Implementing innovation in the UK National Health Service A case study in patient compliance

Missed appointments are a common form of patient non-compliance. One reason often given is they had been forgotten. We evaluate two recent innovations to address this problem introduced at one of the Scottish health boards to increase compliance at consultant-lead outpatient clinics. Patients with long waits were more likely to miss their appointment, but not, apparently, because they were more likely to forget it. Nevertheless, both innovations made a big difference and, combined, reduced recorded non-attendance rate by 90%. The administrative innovation changed the way appointments were made. At its most basic, bookings were made no more than five to seven weeks in advance, at no additional cost. Some of these patients also had to confirm their appointment. This reduced non-attendance still further, but at a cost of at least £150 per missed appointment avoided. The technological innovation used SMS and E-mail messages to send last minute reminders. It more than halved non-attendance, but the inability to collect contact details limited it applicability, and few of the patients reached provided contact details. Some fifty to one hundred messages have had to be sent to avoid one missed appointment. However, the use of the NHS network avoided significant recurrent costs.Outpatient services; Did not attend; SMS messages; Partial booking; Patient focussed booking

Fast Damage Recovery in Robotics with the T-Resilience Algorithm

Damage recovery is critical for autonomous robots that need to operate for a long time without assistance. Most current methods are complex and costly because they require anticipating each potential damage in order to have a contingency plan ready. As an alternative, we introduce the T-resilience algorithm, a new algorithm that allows robots to quickly and autonomously discover compensatory behaviors in unanticipated situations. This algorithm equips the robot with a self-model and discovers new behaviors by learning to avoid those that perform differently in the self-model and in reality. Our algorithm thus does not identify the damaged parts but it implicitly searches for efficient behaviors that do not use them. We evaluate the T-Resilience algorithm on a hexapod robot that needs to adapt to leg removal, broken legs and motor failures; we compare it to stochastic local search, policy gradient and the self-modeling algorithm proposed by Bongard et al. The behavior of the robot is assessed on-board thanks to a RGB-D sensor and a SLAM algorithm. Using only 25 tests on the robot and an overall running time of 20 minutes, T-Resilience consistently leads to substantially better results than the other approaches

In-House Counsel’s Role in the Structuring of Mortgage-Backed Securities

The authors introduce the financial crisis and the role played by mortgage-backed securities. Then describe the controversy at issue: whether, in order to own and enforce the mortgage loans backing those securities, a special-purpose vehicle “purchasing” mortgage loans must take physical delivery of the notes and security instruments in the precise manner specified by the sale agreement. Focusing on this controversy, the authors analyze (i) the extent, if any, that the controversy has merit; (ii) whether in-house counsel should have anticipated the controversy; and (iii) what, if anything, in-house counsel could have done to avert or, after it arose, to mitigate the controversy. Finally, the authors examine how the foregoing analysis can help to inform the broader issue of how in-house counsel should address complex legal transactions

Evolving a Behavioral Repertoire for a Walking Robot

Numerous algorithms have been proposed to allow legged robots to learn to walk. However, the vast majority of these algorithms is devised to learn to walk in a straight line, which is not sufficient to accomplish any real-world mission. Here we introduce the Transferability-based Behavioral Repertoire Evolution algorithm (TBR-Evolution), a novel evolutionary algorithm that simultaneously discovers several hundreds of simple walking controllers, one for each possible direction. By taking advantage of solutions that are usually discarded by evolutionary processes, TBR-Evolution is substantially faster than independently evolving each controller. Our technique relies on two methods: (1) novelty search with local competition, which searches for both high-performing and diverse solutions, and (2) the transferability approach, which com-bines simulations and real tests to evolve controllers for a physical robot. We evaluate this new technique on a hexapod robot. Results show that with only a few dozen short experiments performed on the robot, the algorithm learns a repertoire of con-trollers that allows the robot to reach every point in its reachable space. Overall, TBR-Evolution opens a new kind of learning algorithm that simultaneously optimizes all the achievable behaviors of a robot.Comment: 33 pages; Evolutionary Computation Journal 201

The EUVE point of view of AD Leo

All the Extreme Ultraviolet Explorer (EUVE) observations of AD Leo, totalling 1.1 Ms of exposure time, have been employed to analyze the corona of this single M dwarf. The light curves show a well defined quiescent stage, and a distribution of amplitude of variability following a power law with a ~-2.4 index. The flaring behavior exhibits much similarity with other M active stars like FK Aqr or YY Gem, and flares behave differently from late type active giants and subgiants. The Emission Measure Distribution (EMD) of the summed spectrum, as well as that of quiescent and flaring stages, were obtained using a line-based method. The average EMD is dominated by material at log T(K)~6.9, with a second peak around log T(K)~6.3, and a large increase in the amount of material with log T(K)>~7.1 during flares, material almost absent during quiescence. The results are interpreted as the combination of three families of loops with maximum temperatures at log T(K)~6.3, ~6.9 and somewhere beyond log T(K)>~7.1. A value of the abundance of [Ne/Fe]=1.05+-0.08 was measured at log T(K)~5.9. No significative increment of Neon abundance was detected between quiescence and flaring states.Comment: Full PS version can be found also at http://www.astropa.unipa.it/~jsanz/papers0002.htm

