Sticker System Research Articles

Quality improvement project - Reducing the inadvertent prescribing of unopposed estrogen in primary care Dr Liz Horrocks Banstead PCN.

The aim of the project was to reduce the risk of patients using the estrogen only part of their hormone replacement therapy (HRT) inadvertently in Banstead PCN. Although understanding about the risk of unopposed estrogen is well understood by prescribers, there are numerous flash points where this exposure can occur which was highlighted by several cases encountered during a study period of 3months. Cases encountered revealed numerous reasons for this exposure which were split into three areas: Prescribing factors, dispensing checks and patient understanding. Quality improvement suggestions were tailored to the factors involved. IT system changes to EMIS, our main computer software provider, were proposed to enable safer prescribing. Following discussion with key stakeholders, increased education for pharmacists was proposed alongside an alert sticker system at the dispensing end point. Patient understanding and education for all parties was delivered through various routes. The IT system alterations required are complex and still awaited. Funding was obtained and stickers distributed. The results from a re-audit from this intervention are awaited. Interim education measures at an individual level were meantime explored and the impact of them assessed. Patient education and the role of social media were explored. I produced a short video which was circulated to doctors with the plan to distribute via other clinician social media accounts. A key discovery through this study is that many of the flash points identified can be difficult to detect and many are not measurable. The increasing number of HRT prescriptions, time pressures in primary care and the known risk from using unopposed estrogen of endometrial cancer means these changes are of potential great value.

Critical illness color-coded warning stickers: A novel parent education method – A single-center observational study

Background: Pediatric visits to children's hospitals are mostly outpatient and emergency room (ER) based. In busy outpatient departments (OPD) and ERs, children are reviewed quickly, and instructions are given to parents for management at home. Communication from physicians to the parents of the child may be deficient and incomplete, due to the high workload and other priority tasks. The purpose of this study was to assess the utility of simple color-coded information stickers for the OPD/ER file of the child for parents to recognize danger signs in their child to seek help early again if required.Subjects and Methods: This is a prospective observational study conducted on 1036 children in the age group of 1 month–18 years at a tertiary care hospital in Telangana state of India, for 1 year from January 2018 to January 2019.Results: Fifty-three of the patients were male, and the majority of them were in the 1–5-year age group. The perceived utility of the stickers was 85.3% in the affirmative. Only 14.7% felt they were not useful. Reasons for revisits to the ER/OPD were fever (33%), respiratory causes (37.7%), gastroenteritis causes (18%), head injury (9%), and epistaxis (1.5%).Conclusions: A simple color-coded sticker system used in busy OPDs and ERs in children's hospitals might prove to be a low-cost-effective communication tool for parents to utilize to recognize danger signs and report back for care when necessary.

An algorithmic approach to the use of rapid molecular diagnostics for SARS-CoV-2, influenza viruses, and other respiratory pathogens during an unprecedented respiratory season

Abstract Introduction/Objective The COVID-19 pandemic exacerbated deficiencies of testing personnel, reagents, supplies and disposables, instruments, and automation in many clinical laboratories. Upon entering respiratory season, a strategy was warranted to optimize laboratory resources when supplies were already limited and expected respiratory season test volume was unknown. An algorithm was devised to prioritize test ordering and TAT based on patient clinical scenario. Methods/Case Report The institutional respiratory season SARS-CoV-2 algorithm was constructed by a multidisciplinary team including infectious disease, infection prevention, laboratory, and IT/LIS leadership. CDC guidance on influenza testing was incorporated. Antigen-based testing was discontinued; only molecular amplification- based platforms with FDA EUA were utilized. Platforms had a range of TAT (20 minutes to 8 hours) and included fully- automated high throughput, rapid random access, point-of-care, and CDC SARS-CoV-2 assays. Test bundles included SARS-CoV-2 (monoplex), or SARS-CoV-2 + fluA&B (triplex), or SARS-CoV-2 + respiratory pathogen panel (multiplex RPP; includes 22 targets, including flu A&B). Results (if a Case Study enter NA) Key factors in the algorithm included whether the patient was outpatient or inpatient, hospital employee or not, symptomatic or not, immunocompetent or immunocompromised, and whether a concurrent order for other respiratory pathogens was included or not. Clinician responses for these factors determined the type of swab collected (wet swab in VTM or dry swab) and how quickly the TAT was indicated for a given patient using a colored-dot sticker system. Priority TAT in decreasing order was symptomatic inpatients, asymptomatic pre- procedure patients, asymptomatic admissions, symptomatic employees, and symptomatic outpatients. Conclusion An algorithm for respiratory pathogen testing during an unprecedented respiratory season prioritizes result TAT to an individual patient’s clinical situation while maximizing laboratory stewardship by eliminating redundant influenza testing and requiring ‘all upfront’ orders to avoid add-on orders that require ‘dumpster diving’ for samples. Limitations include inherent differences in sensitivity, LOD, and specificity when multiple different platforms are utilized to detect the same analytes.

