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In the UK, acute mental healthcare is provided by in-patient wards and crisis resolution teams. Readmission to acute care following discharge is common. Acute day units (ADUs) are also provided in some areas.
To assess predictors of readmission to acute mental healthcare following discharge in England, including availability of ADUs.
We enrolled a national cohort of adults discharged from acute mental healthcare in the English National Health Service (NHS) between 2013 and 2015, determined the risk of readmission to either in-patient or crisis teams, and used multivariable, multilevel logistic models to evaluate predictors of readmission.
Of a total of 231 998 eligible individuals discharged from acute mental healthcare, 49 547 (21.4%) were readmitted within 6 months, with a median time to readmission of 34 days (interquartile range 10–88 days). Most variation in readmission (98%) was attributable to individual patient-level rather than provider (trust)-level effects (2.0%). Risk of readmission was not associated with local availability of ADUs (adjusted odds ratio 0.96, 95% CI 0.80–1.15). Statistically significant elevated risks were identified for participants who were female, older, single, from Black or mixed ethnic groups, or from more deprived areas. Clinical predictors included shorter index admission, psychosis and being an in-patient at baseline.
Relapse and readmission to acute mental healthcare are common following discharge and occur early. Readmission was not influenced significantly by trust-level variables including availability of ADUs. More support for relapse prevention and symptom management may be required following discharge from acute mental healthcare.
New occurrences of middle–late Darriwilian (Middle Ordovician) conodonts are reported from the Nyalam region, southern Tibet. The conodont-yielding strata, referred to the Chiatsun Group, accumulated on the north Indian continental margin of northern Gondwana. These Middle Ordovician conodonts include the informal species Histiodella sp. A in the middle part of the Lower Formation of the Chiatsun Group succeeded by a fauna of the Pygodus serra Zone in the upper part of that formation. Pygodus anserinus is recorded from the base of the Upper Formation of the Chiatsun Group. The Nyalam succession and its conodont taxa allow for precise correlation of the strata preserved on top of Mount Qomolangma (Mount Everest), eastern Tibet and the Peri-Gondwana Lhasa (north central Tibet), South China, North China, Tarim Basin and Thailand-Malaysia (Sibumasu Terrane) terranes and/or microcontinents. The middle Darriwilian positive increase in δ13Ccarb values (carbon isotope excursion, or MDICE) is recorded from most terranes, and can be related to a late middle Darriwilian global short-term cooling and sea-level drop. The cooling event prompted temperate- to warm-water taxa to migrate towards the palaeoequator and constrained the Australasian Province to locations near and at the palaeoequator. The intensified oceanic circulation and upwelling on continental margins probably caused some characteristic taxa to become extinct. The incoming fauna was mainly of cool-water taxa. The conodont specimens from southern Tibet are black to pale grey, corresponding to conodont colour index (CAI) values of 5 to 6, which demonstrates that the host sedimentary rocks were once heated to more than 360°C.
The Order Spiriferinida spanning the latest Ordovician to Early Jurassic is a small group of brachiopods overshadowed by other taxon-rich clades during the Paleozoic. It diversified significantly after the end-Permian extinction and became one of the four major clades of Triassic brachiopods. However, the phylogeny and recovery dynamics of this clade during the Triassic still remain unknown. Here, we present a higher-level parsimony-based phylogenetic analysis of Mesozoic spiriferinids to reveal their evolutionary relationships. Ecologically related characters are analyzed to indicate the variances in ecomorphospace occupation and disparity of spiriferinids through the Permian–Triassic (P-Tr) transition. For comparison with potential competitors of the spiriferinids, the pre-extinction spiriferids are also included in the analysis. Phylogenetic trees demonstrate that about half of the Mesozoic families appeared during the Anisian, indicating the greatest phylogenetic diversification at that time. Triassic spiriferinids reoccupied a large part of the ecomorphospace released by its competitor spiriferids during the end-Permian extinction; they also fully exploited the cyrtiniform region and developed novel lifestyles. Ecomorphologic disparity of the spiriferinids dropped greatly in the Early Triassic, but it rebounded rapidly and reached the level attained by the pre-extinction spiriferids in the Late Triassic. The replacement in ecomorphospace occupation between spiriferids and spiriferinids during the P-Tr transition clearly indicates that the empty ecomorphospace released by the extinction of Permian spiriferids was one of the important drivers for the diversification of the Triassic spiriferinids. The Spiriferinida took over the empty ecomorphospace and had the opportunity to flourish.
