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Background Coding practices impact the recorded prevalence of disease. Sepsis, most commonly caused by pneumonia, remains a common cause of mortality worldwide. In April 2017, NHS Digital issued new guidance on coding of septicaemia. Following this, many hospitals reported an increase in mortality from sepsis. We hypothesised that this altered mortality was artefact due to changes in how primary admission diagnosis was recorded during processing of hospital data. Methods Hospital Episode Statistics from the Admitted Patient Care dataset for NHS hospitals in England, from April 2016 to March 2018 were included (twelve months before and after change in coding practices). Adult patients with an International Classification of Diseases 10 (ICD-10) code associated with the Agency for Healthcare Research and Quality (AHRQ) Clinical Classifications Software (CCS) class ‘Septicaemia (except in labour)’ recorded for an inpatient episode were identified. Patient comorbidities were assessed using ICD-10 codes recorded within the admission episode. Results 514,678 hospital episodes with a coded diagnosis of sepsis were studied. After the coding change, there was no increase in the number of episodes where sepsis was coded as a secondary diagnosis, but a significant increase in the number of episodes where sepsis was coded as the primary reason for admission, for all demographic factors studied (sex, ethnicity, social deprivation index). This was sustained for the whole study period. There were significant differences in the case-mix of patients with a primary diagnosis of septicaemia before and after the coding change, including the recorded prevalence of specific comorbidities such as asthma and lung cancer, and an increase in the proportion of patients with a primary diagnosis of sepsis who had any recorded respiratory disease. Reported differences in outcomes could be accounted for by this change in case-mix. Conclusion Changes in coding practices can cause important differences in the types of patients where the diagnosis of interest is recorded, which in turn can influence reported outcomes. The impact of any coding change should be considered carefully when reviewing longitudinal trends in outcomes for any disease where coding practice or diagnostic definitions have changed, within local reporting measures and also in published literature.

Background Left ventricular (LV) function is a major determinant of long-term outcomes after valve replacement surgery. Although conventional (right ventricular) pacemaker therapy is life-saving, it may cause heart failure (HF). Aims To determine whether permanent pacemaker implantation (PPI) confers a risk of HF in surgical valve recipients. Methods The primary endpoint of HF hospitalization and the secondary endpoints of total mortality and total mortality / HF hospitalizations were compared in valve recipients with and without PPI. Traditional as well as multi-state, multivariable modelling was used to assess the influence of PPI on clinical outcomes. Results Amongst patients (n = 135,242) undergoing a first aortic (AVR; n = 111,674), mitral (MVR; n = 18,402) valve replacement, or AVR + MVR (n = 5,166) over 14 years in 176 centre, 12,952 (10.6%) had a PPI at any time during follow-up and 5,805 (4.3%) underwent PPI postoperatively. After 3.9 yrs (median, interquartile range: 6.1), heart failure (HF) hospitalizations (HR: 1.47, 95% C.I. 1.36-1.59), total mortality (HR: 1.10, 95% C.I. 1.05-1.16) and total mortality or HF hospitalizations (HR: 1.17, 95% C.I. 1.12-1.22; see figure) were higher in patients with post-operative PPI than in patients without. Multi-state modelling revealed that the transition hazard from PPI at any time to HF hospitalizations was markedly higher (transition hazard rate: 0.29, 95% C.I. 0.24-0.36) than from valve replacement surgery to HF hospitalization. Conclusions After valve replacement surgery, PPI is associated with increased HF hospitalization and total mortality, particularly after dual valve replacements. Abstract Figure.

The MOLLER experiment proposed at the Thomas Jefferson National Accelerator Facility plans a precision low energy determination of the weak mixing angle via the measurement of the parity-violating asymmetry in the scattering of high energy longitudinally polarized electrons from electrons bound in a liquid hydrogen target (M{\o}ller scattering). A relative measure of the scattering rate is planned to be obtained by intercepting the M{\o}ller scattered electrons with a circular array of thin fused silica tiles attached to air light guides, which facilitate the transport of Cherenkov photons generated within the tiles to photomultiplier tubes (PMTs). The scattered flux will also pass through the light guides of downstream tiles, generating additional Cherenkov as well as scintillation light and is a potential background. In order to estimate the rate of these backgrounds, a gas-filled tube detector was designed and deployed in an electron beam at the MAMI facility at Johannes Gutenberg University, Mainz, Germany. Described in this paper is the design of a detector to measure separately the scintillation and Cherenkov responses of gas mixtures from relativistic electrons, the results of studies of several gas mixtures with comparisons to simulations, and conclusions about the implications for the design of the MOLLER detector apparatus., Comment: Published in NIM.A