The use of assisted autogenic drainage in children with cystic fibrosis; a pilot randomized controlled study

BACKGROUND:Airway clearance therapy (ACT) is standard practice to promote pulmonary mucus clearance in children with cystic fibrosis (CF). However, the efficacy of assisted autogenic drainage (AAD) in children has not been studied. OBJECTIVES:To pilot a home-based randomized controlled trial (RCT) to compare the effects of AAD to standard ACT in children with CF aged one to eight years. METHODS:Children with CF, aged one to eight years, were randomly assigned into intervention (AAD) or control (standard ACT) groups. The ACTs were taught to parents and children, to perform twice daily for a year. Primary outcome measures were number of hospitalizations, days of hospitalization, exacerbations and days of antibiotic therapy in one year. Secondary outcome measures included spirometry, and adherence assessed on every visit (through calendar and sticker system); parental proxy health related quality of life score (EQ-5D-Y), current clinical status (CF Clinical Score), weight-, height-, and BMI-for-age z-scores assessed at baseline and after one year; and preference of ACT and mortality rates were assessed at the end of the study. At the end of the study, a self-designed one on one subjective semi-structured interview with the parent(s)/caregiver(s) regarding physiotherapy management was conducted. RESULTS:Of 36 children screened for inclusion, 16 were enrolled. Seven were randomly allocated to the control group (median [IQR] age 5.7 [3.0–6.0] years, four male and three female), and nine to the intervention group (median [IQR] age 5.8 [5.5–6.6] years, five male and four female). There were no significant between-group differences, however number of exacerbations revealed medium (Cohen’s d = 0.55) effect sizes, favoring the intervention group. Although no significant improvements were seen within the intervention group, large effect sizes were found for the CF subjective and total clinical scores; and health related quality of life (Cohen’s d = 1.07, d = 0.87, and d = 0.86 respectively). This pilot study identified a number of concerns, mainly poor adherence to home-therapy in both arms of the study, and no participant in the intervention group solely performing AAD as per pre-set methodology, limiting interpretation of results. CONCLUSION:There is a need for confirmatory, adequately powered trials to evaluate safety and efficacy of AAD in children with CF. Future research needs to also consider measures to ensure better adherence to ACT.

Static Watson-Crick Linear Grammars and Its Computational Power

DNA computing, or more generally, molecular computing, is a recent development on computations using biological molecules, instead of the traditional silicon-chips. Some computational models which are based on different operations of DNA molecules have been developed by using the concept of formal language theory. The operations of DNA molecules inspire various types of formal language tools which include sticker systems, grammars and automata. Recently, the grammar counterparts of Watson-Crick automata known as Watson-Crick grammars which consist of regular, linear and context-free grammars, are defined as grammar models that generate double-stranded strings using the important feature of Watson-Crick complementarity rule. In this research, a new variant of static Watson-Crick linear grammar is introduced as an extension of static Watson-Crick regular grammar. A static Watson-Crick linear grammar is a grammar counterpart of sticker system that generates the double-stranded strings and uses rule as in linear grammar. The main result of the paper is to determine some computational properties of static Watson-Crick linear grammars. Next, the hierarchy between static Watson-Crick languages, Watson-Crick languages, Chomsky languages and families of languages generated by sticker systems are presented.

