients receiving treatment for ASP or ASB in postintervention group 2. (P was not significant fin the comparison with postintervention group 1.) Among the 3 groups analyzed, we detected no difference in the numbers of patients returning to the ED with a symptomatic UTI within 30 days of ED discharge regardless of whether patients received antibiotics.
Conclusions:
A multifaceted intervention resulted in a significant decrease in inappropriate use of antibiotics for ASP and/or ASB that was maintained 3 years after implementation.
The U.S. has the tools to end the HIV epidemic, but progress has stagnated. A major gap in U.S. efforts to address HIV is the under-utilization of medications that can virtually eliminate acquisition of the virus, known as pre-exposure prophylaxis (PrEP). This document proposes a financing and delivery system to unlock broad access to PrEP for those most vulnerable to HIV acquisition and bring an end to the HIV epidemic.
Inter-species drag forces in granular flows play a central role in setting the speed and extent of segregation, a process that separates grains of different size or density. Here, we study this drag force in detail, using a novel configuration of discrete element simulations that allows us to completely characterise the drag in inertial granular flows by studying it in a uniform environment. By applying opposing forces to grains in monodisperse and size-bidisperse shear flows, we show that the strength of the drag force scales as $I^{-7/4}$, where $I$ is the granular inertial number, and propose a model that explains this scaling by relating the strength of drag to grain velocity fluctuations. These findings suggest that much of the previously observed dependence of the segregation rate on the local shear rate and pressure in dense free-surface flows is due to variation in the strength of the inter-species drag, rather than the strength of forces that drive segregation.
The Winkie Drill is an agile, commercially available rock coring system. The U.S. Ice Drilling Program has modified a Winkie Drill for subglacial rock and ice/rock interface coring, as well as drilling and coring access holes through ice. The original gasoline engine was replaced with an electric motor though the two-speed gear reducer and Unipress hand feed system were maintained. Using standard aluminum AW34 drill rod (for 33.5 mm diameter core), the system has a depth capability of 120 m. The drill uses forward fluid circulation in a closed loop system. The drilling fluid is Isopar K, selected for favorable properties in polar environment. When firn or snow is present at the drill site, casing with an inflatable packer can be deployed to contain the drill fluid. The Winkie Drill will operate from sea level to high altitudes and operation results in minimal environmental impact. The drill can be easily and quickly assembled and disassembled in the field by two people. All components can be transported by Twin Otter or helicopter to the field site.
A new drilling system was developed by the US Ice Drilling Program (IDP) to rapidly drill through overlying ice to collect subglacial rock cores. The Agile Sub-Ice Geological (ASIG) Drill system is capable of drilling up to 700 m of ice in a continuous manner. Intermittent ice core samples can be taken as needed. Ten-plus meters of subglacial bedrock and unconsolidated, frozen sediment cores can be drilled with wireline core retrieval. The functionality of the drill system was demonstrated in 2016–17 at the Pirrit Hills, Antarctica where 8 m of high-quality, continuous granite core was retrieved beneath 150 m of ice. The particulars of the drill system development, features and performance are discussed.
Over the course of the 2014/15 and 2015/16 austral summer seasons, the South Pole Ice Core project recovered a 1751 m deep ice core at the South Pole. This core provided a high-resolution record of paleoclimate conditions in East Antarctica during the Holocene and late Pleistocene. The drilling and core processing were completed using the new US Intermediate Depth Drill system, which was designed and built by the US Ice Drilling Program at the University of Wisconsin–Madison. In this paper, we present and discuss the setup, operation, and performance of the drill system.
The Palaeoproterozoic Birimian Supergroup of the West African Craton (WAC) consists of volcanic belts composed predominantly of basaltic and andesitic rocks and intervening sedimentary basins composed predominantly of wackes and argillites. Mafic metavolcanic rocks and granitoid-hosted enclaves from the Palaeoproterozoic Lawra Belt of Ghana were analysed for geochemical and Sr–Nd isotopic data to constrain the geological evolution of the southeastern part of the WAC. The metavolcanic rocks display mainly tholeiitic signatures, whereas the enclaves show calc-alkaline signatures. The high SiO2 contents (48.6–68.9 wt%) of the enclaves are suggestive of their evolved character. The high Th/Yb values of the samples relative to that of the mantle array may indicate derivation of their respective magmas from subduction-modified source(s). The rocks show positive εNd values of +0.79 to +2.86 (metavolcanic rocks) and +0.79 to +1.82 (enclaves). These signatures and their Nd model ages (TDM2) of 2.31–2.47 Ga (metavolcanic rocks) and 2.39–2.47 Ga (enclaves) suggest they were probably derived from juvenile mantle-derived protoliths, with possible input of subducted pre-Birimian (Archean?) rocks in their source(s). Their positive Ba–Th and negative Nb–Ta, Zr–Hf and Ti anomalies may indicate their formation through subduction-related magmatism consistent with an arc setting. We propose that the metavolcanic rocks and enclaves from the Lawra Belt formed in a similar island-arc setting. We infer that the granitoids developed through variable degrees of mixing/mingling between basic magma and granitic melt during subduction, when blobs of basic to intermediate parental magma became trapped in the granitic magma to form the enclaves.
