OBJECTIVES: This study forms the user requirements phase of the OPTIMAL project, which, through a predictive model and supportive intervention, aims to decrease early hospital readmissions. This phase aims to investigate the needs and characteristics of patients who had been admitted to hospital ≥2 times in the past 12 months.
SETTING: This was a cross-sectional study involving patients from Croydon University Hospital (CUH), London, UK
PARTICIPANTS: A total of 347 patients responded to a postal questionnaire, a response rate of 12.7%. To meet the inclusion criteria, participants needed to be aged ≥ 18 and have been admitted ≥2 times in the previous 12 months (August 2014-July 2015) to CUH.
PRIMARY AND SECONDARY OUTCOMES: To profile patients identified as frequent admitters to assess gaps in care at discharge or post-discharge. Additionally, to understand the patients’ experience of admission, discharge and post-discharge care.
RESULTS: The range of admissions in the past 12 months was 2-30, with a mean of 2.8. At discharge 72.4%, (n= 231/347) were not given a contact for out of hours help. Regression analysis identified patient factors that were significantly associated with frequent admissions (>2 in 12 months), which included age (p=0.008), being in receipt of care (p=0.005) and admission due to a fall (p=0.01), but not receiving polypharmacy. Post-discharge, 41.8% (n=145/347) were concerned about being readmitted to the hospital. In the first 30 days after discharge, over half of patients (54.5% n=189/347) had no contact from a health care professional.
CONCLUSION: Considering that social care needs were more of a determinant of admission risk than medical needs, rectifying the lack of integration, communication and the under-utilisation of existing patient services could prevent avoidable problems during the transition of care and help decrease the likelihood of hospital readmission.
Most molecular processes in living organisms rely on protein–protein interactions, many of which are mediated by β-sheet interfaces; this study investigates the formation of β-sheet interfaces through the conversion of coils into β-strands. Following an exhaustive search in the Protein Data Bank, the corresponding structural dimorphic fragments were extracted, characterised and analysed. Their short strand lengths and specific amino acid profiles indicate that dimorphic β-strand interfaces are likely to be less stable than standard ones and could even convert to coil interfaces if their environment changes. Moreover, the construction of a simple classifier able to discriminate between the sequences of dimorphic and standard β-strand interfaces suggests that the nature of those dimorphic sequences could be predicted, providing a novel means of identifying proteins capable of forming dimers.
To investigate the influence of axial length on different ocular parameters and create a predictive tool for refractive error progression. Two eye models were used to simulate refractive errors, namely the Liou-Brennan and the Goncharov-Dainty. Both models were simulated using Zemax OpticStudio. Simulations were made by varying axial length and central corneal radii of curvature, with values ranging from 21.5 to 28.5 mm and 7.0 to 8.5 mm, respectively. Additionally, simulations of different lens parameters were included. Refractive error maps were produced for different ethnicities and a comparison with experimental results was undertaken. These showed the relationships between axial length and crystalline lens thickness, refractive index and curvatures of the cornea and lens. The concept of refractive error maps may provide more insight into the refractive state of individuals and groups with provision for a comparative analysis. With further experimental data added, such refractive error maps could be used as a predictive tool.
The crystallins have relatively high refractive increments compared to other proteins. The Greek key motif in βγ-crystallins was compared with that in other proteins, using predictive analysis from a protein database, to see whether this may be related to the refractive increment. Crystallins with Greek keys motifs have significantly higher refractive increments and more salt bridges than other proteins with Greek key domains. Specific amino acid substitutions: lysine and glutamic acid residues are replaced by arginine and aspartic acid, respectively as refractive increment increases. These trends are also seen in S-crystallins suggesting that the primary sequence of crystallins may be specifically enriched with amino acids with appropriate values of refractive increment to meet optical requirements. Comparison of crystallins from five species: two aquatic and three terrestrial shows that the lysine/arginine correlation with refractive increment occurs in all species investigated. This may be linked with formation and maintenance of salt bridges.
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