Threats to safe transitions from hospital to home: a consensus study in North West London primary care.

BACKGROUND: Transitions between healthcare settings are vulnerable points for patients. AIM: To identify key threats to safe patient transitions from hospital to primary care settings. DESIGN AND SETTING: Three-round web-based Delphi consensus process among clinical and non-clinical staff from 39 primary care practices in North West London, England. METHOD: Round 1 was a free-text idea-generating round. Rounds 2 and 3 were consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1-3: 'not important', 4-6: 'somewhat important', 7-9: 'very important'). Percentage of votes cast for each patient or medication group were recorded; consensus was defined as ≥75%. RESULTS: A total of 39 practices completed round 1, 36/39 (92%) completed round 2, and 30/36 (83%) completed round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision, and patients who were most at risk. 'Poor quality of handover instructions from secondary to primary care teams' achieved the highest rating (mean rating at round 3 = 8.43) and a 100% consensus that it was a 'very important' threat. Older individuals (97%) and patients with complex medical problems taking >5 medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients. CONCLUSION: This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work would need to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise

Remnant Fermi Surfaces in Photoemission

Recent experiments have introduced a new concept for analyzing the photoemission spectra of correlated electrons -- the remnant Fermi surface (rFs), which can be measured even in systems which lack a conventional Fermi surface. Here, we analyze the rFs in a number of interacting electron models, and find that the results fall into two classes. For systems with pairing instabilities, the rFs is an accurate replica of the true Fermi surface. In the presence of nesting instabilities, the rFs is a map of the resulting superlattice Brillouin zone. The results suggest that the gap in Ca_2CuO_2Cl_2 is of nesting origin.Comment: 4 pages LaTex, 3 ps figure

A competing order scenario of two-gap behavior in hole doped cuprates

Angle-dependent studies of the gap function provide evidence for the coexistence of two distinct gaps in hole doped cuprates, where the gap near the nodal direction scales with the superconducting transition temperature $T_c$, while that in the antinodal direction scales with the pseudogap temperature. We present model calculations which show that most of the characteristic features observed in the recent angle-resolved photoemission spectroscopy (ARPES) as well as scanning tunneling microscopy (STM) two-gap studies are consistent with a scenario in which the pseudogap has a non-superconducting origin in a competing phase. Our analysis indicates that, near optimal doping, superconductivity can quench the competing order at low temperatures, and that some of the key differences observed between the STM and ARPES results can give insight into the superlattice symmetry of the competing order.Comment: 9 pages, 7 fig

Theory of non-Fermi liquid and pairing in electron-doped cuprates

We apply the spin-fermion model to study the normal state and pairing instability in electron-doped cuprates near the antiferromagnetic QCP. Peculiar frequency dependencies of the normal state properties are shown to emerge from the self-consistent equations on the fermionic and bosonic self-energies, and are in agreement with experimentally observed ones. We argue that the pairing instability is in the $d_{x^{2}-y^{2}}$ channel, as in hole-doped cuprates, but theoretical $T_{c}$ is much lower than in the hole-doped case. For the same hopping integrals and the interaction strength as in hole-doped materials, we obtain $T_{c}\sim10$K at the end point of the antiferromagnetic phase. We argue that a strong reduction of $T_{c}$ in electron-doped cuprates compared to hole-doped ones is due to critical role of the Fermi surface curvature for electron-doped materials. The $d_{x^{2}-y^{2}}$-pairing gap $\Delta(\mathbf{k},\omega)$ is strongly non-monotonic along the Fermi surface. The position of the gap maxima, however, does not coincide with the hot spots, as the non-monotonic $d_{x^{2}-y^{2}}$ gap persists even at doping when the hot spots merge on the Brillouin zone diagonals.Comment: 16 page

Pinned Balseiro-Falicov Model of Tunneling and Photoemission in the Cuprates

The smooth evolution of the tunneling gap of Bi_2Sr_2CaCu_2O_8 with doping from a pseudogap state in the underdoped cuprates to a superconducting state at optimal and overdoping, has been interpreted as evidence that the pseudogap must be due to precursor pairing. We suggest an alternative explanation, that the smoothness reflects a hidden SO(N) symmetry near the (pi,0) points of the Brillouin zone (with N = 3, 4, 5, or 6). Because of this symmetry, the pseudogap could actually be due to any of a number of nesting instabilities, including charge or spin density waves or more exotic phases. We present a detailed analysis of this competition for one particular model: the pinned Balseiro-Falicov model of competing charge density wave and (s-wave) superconductivity. We show that most of the anomalous features of both tunneling and photoemission follow naturally from the model, including the smooth crossover, the general shape of the pseudogap phase diagram, the shrinking Fermi surface of the pseudogap phase, and the asymmetry of the tunneling gap away from optimal doping. Below T_c, the sharp peak at Delta_1 and the dip seen in the tunneling and photoemission near 2Delta_1 cannot be described in detail by this model, but we suggest a simple generalization to account for inhomogeneity, which does provide an adequate description. We show that it should be possible, with a combination of photoemission and tunneling, to demonstrate the extent of pinning of the Fermi level to the Van Hove singularity. A preliminary analysis of the data suggests pinning in the underdoped, but not in the overdoped regime.Comment: 18 pages LaTeX, 26 ps. figure

