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Improving the quality of care on psychiatric inpatient wards has been a major focus in recent mental health policy, a recurrent criticism being that contact between staff and patients is limited in time and therapeutic value. Change is unlikely to be achieved without recruitment and retention of a high quality and well-motivated work force.
Aim:
The NHS commissioned national inpatient mental health staff morale study is intended to inform service planning and policy by delivering evidence on the morale of the inpatient mental health workforce and the clinical, organisational, architectural and human resources factors that influence it.
Methods:
100 wards in 17 area ‘Trusts’ are participating in the study, in addition to 40 community teams. The study will take place over two years, and has 6 modules:
1. A quantitative questionnaire for all staff in participating wards and
2. A comparison group in 20 community mental health teams and 20 crisis teams.
3. Case studies of 10 wards scoring in the top and bottom quartile for indicators of morale.
4. Repeated questionnaires for 20 wards in the second year to investigate how morale changes over time.
5. Staff who leave the wards in the course of the first year will be asked their reasons for leaving.
6. Links between rates of staff sickness and morale will be investigated.
Results:
Questionnaires have been distributed to 3,500 staff with a response rate of 65%, results from which will be presented in 2009.
Cardiovascular risk prediction tools are important for cardiovascular disease (CVD) prevention, however, which algorithms are appropriate for people with severe mental illness (SMI) is unclear.
Objectives/aims
To determine the cost-effectiveness using the net monetary benefit (NMB) approach of two bespoke SMI-specific risk algorithms compared to standard risk algorithms for primary CVD prevention in those with SMI, from an NHS perspective.
Methods
A microsimulation model was populated with 1000 individuals with SMI from The Health Improvement Network Database, aged 30–74 years without CVD. Four cardiovascular risk algorithms were assessed; (1) general population lipid, (2) general population BMI, (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those high-risk (> 10%) were assumed to be prescribed statin therapy, others received usual care. Individuals entered the model in a ‘healthy’ free of CVD health state and with each year could retain their current health state, have cardiovascular events (non-fatal/fatal) or die from other causes according to transition probabilities.
Results
The SMI-specific BMI and general population lipid algorithms had the highest NMB of the four algorithms resulting in 12 additional QALYs and a cost saving of approximately £37,000 (US$ 58,000) per 1000 patients with SMI over 10 years.
Conclusions
The general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of a SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Prevention of Clostridioides difficile infection (CDI) is a national priority and may be facilitated by deployment of the Targeted Assessment for Prevention (TAP) Strategy, a quality improvement framework providing a focused approach to infection prevention. This article describes the process and outcomes of TAP Strategy implementation for CDI prevention in a healthcare system.
Methods:
Hospital A was identified based on CDI surveillance data indicating an excess burden of infections above the national goal; hospitals B and C participated as part of systemwide deployment. TAP facility assessments were administered to staff to identify infection control gaps and inform CDI prevention interventions. Retrospective analysis was performed using negative-binomial, interrupted time series (ITS) regression to assess overall effect of targeted CDI prevention efforts. Analysis included hospital-onset, laboratory-identified C. difficile event data for 18 months before and after implementation of the TAP facility assessments.
Results:
The systemwide monthly CDI rate significantly decreased at the intervention (β2, −44%; P = .017), and the postintervention CDI rate trend showed a sustained decrease (β1 + β3; −12% per month; P = .008). At an individual hospital level, the CDI rate trend significantly decreased in the postintervention period at hospital A only (β1 + β3, −26% per month; P = .003).
Conclusions:
This project demonstrates TAP Strategy implementation in a healthcare system, yielding significant decrease in the laboratory-identified C. difficile rate trend in the postintervention period at the system level and in hospital A. This project highlights the potential benefit of directing prevention efforts to facilities with the highest burden of excess infections to more efficiently reduce CDI rates.
The sustainability concept seeks to balance how present and future generations of humans meet their needs. But because nature is viewed only as a resource, sustainability fails to recognize that humans and other living beings depend on each other for their well-being. We therefore argue that true sustainability can only be achieved if the interdependent needs of all species of current and future generations are met, and propose calling this ‘multispecies sustainability’. We explore the concept through visualizations and scenarios, then consider how it might be applied through case studies involving bees and healthy green spaces.