Background Bariatric surgery is an accepted treatment option for severe obesity. Previous analysis of the independently collected Hospital Episode Statistics (HES) data for outcomes after bariatric surgery demonstrated a 30-day postoperative mortality rate of 0·3 per cent in the English National Health Service (NHS). However, there have been no published mortality data for bariatric procedures performed since 2008. This study aimed to assess mortality related to bariatric surgery in England from 2009. Methods HES data were used to identify all patients who had primary bariatric surgery from 2009 to 2016. Clinical codes were used selectively to identify all primary bariatric procedures but exclude revision or conversion procedures and operations for malignant or other benign disease. The primary outcome measures were HES in-hospital and Office for National Statistics (ONS) 30-day mortality after discharge. Results A total of 41 241 primary bariatric procedures were carried out in the NHS between 2009 and 2016, with 29 in-hospital deaths (0·07 per cent). The 30-day mortality rate after discharge was 0·08 per cent (32 of 41 241). Both the in-hospital and 30-day mortality rates after discharge demonstrated a downward trend over the study period. Conclusion Overall in-hospital and 30-day mortality rates remain very low after primary bariatric surgery. An increased uptake of bariatric surgery within the English NHS has been safe.

Background Women are underrepresented in cardiac resynchronization therapy ( CRT ) trials. Some studies suggest that women fare better than men after CRT . We sought to explore clinical outcomes in women and men undergoing CRT ‐defibrillation or CRT‐pacing in real‐world clinical practice. Methods and Results A national database (Hospital Episode Statistics for England) was used to quantify clinical outcomes in 43 730 patients (women: 10 890 [24.9%]; men: 32 840 [75.1%]) undergoing CRT over 7.6 years, (median follow‐up 2.2 years, interquartile range, 1–4 years). In analysis of the total population, the primary end point of total mortality (adjusted hazard ratio [ aHR ], 0.73; 95% CI, 0.69–0.76) and the secondary end point of total mortality or heart failure hospitalization ( aHR , 0.79, 95% CI 0.75–0.82) were lower in women, independent of known confounders. Total mortality ( aHR , 0.73; 95% CI, 0.70–0.76) and total mortality or heart failure hospitalization ( aHR , 0.79; 95% CI, 0.75–0.82) were lower for CRT ‐defibrillation than for CRT ‐pacing. In analyses of patients with ( aHR , 0.89; 95% CI, 0.80–0.98) or without ( aHR , 0.70; 95% CI, 0.66–0.73) a myocardial infarction, women had a lower total mortality. In sex‐specific analyses, total mortality was lower after CRT ‐defibrillation in women ( aHR , 0.83; P =0.013) and men ( aHR , 0.69; P Conclusions Compared with men, women lived longer and were less likely to be hospitalized for heart failure after CRT . In both sexes, CRT ‐defibrillation was superior to CRT ‐pacing with respect to survival and heart failure hospitalization. The longest survival after CRT was observed in women without a history of myocardial infarction.

Aims Randomized controlled trials have shown that cardiac resynchronization therapy (CRT) prolongs survival in patients with heart failure. No studies have explored survival after CRT in relation to individuals in the general population (relative survival, RS). We sought to determine observed and RS after CRT in a nationwide cohort undergoing CRT. Methods and results A national administrative database was used to quantify observed mortality for patients undergoing CRT. Relative survival (RS) was quantified using life tables. In 50 084 patients [age 72.1 ± 11.6 years (mean ± standard deviation)] undergoing CRT with (CRT-D) (n = 25 273) or without (CRT-P) defibrillation (n = 24 811) over 8.8 years (median follow-up 2.7 years, interquartile range 1.3-4.8), expected survival decreased with age. Device type, male sex, ischaemic heart disease, diabetes, and chronic kidney disease predicted excess mortality. In multivariate analyses, excess mortality (analogue of RS) was lower after CRT-D than after CRT-P in all patients [adjusted hazard ratio (aHR) 0.80, 95% confidence interval (CI) 0.76-0.84] as well as in subgroups with (aHR 0.79, 95% CI 0.74-0.84) or without (aHR 0.82, 95% CI 0.74-0.91) ischaemic heart disease. A Charlson Comorbidity Index (CCI) ≥3 portended a higher excess mortality (aHR 3.04, 95% CI 2.76-3.34). Relative survival was higher in 2015-2017 than in 2009-2011 (aHR 0.64, 95% CI 0.59-0.69). Conclusion Reference RS data after CRT is presented. Sex, ischaemic heart disease, diabetes, chronic kidney disease, and CCI were major determinants of RS after CRT. CRT-D was associated with a higher RS than CRT-P in patients with or without ischaemic heart disease. Relative survival after CRT improved from 2009 to 2017.