Dispersion of Ordered Stripe Phases in the Cuprates

A phase separation model is presented for the stripe phase of the cuprates, which allows the doping dependence of the photoemission spectra to be calculated. The idealized limit of a well-ordered array of magnetic and charged stripes is analyzed, including effects of long-range Coulomb repulsion. Remarkably, down to the limit of two-cell wide stripes, the dispersion can be interpreted as essentially a superposition of the two end-phase dispersions, with superposed minigaps associated with the lattice periodicity. The largest minigap falls near the Fermi level; it can be enhanced by proximity to a (bulk) Van Hove singularity. The calculated spectra are dominated by two features -- this charge stripe minigap plus the magnetic stripe Hubbard gap. There is a strong correlation between these two features and the experimental photoemission results of a two-peak dispersion in La$_{2-x}$Sr$_x$CuO$_4$, and the peak-dip-hump spectra in Bi$_2$Sr$_2$CaCu$_2$O$_{8+\delta}$. The differences are suggestive of the role of increasing stripe fluctuations. The 1/8 anomaly is associated with a quantum critical point, here expressed as a percolation-like crossover. A model is proposed for the limiting minority magnetic phase as an isolated two-leg ladder.Comment: 24 pages, 26 PS figure

Flux Phase as a Dynamic Jahn-Teller Phase: Berryonic Matter in the Cuprates?

There is considerable evidence for some form of charge ordering on the hole-doped stripes in the cuprates, mainly associated with the low-temperature tetragonal phase, but with some evidence for either charge density waves or a flux phase, which is a form of dynamic charge-density wave. These three states form a pseudospin triplet, demonstrating a close connection with the E X e dynamic Jahn-Teller effect, suggesting that the cuprates constitute a form of Berryonic matter. This in turn suggests a new model for the dynamic Jahn-Teller effect as a form of flux phase. A simple model of the Cu-O bond stretching phonons allows an estimate of electron-phonon coupling for these modes, explaining why the half breathing mode softens so much more than the full oxygen breathing mode. The anomalous properties of $O^{2-}$ provide a coupling (correlated hopping) which acts to stabilize density wave phases.Comment: Major Revisions: includes comparisons with specific cuprate phonon modes, 16 eps figures, revte

Anisotropic softening of collective charge modes in the vicinity of critical doping in a doped Mott insulator

Momentum resolved inelastic resonant x-ray scattering is used to map the evolution of charge excitations over a large range of energies, momenta and doping levels in the electron doped Mott insulator class Nd$_{2-x}$Ce$_x$CuO$_4$. As the doping induced AFM-SC (antiferromagnetic-superconducting) transition is approached, we observe an anisotropic softening of collective charge modes over a large energy scale along the Gamma to (\pi,\pi)-direction, whereas the modes exhibit broadening ($\sim$ 1 eV) with relatively little softening along Gamma to (\pi,0) with respect to the parent Mott insulator (x=0). Our study indicates a systematic collapse of the gap consistent with the scenario that the system dopes uniformly with electrons even though the softening of the modes involves an unusually large energy scale.Comment: 5 pages + 5 Figure

Dust Size Growth and Settling in a Protoplanetary Disk

We have studied dust evolution in a quiescent or turbulent protoplanetary disk by numerically solving coagulation equation for settling dust particles, using the minimum mass solar nebular model. As a result, if we assume an ideally quiescent disk, the dust particles settle toward the disk midplane to form a gravitationally unstable layer within 2x10^3 - 4x10^4 yr at 1 - 30 AU, which is in good agreement with an analytic calculation by Nakagawa, Sekiya, & Hayashi (1986) although they did not take into account the particle size distribution explicitly. In an opposite extreme case of a globally turbulent disk, on the other hand, the dust particles fluctuate owing to turbulent motion of the gas and most particles become large enough to move inward very rapidly within 70 - 3x10^4 yr at 1 - 30 AU, depending on the strength of turbulence. Our result suggests that global turbulent motion should cease for the planetesimal formation in protoplanetary disks.Comment: 27 pages, 8 figures, accepted for publication in the Ap