Feed represents a substantial proportion of production costs in the dairy industry and is a useful target for improving overall system efficiency and sustainability. The objective of this study was to develop methodology to estimate the economic value for a feed efficiency trait and the associated methane production relevant to Canada. The approach quantifies the level of economic savings achieved by selecting animals that convert consumed feed into product while minimizing the feed energy used for inefficient metabolism, maintenance and digestion. We define a selection criterion trait called Feed Performance (FP) as a 1 kg increase in more efficiently used feed in a first parity lactating cow. The impact of a change in this trait on the total lifetime value of more efficiently used feed via correlated selection responses in other life stages is then quantified. The resulting improved conversion of feed was also applied to determine the resulting reduction in output of emissions (and their relative value based on a national emissions value) under an assumption of constant methane yield, where methane yield is defined as kg methane/kg dry matter intake (DMI). Overall, increasing the FP estimated breeding value by one unit (i.e. 1 kg of more efficiently converted DMI during the cow’s first lactation) translates to a total lifetime saving of 3.23 kg in DMI and 0.055 kg in methane with the economic values of CAD $0.82 and CAD $0.07, respectively. Therefore, the estimated total economic value for FP is CAD $0.89/unit. The proposed model is robust and could also be applied to determine the economic value for feed efficiency traits within a selection index in other production systems and countries.
Immunization data are vital to support responses to vaccine-preventable disease outbreaks. The Oregon Immunization Program developed a unique prototype instrument—the Rapid Response Tool (RRT)—that provides population data to local responders within 2 hours of a request. Data outputs include vaccination coverage by age group and zip code; percentages of students with nonmedical exemptions to vaccination requirements, by school; and current, comprehensive lists of local vaccination providers.
Methods
The RRT was demonstrated to staff at 7 Oregon counties and feedback was solicited via comments and a structured survey.
Results
The RRT received strong support. Attendees identified several uses for RRT data, including outbreak response and ongoing intervention efforts, and they pointed to areas for further development.
Conclusions
The success of the RRT demonstrations illustrates that a well-populated immunization information system can contribute to preparedness work well beyond current standards. (Disaster Med Public Health Preparedness. 2019;13:682–685)
Economists typically use seasonally adjusted data in which the assumption is imposed that seasonality is uncorrelated with trend and cycle. The importance of this assumption has been highlighted by the Great Recession. The paper examines an unobserved components model that permits nonzero correlations between seasonal and nonseasonal shocks. Identification conditions for estimation of the parameters are discussed from the perspectives of both analytical and simulation results. Applications to UK household consumption expenditures and US employment reject the zero correlation restrictions and also show that the correlation assumptions imposed have important implications about the evolution of the trend and cycle in the post-Great Recession period.
In 2011 the Incidence Assay Critical Path Working Group reviewed the current state of HIV incidence assays and helped to determine a critical path to the introduction of an HIV incidence assay. At that time the Consortium for Evaluation and Performance of HIV Incidence Assays (CEPHIA) was formed to spur progress and raise standards among assay developers, scientists and laboratories involved in HIV incidence measurement and to structure and conduct a direct independent comparative evaluation of the performance of 10 existing HIV incidence assays, to be considered singly and in combinations as recent infection test algorithms. In this paper we report on a new framework for HIV incidence assay evaluation that has emerged from this effort over the past 5 years, which includes a preliminary target product profile for an incidence assay, a consensus around key performance metrics along with analytical tools and deployment of a standardized approach for incidence assay evaluation. The specimen panels for this evaluation have been collected in large volumes, characterized using a novel approach for infection dating rules and assembled into panels designed to assess the impact of important sources of measurement error with incidence assays such as viral subtype, elite host control of viraemia and antiretroviral treatment. We present the specific rationale for several of these innovations, and discuss important resources for assay developers and researchers that have recently become available. Finally, we summarize the key remaining steps on the path to development and implementation of reliable assays for monitoring HIV incidence at a population level.
In traditional transit timing variations (TTVs) analysis of multi-planetary systems, the individual TTVs are first derived from transit fitting and later modelled using n-body dynamic simulations to constrain planetary masses. We show that fitting simultaneously the transit light curves with the system dynamics (photo-dynamical model) increases the precision of the TTV measurements and helps constrain the system architecture. We exemplify the advantages of applying this photo-dynamical model to a multi-planetary system found in K2 data very close to 3:2 mean motion resonance, K2-19. In this case the period of the larger TTV variations (libration period) is much longer (>1.5 years) than the duration of the K2 observations (80 days). However, our method allows to detect the short period TTVs produced by the orbital conjunctions between the planets that in turn permits to uniquely characterise the system. Therefore, our method can be used to constrain the masses of near-resonant systems even when the full libration curve is not observed.