We present a detailed overview of the cosmological surveys that we aim to carry out with Phase 1 of the Square Kilometre Array (SKA1) and the science that they will enable. We highlight three main surveys: a medium-deep continuum weak lensing and low-redshift spectroscopic HI galaxy survey over 5 000 deg2; a wide and deep continuum galaxy and HI intensity mapping (IM) survey over 20 000 deg2 from
$z = 0.35$
to 3; and a deep, high-redshift HI IM survey over 100 deg2 from
$z = 3$
to 6. Taken together, these surveys will achieve an array of important scientific goals: measuring the equation of state of dark energy out to
$z \sim 3$
with percent-level precision measurements of the cosmic expansion rate; constraining possible deviations from General Relativity on cosmological scales by measuring the growth rate of structure through multiple independent methods; mapping the structure of the Universe on the largest accessible scales, thus constraining fundamental properties such as isotropy, homogeneity, and non-Gaussianity; and measuring the HI density and bias out to
$z = 6$
. These surveys will also provide highly complementary clustering and weak lensing measurements that have independent systematic uncertainties to those of optical and near-infrared (NIR) surveys like Euclid, LSST, and WFIRST leading to a multitude of synergies that can improve constraints significantly beyond what optical or radio surveys can achieve on their own. This document, the 2018 Red Book, provides reference technical specifications, cosmological parameter forecasts, and an overview of relevant systematic effects for the three key surveys and will be regularly updated by the Cosmology Science Working Group in the run up to start of operations and the Key Science Programme of SKA1.
First some key facts: the Sirius Passet fossil biota is the most remote, least well known and, to date, one of the least diverse of the Cambrian exceptionally preserved assemblages or Lagerstätten (Harper et al., 2019). Following its serendipitous discovery in 1984, by field geologists working for the Geological Survey of Greenland, the locality in the Buen Formation, on the edge of J. P. Koch Fjord in North Greenland has been visited by only seven collecting expeditions, most recently in 2009 and 2011 by multidisciplinary and multinational groups, led by the author when a member of staff in the Natural History Museum of Denmark, University of Copenhagen, and in 2016 and 2017 by a UK–South Korea group. The Sirius Passet Lagerstätte occurs in black mudstones deposited at the shelf–slope break on the Laurentian margin. Although deformed and metamorphosed by a Devonian tectonic event, the Ellesmerian Orogeny, the locality preserves, to a large degree, the original depositional relationships and allows an interpretation of the environmental setting of this early Cambrian ecosystem; thus it is key to understanding the environmental constraints on the Cambrian Explosion. The fossiliferous site is located in the Sirius Pass, beside J. P. Koch Fjord, Peary Land, North Greenland, at 82° 47.59ʹ N, 42° 13.54ʹ W (Figure 22.1) and an altitude of 420 m. This remote locality can only be reached by short take-off and landing aircraft that can use a rough airstrip in the valley, 2 km to the west–north-west.
A review of biodiversity curves of marine organisms indicates that, despite fluctuations in amplitude (some large), a large-scale, long-term radiation of life took place during the early Palaeozoic Era; it was aggregated by a succession of more discrete and regionalized radiations across geographies and within phylogenies. This major biodiversification within the marine biosphere started during late Precambrian time and was only finally interrupted in the Devonian Period. It includes both the Cambrian Explosion and the Great Ordovician Biodiversification Event. The establishment of modern marine ecosystems took place during a continuous chronology of the successive establishment of organisms and their ecological communities, developed during the ‘Cambrian substrate revolution’, the ‘Ordovician plankton revolution’, the ‘Ordovician substrate revolution’, the ‘Ordovician bioerosion revolution’ and the ‘Devonian nekton revolution’. At smaller scales, different regional but important radiations can be recognized geographically and some of them have been identified and named (e.g. those associated with the ‘Richmondian Invasion’ during Late Ordovician time in Laurentia and the contemporaneous ‘Boda event’ in parts of Europe and North Africa), in particular from areas that were in or moved towards lower latitudes, allowing high levels of speciation on epicontintental seas during these intervals. The datasets remain incomplete for many other geographical areas, but also for particular time intervals (e.g. during the late Cambrian ‘Furongian Gap’). The early Palaeozoic biodiversification therefore appears to be a long-term process, modulated by bursts in significant diversity and intervals of inadequate data, where its progressive character will become increasingly clearer with the availability of more complete datasets, with better global coverage and more advanced analytical techniques.
