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Polycentric governance has emergent properties that we argue can be explained through an analysis of the dynamics of institutional change. In this chapter, we use institutional change theories and evolutionary and complex adaptive systems (CAS) thinking to trace mechanisms observed in the change and emergence of polycentric governance. We offer an explanatory model of how polycentric governance changes. Particularly, we consider institutional change of polycentric governance to be negotiated in interdependent (networks of) action situations. Change (or emergence) of governance is the result of endogenous changes (e.g. in power resources actors hold) and/ or of exogenous drivers such as technological change. Polycentric governance shares characteristics with Complex Adaptive Systems (CAS) whose change is evolutionary. We highlight the particular difficulties this perspective entails for assessing institutional performance. We illustrate the evolution of polycentric governance arrangements through two vignettes summarizing case study material from Kenya and Mexico.
The history of London has long been entwined with expansions of financial capital and the machinations of global plutocrats and their more proximate counterparts.1 However, what has happened in the decade since the global financial crisis is without precedent. London has been transformed into a city for global capital rather than one designed to meet the needs and aspirations of the majority of its denizens.2
Low energy and protein intakes have been associated with an increased risk of malnutrition in outpatients with chronic obstructive pulmonary disease (COPD). We aimed to assess the energy and protein intakes of hospitalised COPD patients according to nutritional risk status and requirements, and the relative contribution from meals, snacks, drinks and oral nutritional supplements (ONS), and to examine whether either energy or protein intake predicts outcomes. Subjects were COPD patients (n 99) admitted to Landspitali University Hospital in 1 year (March 2015–March 2016). Patients were screened for nutritional risk using a validated screening tool, and energy and protein intake for 3 d, 1–5 d after admission to the hospital, was estimated using a validated plate diagram sheet. The percentage of patients reaching energy and protein intake ≥75 % of requirements was on average 59 and 37 %, respectively. Malnourished patients consumed less at mealtimes and more from ONS than lower-risk patients, resulting in no difference in total energy and protein intakes between groups. No clear associations between energy or protein intake and outcomes were found, although the association between energy intake, as percentage of requirement, and mortality at 12 months of follow-up was of borderline significance (OR 0·12; 95 % CI 0·01, 1·15; P=0·066). Energy and protein intakes during hospitalisation in the study population failed to meet requirements. Further studies are needed on how to increase energy and protein intakes during hospitalisation and after discharge and to assess whether higher intake in relation to requirement of hospitalised COPD patients results in better outcomes.
The Institute of Translational Health Sciences (ITHS) promotes and supports translational research collaboration between clinicians, communities, and investigators across the five-state Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region. The ITHS has developed a collaborative regional clinical research network, the Northwest Participant & Clinical Interactions Network (NW PCI), involving 12 diverse clinical health systems and academic institutions.
This descriptive article details NW PCI’s development, infrastructure and governance, tools, characteristics, and initial outcomes.
Regional NW PCI sites are conducting largely industry-sponsored studies; they are interested in including more grant-funded research. Regional NW PCI sites had over 1,240 open studies involving over 6700 patients in 2016. NW PCI trials are largely industry-sponsored; NW PCI sites are interested in including more grant-funded research. In its first three years, the NW PCI Coordinating Center facilitated regional sites’ participation in 34 new grant and contract applications across diverse topics.
The NW PCI model supports the goals of the developing CTSA Trial Innovation Network by increasing access to cutting-edge research across the Northwestern U.S., by supporting investigators seeking diverse populations, including those with rare diseases, for their research studies, and by providing settings to test implementation and dissemination of effective interventions.
Why did the Ghanaian state go to such extraordinary lengths to facilitate the reliable broadcast of the World Cup in 2014? During a period of frequent power outages, Ghana swapped power with regional neighbours and directed major domestic industries to reduce production in order to allow Ghanaians to watch their national soccer team compete in the World Cup. This paper investigates the politics of the public service provision of electricity in Ghana. We focus on the short-term crisis during the 2014 World Cup to reveal the citizens' and politicians' expectations about electricity as a public good. Drawing on an analysis of archival documents, Ghanaian newspapers, and interviews with government, business, and NGO officials in the energy sector, we argue that the Ghanaian state historically has created the expectation of electricity as a right of national citizenship and explore how this intersects with competitive party politics today.
The aim of this review paper is to consider how the principles of clinical audit could be applied to the development of an audit of nutritional care in hospitals and care homes, based on criteria derived from the Essence of Care: Food and Drink. A literature review identified fifteen key papers that included guidance or standards for nutritional care in hospitals or care homes. These were used to supplement the ten factors suggested by the Essence of Care to develop a set of potential audit criteria covering all aspects of the nutritional care pathway including the identification of risk of malnutrition, implementation of nutritional care plans, referral to healthcare professionals for further nutritional assessment and nutritional support strategies. A series of audit tools have been developed, including an organisational level audit tool, a staff questionnaire, a patients' and residents' records audit tool and a patients' and residents' experiences questionnaire. Further issues to consider in designing a national nutritional audit include the potential role of direct observation of care, the use of trained auditors and the scope for including the results of pre-existing local audits. In conclusion, a national audit would need to encompass a very large number of health and care organisations of widely varying sizes and types and a diverse range of people.
