Use of hospital services by age and comorbidity after an index heart failure admission in England: an observational study

© Published by the BMJ Publishing Group Limited.Objectives To describe hospital inpatient, emergency department (ED) and outpatient department (OPD) activity for patients in the year following their first emergency admission for heart failure (HF). To assess the proportion receiving specialist assessment within 2â €...weeks of hospital discharge, as now recommended by guidelines. Design Observational study of national administrative data. Setting All acute NHS hospitals in England. Participants 82â €...241 patients with an index emergency admission between April 2009 and March 2011 with a primary diagnosis of HF. Main outcome measures Cardiology OPD appointment within 2â €...weeks and within a year of discharge from the index admission; emergency department (ED) and inpatient use within a year. Results 15.1% died during the admission. Of the 69â €...848 survivors, 19.7% were readmitted within 30â €...days and half within a year, the majority for non-HF diagnoses. 6.7% returned to the ED within a week of discharge, of whom the majority (77.6%) were admitted. The two most common OPD specialties during the year were cardiology (24.7% of the total appointments) and anticoagulant services (12.5%). Although half of all patients had a cardiology appointment within a year, the proportion within the recommended 2â €...weeks of discharge was just 6.8% overall and varied by age, from 2.4% in those aged 90+ to 19.6% in those aged 18-45 (p<0.0001); appointments in other specialties made up only some of the shortfall. More comorbidity at any age was associated with higher rates of cardiology OPD follow-up. Conclusions Patients with HF are high users of hospital services. Postdischarge cardiology OPD follow-up rates fell well below current National Institute for Health and Care Excellence guidelines, particularly for the elderly and those with less comorbidity

A panel analysis of UK industrial company failure

We examine the failure determinants for large quoted UK industrials using a panel data set comprising 539 firms observed over the period 1988-93. The empirical design employs data from company accounts and is based on Chamberlain’s conditional binomial logit model, which allows for unobservable, firm-specific, time-invariant factors associated with failure risk. We find a noticeable degree of heterogeneity across the sample companies. Our panel results show that, after controlling for unobservables, lower liquidity measured by the quick assets ratio, slower turnover proxied by the ratio of debtors turnover, and profitability were linked to the higher risk of insolvency in the analysis period. The findings appear to support the proposition that the current cash-flow considerations, rather than the future prospects of the firm, determined company failures over the 1990s recession

Event‐scale dynamics of a parabolic dune and its relevance for mesoscale evolution

Parabolic dunes are wide-spread aeolian landforms found in a variety of environments. Despite modelling advances and good understanding of how they evolve, there is limited empirical data on their dynamics at short time-scales of hours, and on how these dynamics relate to their medium-term evolution. This study presents the most comprehensive dataset to date on aeolian processes (airflow and sediment transport) inside a parabolic dune at an event-scale. This is coupled with information on elevation changes inside the landform to understand its morphological response to a single wind event. Results are contextualized against the medium-term (years) allowing us to investigate one of the most persistent conundrums in geomorphology, that of the significance of short-term findings for landform evolution. Our field data suggested three key findings: 1) sediment transport rates inside parabolic dunes correlate well with wind speeds rather than turbulence; 2) up to several tonnes of sand can move through these landforms in a few hours; 3) short-term elevation changes inside parabolic dunes can be complex and different from long-term net spatial patterns, including simultaneous erosion and accumulation along the same wall. Modeled airflow patterns along the basin were similar to those measured in situ for a range of common wind directions, demonstrating the potential for strong transport during multiple events. Meso-scale analyses suggested that the measured event was representative of the type of events potentially driving significant geomorphic changes over years, with supply-limiting conditions playing an important role in resultant flux amounts

Subjective evaluation of the environmental quality in China's industrial corridors.

Based on 270 questionnaire surveys in 8 cities of 5 industrial corridors in China, this study aims to examine the effects of industry construction on the evaluation of environmental pollution, natural environment, built environment, personal perception and development and policy. The results show that the evaluations on environmental pollution and landscape design are both below the medium level, but the evaluations of the living comfort and safety are both above the medium level. Further analysis, females usually give lower evaluation scores than males, and age and health situations are negatively related to the evaluation results; People indicate a great desire to reduce the environmental pollution and protect the natural environment. Moreover, the landscape was analysed using colour extraction techniques based on video recording, there are significant correlations between industrial pixel ratio and evaluation results of air quality, vegetation pixel ratio and evaluation results of river water quality, and public facilities pixel ratio and evaluation results of comfort levels

Evolutionary and socio-cultural influences on feelings and attitudes towards nature: a cross-cultural study