To date, there are no published data on the association of patient-centered outcomes and accurate public-safety answering point (PSAP) dispatch in an American population. The goal of this study is to determine if PSAP dispatcher recognition of out-of-hospital cardiac arrest (OHCA) is associated with neurologically intact survival to hospital discharge.
This retrospective cohort study is an analysis of prospectively collected Quality Assurance/Quality Improvement (QA/QI) data from the San Antonio Fire Department (SAFD; San Antonio, Texas USA) OHCA registry from January 2013 through December 2015. Exclusion criteria were: Emergency Medical Services (EMS)-witnessed arrest, traumatic arrest, age <18 years old, no dispatch type recorded, and missing outcome data. The primary exposure was dispatcher recognition of cardiac arrest. The primary outcome was neurologically intact survival (defined as Cerebral Performance Category [CPC] 1 or 2) to hospital discharge. The secondary outcomes were: bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and prehospital return of spontaneous return of circulation (ROSC).
Of 3,469 consecutive OHCA cases, 2,569 cases were included in this analysis. The PSAP dispatched 1,964/2,569 (76.4%) of confirmed OHCA cases correctly. The PSAP dispatched 605/2,569 (23.6%) of confirmed OHCA cases as another chief complaint. Neurologically intact survival to hospital discharge occurred in 99/1,964 (5.0%) of the recognized cardiac arrest group and 28/605 (4.6%) of the unrecognized cardiac arrest group (OR = 1.09; 95% CI, 0.71–1.70). Bystander CPR occurred in 975/1,964 (49.6%) of the recognized cardiac arrest group versus 138/605 (22.8%) of the unrecognized cardiac arrest group (OR = 3.34; 95% CI, 2.70–4.11).
This study found no association between PSAP dispatcher identification of OHCA and neurologically intact survival to hospital discharge. Dispatcher identification of OHCA remains an important, but not singularly decisive link in the OHCA chain of survival.
The brachiopods collected from the Kuanyinchiao Beds (Hirnantian, uppermost Ordovician) in Meitan and Zunyi counties, northern Guizhou, include 13 species and one undetermined taxon, dominated by Hirnantia sagittifera (M'Coy, 1851) (which accounts for over one-third of the specimens), together with common Eostropheodonta hirnantensis (M'Coy, 1851). They are assigned to the Hirnantia–Eostropheodonta Community, which probably inhabited a shallow-water, nearshore Benthic Assemblage (BA) 2 to upper BA 3 environment. Population analysis shows that the community was well adapted to this environment after the first phase of the end-Ordovician mass extinction. Representative specimens of all the species are illustrated, and a new species, Minutomena missa, is described herein. The variation in Hirnantia sagittifera was noted in many of previous studies but was not statistically evidenced. Here we have measured representative specimens of that famous species from the major paleoplates and terranes in the world, along with other species assigned to the genus from South China. Having used principal component analysis (PCA), significant variations in the species are documented statistically and revised, and three nominal species, one subspecies, and two morphotypes are now reassigned to Hirnantia sagittifera sensu stricto.
This introduction canvasses broad themes relating to the nexus of innovation and institutions. It first examines the notion of a “new combination” – a core analytical concept in economic theories of innovation and explanations of emergent novelty through bottom-up processes. Following Schumpeter, different theorists have made different claims about the composition and structure of new combinations. Possible constituent elements include factors of production, capital goods, routines, information, ideas, technologies, and property rights. The article then looks synoptically at the institutional dimensions of innovation from alternative perspectives that focus upon different kinds of institutional rules and policy solutions to innovation problems. Neoclassical and evolutionary approaches tend to emphasize specific policy interventions in markets to channel behavior toward particular desired outcomes, whereas institutional and Austrian approaches tend to focus upon general institutional rules (e.g. property and contract) that frame markets and innovation processes. Finally, this article summarizes the papers in the special issue.
The use of information technology in healthcare has accelerated progress toward the long-term goal of a learning healthcare system, in which data from prior clinical experience provides an ever-expanding resource to guide continuous improvements in health care. Although still in its early stages, the use of data from clinical experience to supplement data from premarket testing is changing the roles of Food and Drug Administration (FDA) and public and private health insurers in healthcare innovation and technology assessment. It could change who decides what research questions to pursue, whose evidentiary standards decide what counts as actionable knowledge, and who pays the costs of research. The shape and direction of resulting changes will depend on which actors and institutions decide to step forward and claim a larger role in healthcare innovation in response to technological and regulatory change.