Objectives: Healthcare expenditure per-capita in the USA is higher than in England. We hypothesised that clinical outcomes after cardiac revascularisation are better in the USA. We compared costs and outcomes of patients undergoing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in England and New York State (NYS). Methods: Costs and total mortality were assessed using the Hospital Episode Statistics for England and the Statewide Planning and Research Cooperative System for NYS. Outcomes after a first CABG or PCI were assessed in patients undergoing a first CABG (n=142 969) or PCI (n=431 416). Results: After CABG, crude total mortality in England was 0.72% lower at 30 days and 3.68% lower at 1 year (both P

GaN single crystal films were grown by atomic layer epitaxy at 550 °C. The room temperature photoluminescence properties of these low‐temperature‐grown films are dominated by band edge emission with intensity comparable to those grown by metalorganic chemical vapor deposition at 1000 °C. The as‐grown films have background‐carrier concentrations that can be controlled to levels in the 1016/cm−3 range. Atomic layer epitaxy is therefore a good approach to the low temperature growth of nitride compounds.

Increased realization of the spatial heterogeneity found within in vivo tissue microenvironments has prompted the desire to engineer similar complexities into in vitro culture substrates. Microcontact printing (μCP) is a versatile technique for engineering such complexities onto cell culture substrates because it permits microscale control of the relative positioning of molecules and cells over large surface areas. However, challenges associated with precisely aligning and superimposing multiple μCP steps severely limits the extent of substrate modification that can be achieved using this method. Thus, we investigated the feasibility of using a vision guided selectively compliant articulated robotic arm (SCARA) for μCP applications. SCARAs are routinely used to perform high precision, repetitive tasks in manufacturing, and even low-end models are capable of achieving microscale precision. Here, we present customization of a SCARA to execute robotic-μCP (R-μCP) onto gold-coated microscope coverslips. The system not only possesses the ability to align multiple polydimethylsiloxane (PDMS) stamps but also has the capability to do so even after the substrates have been removed, reacted to graft polymer brushes, and replaced back into the system. Plus, non-biased computerized analysis shows that the system performs such sequential patterning with

92 Background: At a community hospital satellite of an academic cancer center, baseline data indicated that 49% of patients waited longer than 30 minutes from arrival in the treatment chair until treatment was started, resulting in dissatisfaction and decreased chair turnover. Methods: A team was assembled, including physicians, nurses, pharmacists, and administrative staff. The team constructed a detailed process flow map and performed a cause-and-effect analysis. Wait time data were collected using the electronic scheduling system and time sheets. Additionally, nurses used a structured data collection sheet to categorize the reasons for prolonged wait times. A p-type statistical process control chart was constructed to track the proportion of infusion visits per day with wait times longer than 30 minutes. The team brainstormed process improvements and selected ones to implement by employing a priority/pay-off matrix. Results: Baseline data were assessed for 403 visits over a 3 week period. Of 232 visits with wait times longer than 30 minutes, 98 (42%) involved excessive waiting for the physician to see the patient or write orders. One of 4 physicians was responsible for 56 (57%) of these. This physician’s patients were seen exclusively in the infusion room, while the other physicians saw patients in the exam room before sending them to the infusion area. Three PDSA cycles were conducted: (1) All physicians started seeing patients in the exam room before sending them to infusion chairs, (2) Specific treatments were selected that could be routinely administered without the physician seeing the patient, and (3) A reminder system prompted physicians to enter treatment orders within 24 hours of each patient’s visit. After 6 months, 29% of patients waited longer than 30 minutes, down from 49% at baseline. Conclusions: These interventions implemented using PDSA cycles successfully reduced wait times. Measurement and presentation of data were critical in persuading physicians to practice in a more homogeneous fashion.

The MIG-15 tire contained a high percentage of GR-S synthetic rubber. The tread design had no groove cracking and the underskid depth was about 200% over that required in the US tires. The breaker strips were eliminated, 1 chafing strip was used for both beads, and Perlon was used for the tire casing. The tread and cushion adhesions of the casing were good, but the outer-ply adhesion was low. It was estimated that the casing would withstand about 30 landings with a 100-psi tire pressure and a 120- to 130-mph landing speed.