Mounting environmental issues have prompted reconsideration of the human–nature relationship. Accordingly, attitudes to nature, as an important dimension of human–nature interactions, have become a research focus. How feelings and attitudes towards nature are influenced by evolutionary and social-cultural constructions, and whether there is variation between different cultural groups, demands more attention. Using a survey of visitors to two very different National Parks, the New Forest National Park, England and Jiuzhaigou Scenic Area, China, this paper shows that of nationality and living environment, differences between the two nationalities were significant in respect of both attitudes and feelings. Specifically, it demonstrates that the biophilia thesis, which purports that people have an innate and a genetically inherited need for affiliation with nature, is influenced by their socio-cultural environment, in particular their national culture, but also by their current living place. The study contributes to our understanding of sustainable tourism in natural areas

MultiBUGS: A Parallel Implementation of the BUGS Modeling Framework for Faster Bayesian Inference

MultiBUGS is a new version of the general-purpose Bayesian modeling software BUGS that implements a generic algorithm for parallelizing Markov chain Monte Carlo (MCMC) algorithms to speed up posterior inference of Bayesian models. The algorithm parallelizes evaluation of the product-form likelihoods formed when a parameter has many children in the directed acyclic graph (DAG) representation; and parallelizes sampling of conditionally-independent sets of parameters. A heuristic algorithm is used to decide which approach to use for each parameter and to apportion computation across computational cores. This enables MultiBUGS to automatically parallelize the broad range of statistical models that can be fitted using BUGS-language software, making the dramatic speed-ups of modern multi-core computing accessible to applied statisticians, without requiring any experience of parallel programming. We demonstrate the use of MultiBUGS on simulated data designed to mimic a hierarchical e-health linked-data study of methadone prescriptions including 425,112 observations and 20,426 random effects. Posterior inference for the e-health model takes several hours in existing software, but MultiBUGS can perform inference in only 28 minutes using 48 computational core

Use of hospital services by age and comorbidity after an index heart failure admission in England: an observational study

Objectives To describe hospital inpatient, emergency department (ED) and outpatient department (OPD) activity for patients in the year following their first emergency admission for heart failure (HF). To assess the proportion receiving specialist assessment within 2 weeks of hospital discharge, as now recommended by guidelines. Design Observational study of national administrative data. Setting All acute NHS hospitals in England. Participants 82 241 patients with an index emergency admission between April 2009 and March 2011 with a primary diagnosis of HF. Main outcome measures Cardiology OPD appointment within 2 weeks and within a year of discharge from the index admission; emergency department (ED) and inpatient use within a year. Results 15.1% died during the admission. Of the 69 848 survivors, 19.7% were readmitted within 30 days and half within a year, the majority for non-HF diagnoses. 6.7% returned to the ED within a week of discharge, of whom the majority (77.6%) were admitted. The two most common OPD specialties during the year were cardiology (24.7% of the total appointments) and anticoagulant services (12.5%). Although half of all patients had a cardiology appointment within a year, the proportion within the recommended 2 weeks of discharge was just 6.8% overall and varied by age, from 2.4% in those aged 90+ to 19.6% in those aged 18–45 (p<0.0001); appointments in other specialties made up only some of the shortfall. More comorbidity at any age was associated with higher rates of cardiology OPD follow-up. Conclusions Patients with HF are high users of hospital services. Postdischarge cardiology OPD follow-up rates fell well below current National Institute for Health and Care Excellence guidelines, particularly for the elderly and those with less comorbidity

The Tatton-Brown-Rahman Syndrome: A clinical study of 55 individuals with de novo constitutive DNMT3A variants.

Tatton-Brown-Rahman syndrome (TBRS; OMIM 615879), also known as the DNMT3A-overgrowth syndrome, is an overgrowth intellectual disability syndrome first described in 2014 with a report of 13 individuals with constitutive heterozygous DNMT3A variants. Here we have undertaken a detailed clinical study of 55 individuals with de novoDNMT3A variants, including the 13 previously reported individuals. An intellectual disability and overgrowth were reported in >80% of individuals with TBRS and were designated major clinical associations. Additional frequent clinical associations (reported in 20-80% individuals) included an evolving facial appearance with low-set, heavy, horizontal eyebrows and prominent upper central incisors; joint hypermobility (74%); obesity (weight ³2SD, 67%); hypotonia (54%); behavioural/psychiatric issues (most frequently autistic spectrum disorder, 51%); kyphoscoliosis (33%) and afebrile seizures (22%). One individual was diagnosed with acute myeloid leukaemia in teenage years. Based upon the results from this study, we present our current management for individuals with TBRS