Static Watson-Crick Context-Free Grammars

Sticker systems and Watson-Crick automata are two modellings of DNA molecules in DNA computing. A sticker system is a computational model which is coded with single and double-stranded DNA molecules; while Watson-Crick automata is the automata counterpart of sticker system which represents the biological properties of DNA. Both of these models use the feature of Watson-Crick complementarity in DNA computing. Previously, the grammar counterpart of the Watson-Crick automata have been introduced, known as Watson-Crick grammars which are classified into three classes: Watson-Crick regular grammars, Watson-Crick linear grammars and Watson-Crick context-free grammars. In this research, a new variant of Watson-Crick grammar called a static Watson-Crick context-free grammar, which is a grammar counterpart of sticker systems that generates the double-stranded strings and uses rule as in context-free grammar, is introduced. The static Watson-Crick context-free grammar differs from a dynamic Watson-Crick context-free grammar in generating double-stranded strings, as well as for regular and linear grammars. The main result of the paper is to determine the generative powers of static Watson-Crick context-free grammars. Besides, the relationship of the families of languages generated by Chomsky grammars, sticker systems and Watson-Crick grammars are presented in terms of their hierarchy.

Computational Power of Static Watson-Crick Context-free Grammars

Sticker system is a computer model which is coded with single and double-stranded molecules of DNA; meanwhile, Watson-Crick automata is the automata counterpart of the sticker system representing the biological properties of DNA. Both are the modelings of DNA molecules in DNA computing which use the feature of Watson-Crick complementarity. Formerly, Watson-Crick grammars which are classified into three classes have been introduced [1]. In this research, a grammar counterpart of sticker systems that uses the rule as in context-free grammar is introduced, known as a static Watson-Crick context-free grammar. The research finding on the computational power of these grammar shows that the family of context-free languages is strictly included in the family of static Watson-Crick context-free languages; the static Watson-Crick context-free grammars can generate non context-free languages; the family of Watson-Crick context-free languages is included in the family of static Watson-Crick context-free languages which are presented in terms of their hierarchy.

Static Watson-Crick regular grammar

DNA computing, or more generally, molecular computing, is a recent development at the interface of computer science and molecular biology. In DNA computing, many computational models have been proposed in the framework of formal language theory and automata such as Watson-Crick grammars and sticker systems. A Watson-Crick grammar is a grammar model that generates double stranded strings, whereas a sticker system is a DNA computing model of the ligation and annealing operations over DNA strands using the Watson-Crick complementarity to form a complete double stranded DNA sequence. Most of the proposed DNA computing models make use of this concept, including the Watson-Crick grammars and sticker systems. Watson-Crick grammars and their variants can be explored using formal language theory which allows the development of new concepts of Watson-Crick grammars. In this research, a new variant of Watson-Crick grammar called a static Watson-Crick regular grammar is introduced as an analytical counterpart of sticker systems. The computation of a sticker system starts from a given set of incomplete double stranded sequence to form a complete double stranded sequence. Here, a static Watson-Crick regular grammar differs from a dynamic Watson-Crick regular grammar in generating double stranded strings: the latter grammar produces each strand string “independently” and only check for the Watson-Crick complementarity of a generated complete double stranded string at the end, while the former grammar generates both strand strings “dependently”, i.e., checking for the Watson-Crick complementarity for each complete substring. In this paper, computational properties of static Watson-Crick regular grammars are investigated to correlate with the Chomsky hierarchy and hierarchy of the families of dynamic Watson-Crick regular languages. The relationship between families of languages generated by static Watson-Crick regular grammars with several variants of sticker systems, Watson-Crick regular grammars and Chomsky grammars are presented by showing the hierarchy.

Variants of weighted sticker systems with different weighting spaces

Sticker systems have been introduced as one of the DNA computing models by using the recombination behavior of DNA molecules in 1998. Abstractly, the systems use the Watson-Crick complementary principle of DNA molecules to perform the computation in generating new strings. By associating some weights to the axioms and dominoes of sticker system, a new version of restricted sticker system namely weighted sticker system has been introduced. In this paper, we study the generative power of weighted sticker systems by considering the languages generated by weighted sticker system with different weighting spaces and cut-points. The relations of the languages generated by weighted sticker systems in the Chomsky hierarchy are also investigated.