Digital markets offer abundant free content but exhibit extreme concentration among content aggregation intermediaries. These characteristics are linked. Weak copyright environments select against stand-alone content-delivery structures and select for bundled aggregation structures in which free content for users promotes positively priced advertising and data-collection services for firms. Dominant intermediaries promote commoditization, and the reallocation of market rents from content producers to content aggregators, through litigation and free content distribution that weaken copyright protections. The potential net welfare effects raise concern. Network effects, compounded by weak inventory constraints, scale economies, and learning effects, promote winner-takes-all outcomes in the intermediary services market while weak copyright may generate output distortions in the content production market.
We examine brand building from the perspective of complex adaptive systems. Brand building is a neglected engine of capital formation, innovation and institutional change in market economies. The nature of brands and the service streams they generate have been construed too narrowly. Brands are capital: entrepreneurs use brands as market-making devices that create value and capture profit, while consumers use brands to derive psychic income and lifestyle benefits. Brands are building blocks that can be combined in production to fill perceived gaps in brand architectures and capital structures. These structures are themselves complex adaptive systems. In an era of digital technological platforms, complex generative networks are the institutional locus of brand creation and brand extensions. Innovation in brand building is a socially distributed, service-intensive and interpretive process; it entails combinatorial experiments in resource integration by heterogeneous and socially connected actors, such as entrepreneur-producers, end-users and distributors. Legal brand owners never have total control over their brands – customer networks often exercise substantial de facto control rights (economic property rights) over the use and transformation of brands. Both the entire branding system (as a form of organization) and individual iconic brands can crystallize into relatively stable institutions that orient and coordinate market behaviour.
This paper analyses the origin of innovation using institutional economic theory. Because of distributed information and fundamental uncertainty, an efficient institutional context for the economic organization of innovation in its early stages is often that of a common pool resource. The theory of the innovation commons draws upon Hayek, Williamson and Ostrom to present the innovation problem as a combined knowledge problem, implicit contracting problem and collective action governance problem. Innovation commons theory also implies that Kirzner's model of entrepreneurial opportunity discovery extends to higher-order groups, suggesting a multilevel selection model of economic evolution.
Does innovation proceed from the top down or the bottom up? This is a crucial question for those who think about the sources of economic growth and especially for those who think about policies and institutions to promote innovation. The answer lies in part with the structure of the existing system of production and the array of assets that an innovation would displace, especially on the extent of complementarity and modularity in that structure. But it also depends on institutions. This paper argues for the centrality of decision rights to the process of innovation. Especially if it takes place in a systemic, non-modular way, innovation may require unified decision rights, often implying integrated control of complementary stages of production, in order to overcome the dynamic transaction costs of change. But the processes of subdivision, differentiation, and learning – the processes of fission, forking, and fine tuning – may also require changes in decision rights in order to overcome dynamic transaction costs. I illustrate these points with a case study of three generations of an American family of inventor-entrepreneurs in electricity and electronics.
Since the end of the shakeout following the bursting of the dot com bubble, we have seen substantial innovation in the institutions and organizational arrangements used to finance early-stage high growth technology companies. This paper will document the emergence of business accelerators, angel groups, micro venture capital funds and online equity crowdfunding platforms, and show the rapid growth in angel investing over this period. It will also document the corresponding movement away from traditional venture capital activity at the early stage of company development. The paper will explain how technological advance, specifically the decline in the cost of bringing a new software product to market, has driven this shift in the institutions of early-stage finance.
Was technological progress during and after the Industrial Revolution top-down or bottom-up? The technology that created the great inventions was driven by a combination of pathbreaking ideas and the dexterity and skills of trained artisans. While those forms of human capital were quite different, they both came out of small elites of intellectuals and craftsmen, what are rapidly becoming known as “upper-tail human capital.” I analyze the institutions that drove the incentives for both, and show that they came together to produce the Great Enrichment. These incentives were both material and social: between 1500 and 1700, the search for financial security and reputation cooperated in producing a unique institutional environment in which the elites in Western Europe produced the three legged-stool of European modernity: the Reformation, the Scientific Revolution, and the Enlightenment. Once these three movements had succeeded, the foundation for modern economic growth had been laid.