Media reporting of suicide and adherence to media guidelines

Background: International research consistently shows evidence for an association between sensationalised and detailed media reporting, and suicidal behaviour. Aim: This study examined the quality of media reporting of suicide and adherence to media guidelines in Ireland. Methods: In accordance with the criteria outlined in the media guidelines for reporting suicide, 243 media articles were screened and analysed for quality of reporting of two high-profile cases of suicide and two cases of suicide that became high profile following a period of intense media coverage that occurred between September 2009 and December 2012. Results: A minority of articles breached the media guidelines in relation to sensationalised language (11.8%), placement of reports on the front page of the newspaper (9.5%), publishing of inappropriate photographs (4.2%) and mention of location of suicide (2.4%), while no articles disclosed the contents of a suicide note. However, in the majority of articles analysed, journalists did not refer to appropriate support services for people vulnerable to, and at risk of suicide (75.8%) or mention wider issues that are related to suicidal behaviour (53.8%). Overemphasis of community grief (48.3%) was also common. Nearly all articles (99.2%) breached at least one guideline and 58.9% of articles breached three or more guidelines. Conclusion: Overall, adherence to media guidelines on reporting suicide in Ireland improved in certain key areas from September 2009 until December 2012. Nonetheless, important challenges remain. Increased monitoring by media monitoring agencies, regulators and government departments is required. Implementation should be conducted using a pro-active approach and form part of the curriculum of journalists and editors. The inclusion of guidelines for the reporting of suicidal behaviour in press codes of conduct for journalists warrants consideration

Возможности радикального лечения варикотромбофлебита на фоне варикозной болезни и трофических язв

КОНЕЧНОСТИ НИЖНЕЙ ЯЗВАТРОМБОФЛЕБИТ /ХИРВАРИКОЗНАЯ ЯЗВАВАРИКОЗНОЕ РАСШИРЕНИЕ ВЕН /ОС

The laterality of the gallop gait in Thoroughbred racehorses

<div><p>Laterality can be observed as side biases in locomotory behaviour which, in the horse, manifest <i>inter alia</i> as forelimb preferences, most notably in the gallop. The current study investigated possible leading-leg preferences at the population and individual level in Thoroughbred racehorses (n = 2095) making halt-to-gallop transitions. Videos of flat races in the UK (n = 350) were studied to record, for each horse, the lead-leg preference of the initial stride into gallop from the starting stalls. Races from clockwise (C) and anti-clockwise (AC) tracks were chosen alternately at random to ensure equal representation. Course direction, horse age and sex, position relative to the inside rail and finishing position were also noted. On C courses, the left/right ratio was 1.15, which represents a significant bias to the left (z = –2.29, p = 0.022), while on AC courses it was 0.92 (z = 0.51, p = 0.610). In both course directions, there was no significant difference between winning horses that led with the left leading leg versus the right (C courses, z = –1.32, p = 0.19 and AC courses, z = –0.74, p = 0.46). Of the 2,095 horses studied 51.26% led with their L fore and 48.74% with their R, with no statistically significant difference (z = -1.16, p = 0.25). Therefore, there was no evidence of a population level motor laterality. Additionally, 22 male and 22 female horses were randomly chosen for repeated measures of leading leg preference. A laterality index was calculated for each of the 44 horses studied using the repeated measures: 22 exhibited right laterality (of which two were statistically significant) and 21 exhibited left laterality (eight being statistically significant); one horse was ambilateral. Using these data, left lateralized horses were more strongly lateralized on an individual level than the right lateralized horses (t = 2.28, p = 0.03, DF = 34) and mares were more left lateralized than males (t = 2.4, p = 0.03, DF = 19).</p></div

Spread of Plague Among Black-Tailed Prairie Dogs Is Associated With Colony Spatial Characteristics

Sylvatic plague (Yersinia pestis) is an exotic pathogen that is highly virulent in black-tailed prairie dogs (Cynomys ludovicianus) and causes widespread colony losses and individual mortality rates \u3e95%. We investigated colony spatial characteristics that may influence inter-colony transmission of plague at 3 prairie dog colony complexes in the Great Plains. The 4 spatial characteristics we considered include: colony size, Euclidean distance to nearest neighboring colony, colony proximity index, and distance to nearest drainage (dispersal) corridor. We used multi-state mark–recapture models to determine the relationship between these colony characteristics and probability of plague transmission among prairie dog colonies. Annual mapping of colonies and mark–recapture analyses of disease dynamics in natural colonies led to 4 main results: 1) plague outbreaks exhibited high spatial and temporal variation, 2) the site of initiation of epizootic plague may have substantially influenced the subsequent inter-colony spread of plague, 3) the longterm effect of plague on individual colonies differed among sites because of how individuals and colonies were distributed, and 4) colony spatial characteristics were related to the probability of infection at all sites although the relative importance and direction of relationships varied among sites. Our findings suggest that conventional prairie dog conservation management strategies, including promoting large, highly connected colonies, may need to be altered in the presence of plague