Generative capacity of sticker systems with the presence of weights

DNA computing involves computing models which use the recombination behavior of DNA molecules as computation devices. This idea was successfully applied by Adleman in his biological experiment in order to show the solvability of the Hamiltonian path problem for larger instances. In 1998, a DNA based computation model, called sticker system, which is an abstraction of the computations using the recombination behavior as in Adleman’s experiment was proposed. In 2013, a new variant of sticker system using weights was introduced, namely the weighted sticker system. In this paper, the generative capacity for several variants of bounded delay and nonrestrictive weighted sticker systems are investigated. The relation between families of languages generated by several variants of weighted sticker systems and weighted grammars are also presented.

G501(P) To assess the functional status, social habits, and worries in a group of unaccompanied refugee and asylum-seeking minors and the implications of these on health behaviour and mental health

Method Unaccompanied minors used a colour sticker system to answer questions about their abilities, function, social habits and desires, and worries during contact sessions with local charity. Results “I worry about….feeling sad all the time” 83% respondents “I worry about….not being able to sleep” 92% respondents “I worry about….having nightmares” 66% respondents “I worry about….the police” 50% respondents “I worry about….my health” 42% respondents 55% described difficulty accessing health services 42% interviewed said that if they had a problem they would definitely share it with only 1 person, or no-one. Conclusions The NHS is currently facing a crisis in providing mental health for young people-many young people with acute mental health needs are unable to access CAMHS beds in the wider area. Our study has highlighted the potential for mental health problems in a group of young adults where ‘feeling sad’, ‘nightmares’ and ‘not sleeping’ are common occurrences. It is well documented that access to mental health services to asylum seekers during the resettlement period is very poor, however these unaccompanied minors are at further risk as they are on their own and often living with unknown adults and in undesirable accommodation. Protective factors to refugee/asylum seeking children have been documented as good settlement and social support in new country. However, for this specific group of children this is stability they often lack, putting them at further risk. Studies and recent highly publicised reports have found that children in care are at higher risk of physical and sexual abuse and mental health problems, our study found that 16% would not feel comfortable sharing a problem with anyone, and a further 25% would only share it with 1 named role. Ensuring a proactive approach to mental health in this community is key, small specialist organisations are vital for providing additional support to these unaccompanied minors, providing stability and facilitating positive, trusting relationships with adults.

Sticker Systems Over Monoids

Molecular computing has gained many interests among researchers since Head introduced the first theoretical model for DNA based computation using the splicing operation in 1987. Another model for DNA computing was proposed by using the sticker operation which Adlemanused in his successful experiment for the computation of Hamiltonian paths in a graph: a double stranded DNA sequence is composed by prolonging to the left and to the right a sequence of (single or double) symbols by using given single stranded strings or even more complex dominoes with sticky ends, gluing these ends together with the sticky ends of the current sequence according to a complementarity relation. According to this sticker operation, a language generative mechanism, called a sticker system, can be defined: a set of (incomplete) double-stranded sequences (axioms) and a set of pairs of single or double-stranded complementary sequences are given. The initial sequences are prolonged to the left and to the right by using sequences from the latter set, respectively. The iterations of these prolongations produce “computations” of possibly arbitrary length. These processes stop when a complete double stranded sequence is obtained. Sticker systems will generate only regular languages without restrictions. Additional restrictions can be imposed on the matching pairs of strands to obtain more powerful languages. Several types of sticker systems are shown to have the same power as regular grammars; one type is found to represent all linear languages whereas another one is proved to be able to represent any recursively enumerable language. The main aim of this research is to introduce and study sticker systems over monoids in which with each sticker operation, an element of a monoid is associated and a complete double stranded sequence is considered to be valid if the computation of the associated elements of the monoid produces the neutral element. Moreover, the sticker system over monoids is defined in this study.

Probabilistic sticker systems

A model for DNA computing using the recombination behaviour of DNA molecules known as a sticker system has been introduced by Adleman in 1994. A sticker model is an abstract computational model which uses the Watson-Crick complementary principle of DNA molecules. Starting from the axioms – incomplete double stranded sequences, and iteratively using sticking operations, complete double stranded sequences are obtained. It is known that sticker systems with finite sets of axioms and sticker rules generate only regular languages. Hence, different types of restrictions have been considered to increase the computational power of sticker systems. In this paper, we introduce probabilistic sticker systems in which probabilities are initially associated with the axioms, and the probability of the generated string is computed by multiplying the probabilities of all occurrences of the initial strings used in the computation of the string.

