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Background: Many Australian adults are not receiving timely or effective diabetes management to prevent or delay the onset of diabetes related complications. Integrated care, a worldwide trend in healthcare reform, aims to reduce the fragmented delivery of health services and improve outcomes. This study aimed to test whether a specialist-led integrated model of care provided to a small subset of patients in general practices leads to spillover clinical improvements in all patients of the practice with type 2 diabetes., Methods: Seventy-two general practice sites (clusters) in New South Wales, Australia received the Diabetes Alliance intervention, creating a non-randomised open cohort stepped wedge trial. The intervention comprised of case conferencing, delivered directly to a small proportion of adults with type 2 diabetes (n = 1,072) of the general practice sites; as well as practice feedback, education and training. Spillover clinical improvements were assessed on all adults with type 2 diabetes within the general practice sites (n = 22,706), using practice level data recorded in the MedicineInsight electronic database, compared before and after the intervention. Outcome measures included frequency of diabetes screening tests in line with the Annual Cycle of Care, and clinical results for weight, blood pressure, HbA1c, lipids, and kidney function., Results: Compared to before Diabetes Alliance, the odds of all practice patients receiving screening tests at or above the recommended intervals were significantly higher for all recommended tests after Diabetes Alliance (odds ratio range 1.41-4.45, p < 0.0001). Significant improvements in clinical outcomes were observed for weight (absolute mean difference: -1.38 kg), blood pressure (systolic - 1.12 mmHg, diastolic - 1.18 mmHg), HbA1c (-0.03% at the mean), total cholesterol (-0.11 mmol/L), and triglycerides (-0.02 mmol/L) (p < 0.05). There were small but significant declines in kidney function., Conclusions: Integrated care delivered to a small subset of patients with type 2 diabetes across a large geographic region has spillover benefits that improve the process measures and clinical outcomes for all practice patients with type 2 diabetes., Trial Registration: ACTRN12622001438741; 10th November 2022, retrospectively registered: https://www.anzctr.org.au/ACTRN12622001438741.aspx ., (© 2024. The Author(s).)

: Objective: In many hospitals, nurse-led "safety huddles" are used to relay patient safety information, although whether this effectively identifies patients at risk for harm has not been determined. New electronic risk assessment tools are designed to identify patients at risk for harm during hospitalization, based on specific markers in the electronic health record. This study sought to compare the results of both methods. The findings may help to enhance decision making at the level of care delivery., Methods: A nonexperimental correlational study was conducted over a three-week period in 2015 in a large metropolitan acute care community hospital. Nurses on three units-a medical-surgical unit, a progressive care unit, and an orthopedic unit-constituted the convenience sample. Designated safety huddle leaders collected data using the daily census sheet to record the nurses' perceived risk of harm for each patient and the reason for risk concern. Separately, designated advanced practice nurses collected the electronic risk assessment tool's reports from the same units. Data were paired as they were entered into the database and analyzed to determine correlation. Perceptions of harm from the nurses, recorded as yes or no responses, were compared with the electronic tool's identification of high risk or moderate-to-low risk., Results: In 746 data pairs, differences between the nurses' harm risk perceptions and the electronic tool's harm risk reports were statistically significant, supporting our prediction that there would be no correlation. The most significant difference was seen in instances when a nurse identified a patient as being at higher risk than the electronic tool did, often citing behavioral or psychosocial issues as the reason for concern., Conclusions: Nurses perceived harm risk differently than the electronic tool did. In situations when the electronic tool cited risk and the nurse perceived no risk, the risks were currently being addressed in the plan of care. In situations when the nurse perceived higher risk than the electronic tool did, the nurse often cited behavioral or psychosocial issues (which frequently lacked defined data points in the electronic health record and thus were not available to the tool). Changes in data mining algorithms must incorporate and weight the impact of psychosocial and behavioral elements together with other risk factors in order to provide meaningful practice recommendations.

Reliable real-time low-latency spike sorting with large data throughput is essential for studies of neural network dynamics and for brain-machine interfaces (BMIs), in which the stimulation of neural networks is based on the networks' most recent activity. However, the majority of existing multi-electrode spike-sorting algorithms are unsuited for processing high quantities of simultaneously recorded data. Recording from large neuronal networks using large high-density electrode sets (thousands of electrodes) imposes high demands on the data-processing hardware regarding computational complexity and data transmission bandwidth; this, in turn, entails demanding requirements in terms of chip area, memory resources and processing latency. This paper presents computational complexity optimization techniques, which facilitate the use of spike-sorting algorithms in large multi-electrode-based recording systems. The techniques are then applied to a previously published algorithm, on its own, unsuited for large electrode set recordings. Further, a real-time low-latency high-performance VLSI hardware architecture of the modified algorithm is presented, featuring a folded structure capable of processing the activity of hundreds of neurons simultaneously. The hardware is reconfigurable “on-the-fly” and adaptable to the nonstationarities of neuronal recordings. By transmitting exclusively spike time stamps and/or spike waveforms, its real-time processing offers the possibility of data bandwidth and data storage reduction.

We report a case of Candida glabrata sepsis associated with chorioamnionitis in an in vitro fertilization-assisted pregnancy. There is a strong association between C. glabrata chorioamnionitis and assisted fertility techniques. Candida glabrata chorioamnionitis presents unique management challenges.