When a lightning bolt darts across the sky, the thunderclap that reaches our ears a few seconds later is an example of a fluid dynamical shock: a wave across which flow properties such as pressure and density change almost discontinuously. In compressible fluids these shocks are associated with high-energy supersonic flows and so require specialist equipment to realise in steady state. But in granular media, shocks occur much more readily and at flow speeds easily obtainable in the laboratory. In the featured article, Khan et al. (J. Fluid Mech., vol. 884, 2020, R4) exploit this to explore a remarkable range of steady and oscillatory shocks and shock interactions, which demonstrate many of the unique rheological complexities of granular flow.
The growing prevalence of non-communicable diseases, combined with greater recognition of the effectiveness of lipid lowering agents (LLAs), has fuelled their increasing use in recent years. Similarly, increasing recognition of mental health and, arguably, societal expectations and pressures, has driven appreciable growth in antidepressant prescribing in recent years. Concurrent with this, growing resource pressures enhanced by the continual launch of new premium priced medicines necessitates reforms and initiatives within finite budgets. Scotland has introduced multiple measures in recent years to improve both the quality and efficiency of prescribing. There is a need to document these initiatives and outcomes to provide future direction.
Methods
Assessment of the utilization (items dispensed) and expenditure of key LLAs (mainly statins) and SSRIs between 2001 and 2017 in Scotland alongside initiatives.
Results
Multiple interventions have increased international non-proprietary name (INN) prescribing (99% for statins and up to 99.9% for SSRIs). They have also increased preferential prescribing of generic versus patented statins with low costs for generics, reduced inappropriate prescribing of ezetimibe due to effectiveness concerns, and increased the prescribing of higher dose statins (71% in 2015). These measures have resulted in a 50% reduction in LLA expenditure between 2001 and 2015 despite a 412% increase in utilization. Initiatives to reduce the prescribing of escitalopram as lack of evidence demonstrating cost-benefits over generic citalopram, along with high INN prescribing, achieved a 73.7% reduction in SSRI expenditure between 2001 and 2017 despite a 2.34-fold increase in utilisation. Concerns with paroxetine, and more recently citalopram and escitalopram following safety warnings, resulted in a considerable reduction in their use alongside a significant increase in sertraline.
Conclusions
Generic availability coupled with multiple measures has resulted in appreciable shifts in statin and SSRI prescribing behavior and reduced ezetimibe prescribing, resulting in improvements in both the quality and efficiency of prescribing to provide future direction.
To increase the proportion of patients with no psychotropic drug discrepancies at the community mental health team (CMHT)–general practice interface. Three CMHTs participated. Over a 14 month period, quality improvement methodologies were used: individual patient-level feedback to patient's prescribers, run charts and meetings with CMHTs.
Results
One CMHT improved medicines reconciliation accuracy and demonstrated significant reductions in prescribing discrepancies. One in three (119/356) patients had ≥1 discrepancy involving 20% (166/847) of all prescribed psychotropics. Discrepancies were graded as: ‘fatal’ (0%), ‘serious’ (17%) and ‘negligible/minor harm’ (83%) but were associated with extra avoidable prescribing costs. For medicines routinely supplied by secondary care, 68% were not recorded in general practice electronic prescribing systems.
Clinical implications
Improvements in medicines reconciliation accuracy were achieved for one CMHT. This may have been partly owing to a multidisciplinary team approach to sharing and addressing prescribing discrepancies. Improving prescribing accuracy may help to reduce avoidable drug-related harms to patients.
The drilling of a deep borehole in ice is an undertaking that spans several seasons. Over recent decades such drilling has become widespread in both polar regions. Owing to the remoteness of the drill sites, considerable cost is associated with the drilling of a deep borehole of several thousand meters. The replicate coring system allows re-drilling of ice core at select depths within an existing parent borehole. This effectively increases the yield of the existing borehole and permits re-sampling of ice in areas of high scientific value. The replicate coring system achieves this through the combination of actuators, motors, sensors and a computerized control system. The replicate coring drill is a further development of the deep ice-sheet coring (DISC) drill, extending the capabilities of the DISC drill to include replicate coring.
The Blue Ice Drill (BID) is a large-diameter agile drill system designed by the Ice Drilling Design and Operations group of the University of Wisconsin–Madison to quickly core-clean 241 mm diameter ice samples from near-surface sites. It consists of a down-hole motor/gear reducer rotating a coring cutter and core barrel inside an outer barrel for efficient cuttings transport in solid ice. A variable-frequency drive and custom control box regulates electrical power to the drill. Torque reaction is accomplished on the surface via handles attached to a torsion stem. Core recovery is achieved with either core dogs in the sonde or with a separate core recovery tool. All down-hole tools are suspended on a collapsible tripod via ropes running on a capstan winch. The BID is operated by a minimum of two people and has been used successfully during two seasons of coring on a blue ice area of Taylor Glacier, Antarctica. An updated version of the drill system, BID-Deep, has been designed to recover cores to depths up to 200 m.