An audit of patient inclusion in retinopathy of prematurity (ROP) screening and whether discharge summaries contained ROP information with suggestions for improvement

Correspondence: Samantha Harding Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK Tel: +44 207 405 9200 Fax: +44 207 829 8647 Email samanthaharding86@googlemail.com Abstract: In a busy neonatal unit with a number of very sick children it can be difficult to highlight those children requiring retinopathy of prematurity screening and to include this in the patient’s discharge summary to ensure continuity of care. This audit looks at how efficiently children are included in the retinopathy of prematurity (ROP) screening programme at one tertiary referral unit and how well information is recorded in the discharge summary. A total of 185 infants were audited over two, 3-month periods with a sticker system for the notes devised between measurements. Re-audit showed improvement in the numbers included for ROP screening and the frequency with which ROP information was included in the discharge summaries. This simple, low cost system provides an effective method of ensuring optimum care for premature infants with ROP.

Sticker P System

A computability model based on DNA sequences called sticker systems was introduced by Kari et al. (1998). Sticker systems are language generating devices based on the sticker operation. In this work, a theoretical study about a new class of P system based on the sticker operation has been proposed. In this system, objects are double stranded sequences with sticky ends and evolution rules are sticking rules based on sticker operation. The authors compare the language generated by the proposed system with regular languages. The authors suggest another P system based on the bidirectional sticker system.

Analysis for Graph Coloring Problem Based on Sticker and Deletion Systems

Graph coloring problem is a NP-complete one of graph and combinatorial optimization.The computational time increases exponentially with the size of the researched problem solved using the usual methods.Thus it is impossible to settle it efficiently.Sticker system and deletion system are the language generated mechanisms based on sticking and deleting operations respectively.In this paper,graph coloring problem was combined with the number of bad edges and transformed into a problem of searching for the longest sequence.On the basis,the chromatic number and all the color classes of graph were obtained using the parallelism of two formal models:sticker system and deletion system.Compared with the existing DNA algorithm for graph coloring problem,the proposed algorithm is of lower complexity.

Sticker DNA computer model —Part I: Theory

Sticker model is one of the basic models in the DNA computer models. This model is coded with single-double stranded DNA molecules. It has the following advantages that the operations require no strands extension and use no enzymes; What’s more, the materials are reusable. Therefore it arouses attention and interest of scientists in many fields. In this paper, we will systematically analyze the theories and applications of the model, summarize other scientists’ contributions in this field, and propose our research results. This paper is the theoretical portion of the sticker model on DNA computer, which includes the introduction of the basic model of sticker computing. Firstly, we systematically introduce the basic theories of classic models about sticker computing; Secondly, we discuss the sticker system which is an abstract computing model based on the sticker model and formal languages; Finally, extend and perfect the model, and present two types of models that are more extensive in the applications and more perfect in the theory than the past models: one is the so-calledk-bit sticker model, the other is full-message sticker DNA computing model.

Differential Reinforcement of Other Behavior in the Treatment of Inappropriate Behavior and Aggression in an Adult with Mental Retardation at a Vocational Center

Differential reinforcement of other behavior (DRO) was used to reduce aggression and other inappropriate actions in a 26-year-old man with moderate mental retardation employed at a vocational center. Initially high baseline levels of inappropriate behavior were reduced by implementing contingent praise and a sticker system used to earn points needed to gain access to social activities. The procedure was low cost, required minimal time and effort on the part of center staff, and made it possible for the client to remain employed at the vocational center.

Documentation of Community Clergy Visits in an Acute Care Hospital

Hospitals function and are dependent upon good documentation. Increased sensitivity to patients' spiritual needs as an important part of the healing process has highlighted the fact that, compared to the vast amount of pastoral care that is delivered, relatively little documentation is actually made. This hospital sought to demonstrate and document pastoral care given by community clergy through the use of a sticker system. This article describes the objectives of the program, the process of instituting it in a community hospital, and the opportunities for evaluation and performance improvement.

How Converting to a Sticker System for Charging of Medical Supplies

How Converting to a Sticker System for Charging of Medical Supplies