Escherichia coli O157 infections cause an estimated 60 deaths and 73000 illnesses annually in the United States. A marked summer peak in incidence is largely unexplained. We investigated an outbreak of E. coli O157 infections at an agricultural fair in Ohio and implicated consumption of beverages made with fairground water and sold by a geographically localized group of vendors who were all on the same branch of the fairground water distribution system. To examine county fair attendance as a risk factor for infection, we conducted two further epidemiological studies. In the first, we enhanced surveillance for E. coli O157 infections in 15 Northeast Ohio counties during the 2000 agricultural fair season and showed increased risk of E. coli O157 infection among fair attendees. In the second study, we examined Ohio Public Health Laboratory Information Service (PHLIS) data for 1999 using a time-varying covariate proportional hazards model and demonstrated an association between agricultural fairs and E. coli O157 infections, by county. Agricultural fair attendance is a risk factor for E. coli O157 infection in the United States and may contribute to the summer peak in incidence. Measures are needed to reduce transmission of enteric pathogens at agricultural fairs.
A new generation of thin film shape memory alloy (SMA) for MEMS micro-actuator has been developed, in which film structure and chemistry are optimized, for enhanced higher transition temperature, higher strain recovery rate as well as reduced actuation time by improving the heat transfer rates. Thin film TiPdNi was produced using Ion Beam Assisted Deposition (IBAD) technique both by in-situ heat treating during deposition and followed by post processing heat treatment. Films deposited on unheated substrates were found to be highly amorphous with minimal B2 austenite crystallization, while films deposited on heated substrates produced a highly crystallized twinned B19 martensitic structure through the bulk of the film. For films deposited on heated substrates, a 70 nm thick transition layer was found to exist between the bulk film and silicon substrate. Severe delamination and oxidation as a result of post heat treatment on IBAD deposited samples made in-situ heat treatment most suitable for processing thin film SMAs for MEMS applications. The desire to introduce this innovative technology to the field of SMA micro-actuators is based on two primary advantages of IBAD process over existing technology used to apply thin film SMAs. First, the chemical composition and grain size of the applied coating can be precisely controlled over a wide range of values. Second, the SMA can be deposited as thin films ≤ 2 μm thick with smaller grain size, much denser than films applied using sputter deposition technology. The effects of various processing parameters, and post processing heat treatment, on properties of the thin film SMA were studied.
Psychiatric patients have an elevated risk of suicide while in hospital.
To compare social, clinical and health-care delivery factors in in-patient and out-patient suicides and their controls.
Retrospective case-control study of 59 in-patients and 106 controls, matched for age, gender, diagnosis and admission date. Odds ratios were calculated using conditional multiple logistic regression.
There were seven independent increased-risk factors: history of deliberate self-harm, admission under the Mental Health Act, involvement of the police in admission, depressive symptoms, violence towards property, going absent without leave and a significant care professional being on leave. When compared with out-patient suicides, in-patients were more often female and male in-patients had a psychotic illness. Unlike the out-patient suicides, social factors were not found to be significant.
The characteristics of inpatient and out-patient suicides differ. Identified risk factors have relatively low sensitivity and specificity.
Psychiatric patients have a higher suicide risk following hospital discharge.
To identify social, clinical and health-care delivery factors in recently discharged patients.
Retrospective case-control study of 234 patients who died within 1 year of hospital discharge, matched for age, gender, diagnosis and admission period with 431 controls. Odds ratios for identified risk factors were calculated using conditional multiple logistic regression.
Independent increased-risk factors were: not being White; living alone; history of deliberate self-harm (DSH); suicidal ideation precipitating admission; hopelessness; admission under different consultant; onset of relationship difficulties; loss of job; in-patient DSH; unplanned discharge; significant care professional leaving/on leave. Reduced-risk factors were: shared accommodation; delusions at admission; misuse of non-prescribed substances; and continuity of contact.
Continuity of contact may reduce suicide risk. Discontinuity of care from a significant professional is associated with increased risk of suicide.
A postal questionnaire survey of nearly a thousand doctors investigated their awareness of the Defeat Depression campaign. Nearly all the consultant psychiatrists had heard of the campaign compared to less than half of the geriatricians and the general practitioners (GPs). Just over half of the psychiatry trainees had heard of the campaign. GPs who had not heard of the campaign were also less likely to continue antidepressant treatment beyond three months after recovery, less familiar with the psychological therapies, and less confident about treating depression in the elderly. The campaign may benefit from an increased emphasis on doctors other than psychiatrists.
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