Lessons learned from the hospital to home community care program in Singapore and the supporting AI multiple readmissions prediction model

In a prior practice and policy article published in Healthcare Science,we introduced the deployed application of an artificial intelligence(AI)model to predict longer‐term inpatient readmissions to guide community care interventions for patients with complex conditions in the context of Singapore's Hospital to Home(H2H)program that has been operating since 2017.In this follow on practice and policy article,we further elaborate on Singapore's H2H program and care model,and its supporting AI model for multiple readmission prediction,in the following ways:(1)by providing updates on the AI and supporting information systems,(2)by reporting on customer engagement and related service delivery outcomes including staff‐related time savings and patient benefits in terms of bed days saved,(3)by sharing lessons learned with respect to(i)analytics challenges encountered due to the high degree of heterogeneity and resulting variability of the data set associated with the population of program participants,(ii)balancing competing needs for simpler and stable predictive models versus continuing to further enhance models and add yet more predictive variables,and(iii)the complications of continuing to make model changes when the AI part of the system is highly interlinked with supporting clinical information systems,(4)by highlighting how this H2H effort supported broader Covid‐19 response efforts across Singapore's public healthcare system,and finally(5)by commenting on how the experiences and related capabilities acquired from running this H2H program and related community care model and supporting AI prediction model are expected to contribute to the next wave of Singapore's public healthcare efforts from 2023 onwards.For the convenience of the reader,some content that introduces the H2H program and the multiple readmissions AI prediction model that previously appeared in the prior Healthcare Science publication is repeated at the beginning of this article.

All Roads Lead to Home

In today’s world, there are some essential elements that make up a nation’s lasting strengths and prosperity. The commonly recognized elements may include abundant capital, solid industrial bases, strategic energy and raw materials, a high level of science

Mortality following combined fractures of the hip and proximal humerus

BACKGROUND Hip fractures and proximal humerus fractures are known to be associated with increased mortality,but the impact on mortality of combining these two common injuries is not well known.AIM To compare mortality,inpatient stay and discharge destination for patients with combined hip and proximal humerus fractures with those sustaining isolated hip fractures.METHODS Using the United Kingdom national hip fracture database,we identified all hip fracture patients over the age of 60 admitted to a single trauma unit from 2010-2016.Patients sustaining a proximal humerus fracture in addition to their hip fracture were identified using hospital coding data.We calculated the 30-d and one-year mortality for both the hip fracture cohort and the combined hip and proximal humerus fracture cohort.Other variables recorded included age,gender and whether the proximal humerus was treated with or without an operation.RESULTS We identified 4131 patients with hip fractures within the study period and out of those 40 had sustained both a hip and a proximal humerus fracture.Mean age in the hip fracture cohort was 80.9 years and in the combined fracture group 80.3 years.Out of the 40 patients in the combined group four were treated operatively.The 30-d mortality for our hip fracture cohort was 7.2%compared to the mortality of our combined cohort of 12.5%(P=0.163).The one-year mortality for our hip fracture cohort was 26.4%compared to 40%for the combined fracture cohort(P=0.038).We also found patients with combined injuries were less likely to return to their own home.CONCLUSION The 30-d and one-year mortality is higher for those patients who have sustained a combined hip and proximal humerus fracture when compared to those with a hip fracture alone.

Professional Learning Communities(PLCs)of Chemistry Teachers

The models of Professional Learning Communities(PLCs)are based on principles of learning that emphasize the co-construction of knowledge by learners,who in this case are the teachers themselves.Teachers in a PLC meet regularly to explore their practices and the learning outcomes of their students,analyze their teaching and their students’learning processes,draw conclusions,and make changes in order to improve their teaching and the learning of their students.It was found that participation in a PLC influences teaching practice,so teachers become more student-centered.Moreover,the teaching culture improves as the community increases the degree of cooperation among teachers,and focuses on the processes of learning rather than the accumulation of knowledge.This enables students to be innovative,creative,and critical.In addition,trust is developed among the participants,which enables them to discuss and analyze their students’cognitive and affective problems,misconceptions,and learning outcomes.

重引入林麝的家域利用与个体迁移

林麝(Moschus berezovskii)是典型的林栖偶蹄目动物,被列为国家Ⅰ级保护野生动物。栖息地破坏引起的家域丧失是导致其濒危的重要因素。了解其家域面积,生境偏好等基本信息,是更好保护这一重要珍稀濒危动物的前提。但是,由于林麝生性机警,在野外环境中难以人为追踪,这些数据相对缺乏。2017年6月,我们为8只野化训练后的圈养林麝佩戴GPS项圈,并放归到陕西省平河梁国家级自然保护区。经过一年的监测,共获取6只林麝的野外活动点位,利用固定核空间法计算出家域面积,并分析了其家域特征和迁徙行为。结果显示:林麝在非繁殖期间各自占据独立的家域,表现出独居的特征;它们倾向于选择植被丰富、接近水源、半阴半阳、坡度陡峭并多悬崖峭壁的区域作为栖息地;一雄一雌两个个体全年家域面积分别为168.85hm^2、64.87hm^2,全年核心家域面积分别为40.08 hm^2、15.36 hm^2;在交配期间,雄性林麝会主动向雌性靠近,从而发生家域重叠。基于以上数据,本研究提出,林麝的实际家域面积,可能高于此前粗估,并建议在后续保护工作中,需要注重保障其基本生存面积。

荒漠区不同放牧干扰下五趾跳鼠的巢区变化及影响因素

于2017~2019年在阿拉善荒漠区的过度放牧区和轮牧区,采用标志重捕法对五趾跳鼠种群进行监测,并应用最小凸多边形法研究其巢区变化。结果表明:雄性五趾跳鼠巢区面积大于雌性,但差异不显著;五趾跳鼠平均巢区面积表现出夏季(1085.56±676.93m^(2))>春季(856.47±779.40m^(2))>秋季(834.42±793.56m^(2))的趋势,季节之间有显著差异(P<0.05);五趾跳鼠平均巢区面积在过牧区为1084.82±873.44m^(2),轮牧区为766.15±585.15m^(2),过牧区显著大于轮牧区(P<0.05)。五趾跳鼠的巢区主要受季节、放牧方式及栖息地食物资源影响。

Energy management of micro renewable energy source and electric vehicles at home level

As renewable energy source(RES)tend to be integrated more and more at home and electric vehicles(EVs)take a greater share in the personal automobile market,users see a chance to charge their EVs by microRES.In this context,this paper presents a review about opportunities and challenges needed to be overcome by the EV users to implement a vehicle to home system in their homes,as well as the integration of micro-RES.Several practical scenarios are presented,with different demand profiles,by integrating renewable energy that could be used to charge the EV.