This essay considers American Catholics who, from the late 1950s to the early 1970s, reflected seriously on the religious significance of technology in general, and space science in particular. American Catholics, while no more immune from the belief that space science would create fundamental changes in human life than their Protestant, Jewish, and secular counterparts, nevertheless sought to understand the Space Age in their own distinctive terms. Catholic discussion of these issues revolved around the contributions of two theologians. From the earliest moments of the Space Age, Thomas Aquinas provided a justification for the work of Catholic scientists and astronauts within a Cold War framework. However, Pierre Teilhard de Chardin's cosmic vision helped American Catholics integrate feelings of wonder and hope with darkly realistic fears about the military consequences of the space race. Thomas and Teilhard, fundamentally optimists, helped Catholics elaborate a vision of a way forward through the very real threats Americans confronted in the “long 1960s,” a vision they developed in books, articles, and speeches, but also in art, liturgy, and fiction. Ultimately, however, both extreme hopes about cosmic unification and extreme fears about total annihilation modulated, and like their fellow Americans interested in space flight during the 1960s, American Catholics turned in the early 1970s to a renewed focus on the Earth.
Edited by
John Allan, Consultant Archaeologist to the Dean and Chapter of Exeter Cathedral,Nat Alcock, Emeritus Reader in the Department of Chemistry, University of Warwick,David Dawson, Independent archaeologist and museum and heritage consultant
Edited by
John Allan, Consultant Archaeologist to the Dean and Chapter of Exeter Cathedral,Nat Alcock, Emeritus Reader in the Department of Chemistry, University of Warwick,David Dawson, Independent archaeologist and museum and heritage consultant
Edited by
John Allan, Consultant Archaeologist to the Dean and Chapter of Exeter Cathedral,Nat Alcock, Emeritus Reader in the Department of Chemistry, University of Warwick,David Dawson, Independent archaeologist and museum and heritage consultant
Edited by
John Allan, Consultant Archaeologist to the Dean and Chapter of Exeter Cathedral,Nat Alcock, Emeritus Reader in the Department of Chemistry, University of Warwick,David Dawson, Independent archaeologist and museum and heritage consultant
Edited by
John Allan, Consultant Archaeologist to the Dean and Chapter of Exeter Cathedral,Nat Alcock, Emeritus Reader in the Department of Chemistry, University of Warwick,David Dawson, Independent archaeologist and museum and heritage consultant
During the last forty years, South-West England has been the focus of some of the most significant work on the early modern house and household in Britain. Its remarkable wealth of vernacular buildings has been the object of much attention, while the area has also seen productive excavations of early modern household goods, shedding new light on domestic history. This collection of papers, written by many of the leading specialists in these fields, presents a number of essays summarizing the overall understanding of particular themes and places, alongside case studies which publish some of the most remarkable discoveries. They include the extraordinary survival of wall-hangings in a South Devon farm, the discovery of painted rooms in an Elizabethan town house, and a study of a table-setting mirrored on its ceiling. Also considered are forms of decoration which seem specific to particular areas of the West Country houses. Taken together, the papers offer a holistic view of the household in the early modern period. John Allan is Consultant Archaeologist to the Dean & Chapter of Exeter Cathedral; Nat Alcock is Emeritus Reader in the Department of Chemistry, University of Warwick; David Dawson is an independent archaeologist and museum and heritage consultant. Contributors: Ann Adams, Nat Alcock, John Allan, James Ayres, Stuart Blaylock, Peter Brears, Tania Manuel Casimiro, Cynthia Cramp, Christopher Green, Oliver Kent, Kate Osborne, Richard Parker, Isabel Richardson, John Schofield, Eddie Sinclair, John R.L. Thorp, Hugh Wilmott.
Edited by
John Allan, Consultant Archaeologist to the Dean and Chapter of Exeter Cathedral,Nat Alcock, Emeritus Reader in the Department of Chemistry, University of Warwick,David Dawson, Independent archaeologist and museum and heritage consultant
Edited by
John Allan, Consultant Archaeologist to the Dean and Chapter of Exeter Cathedral,Nat Alcock, Emeritus Reader in the Department of Chemistry, University of Warwick,David Dawson, Independent archaeologist and museum and heritage consultant
Edited by
John Allan, Consultant Archaeologist to the Dean and Chapter of Exeter Cathedral,Nat Alcock, Emeritus Reader in the Department of Chemistry, University of Warwick,David Dawson, Independent archaeologist and museum and heritage consultant
Edited by
John Allan, Consultant Archaeologist to the Dean and Chapter of Exeter Cathedral,Nat Alcock, Emeritus Reader in the Department of Chemistry, University of Warwick,David Dawson, Independent archaeologist and museum and heritage consultant