Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network.

BACKGROUND: Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. METHOD: We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. RESULTS: We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR - Patients at risk of readmission and ACG - Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. CONCLUSIONS: Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don't change

Towards a complex system of personal and group characteristics for ICT appropriation

This research tackles the phenomenon of digital inclusion, considered as a type of social development that has grown, due to the advance of information and communication technologies (ICT). It is worth noting that, the "ICT advance" has not been uniformly distributed, since there is a difference regarding the access to technology, and to the use of it among groups and people. Though the governments, the organizations and the ICT institutions, recognize the social nature of the digital inclusion, and also, they are aware of the necessity of integrating communities and people, with the process of program and/or project management; these people and communities are not considered, in the proposals that are being made about this issue. Likewise, though it is clear in the revision of literature, the necessity of having quantitative and qualitative approaches, the numerical approach that is being performed in the phenomenon is evident. Additionally, it has been identified the fact that, there are diverse personal and social characteristics, that allow the appropriation of ICT tools, as well as their use to achieve goals and to improve the conditions, for participating in the employment, education and political activities. The digital inclusion is a situation that involves different factors, such as: cultural, technical, social, financial, regulatory, moral and even ecological. If this topic is tackled in a quantitative way, the aforementioned factors seem to be unrelated. However, in the literature analysis, their relation is obvious, as well as the fact that they cannot be unrelated form one another. In other words, the elements that conform the digital inclusion phenomenon, are not only heterogeneous, but also inter-definable. The former statement justifies the analysis of the digital inclusion phenomenon, as a complex system; since regarding the ICT appropriation, there is a wide variety of proposals, considering the personal and social variables, that regulate this process. Nevertheless, there is not yet a consensus about these variables, which is the proposal presented in this paper

Linguistic alignment and theory of mind impairments in schizophrenia patients' dialogic interactions

BACKGROUND: Impairments of contextual processing and theory of mind (ToM) have both been offered as accounts of the deviant language characterising formal thought disorder (FTD) in schizophrenia. This study investigated these processes in patients' dialogue. We predicted that FTD patients would show a decrement in linguistic alignment, associated with impaired ToM in dialogue. METHODS: Speech samples were elicited via participation in an interactive computer-based task and a semi-structured interview to assess contextual processing abilities and ToM skills in dialogue, respectively, and from an interactive card-sorting task to measure syntactic alignment. Degree of alignment in dialogue and the syntactic task, and evidence of ToM in (i) dialogue and (ii) a traditional ToM task were compared across schizophrenia patients with FTD (n = 21), non-FTD patients (n = 22) and healthy controls (n = 21). RESULTS: FTD patients showed less alignment than the other two groups in dialogue, and than healthy controls on the syntactic task. FTD patients showed poorer performance on the ToM task than the other two groups, but only compared to the healthy controls in dialogue. The FTD group's degree of alignment in dialogue was correlated with ToM performance in dialogue but not with the traditional ToM task or with syntactic alignment. CONCLUSIONS: In dialogue, FTD patients demonstrate an impairment in employing available contextual information to facilitate their own subsequent production, which is associated with a ToM deficit. These findings indicate that a contextual processing deficit impacts on exploiting representations via the production system impoverishing the ability to make predictions about upcoming utterances in dialogue

‘They are doing it because they love it’: U.S. and English fan perceptions of women footballers as ‘role models’

We draw from 102 interviews with American and English adults who attended the 2019 Women’s World Cup to examine how fans perceive women footballers as ‘role models’, with attention to the operations of gender ideology. Despite the recent professionalization and commercialization of women’s football, there is a dearth of research on fan perspectives of players as role models. Our findings show that most fans perceive role modelling as women’s accessibility and authenticity in interaction. Fans naturalize women’s often uncompensated labor as role models through a supposed love for their sport and desire to see its future growth, endorsing a gender essentialist view of women as notably caring and giving in comparison to men. However, a minority of fans embrace a more critical view by identifying role modelling as an expectation placed disproportionately on women within an already unequal resource environment. We conclude that role modelling is a gendered expectation for elite women footballers and that fans can be a source of pressure towards its enactment

Integrated auditing system for maritime risk management (lASMAR)

There has been an increasing recent work in the assessment of risk in the maritime transportation systems. Maritime transportation of goods (solid or liquid) has been since ancient times the main way of interrelation between nations and people and has given relatively substantial development in economic and financial growth. Risk is inherent in the marine transportation systems due to highly unpredictable multi functional operation in which uncertainties are very difficult to be optimized. The presence of uncertainty in maritime activities is well recognized and two types of uncertainty considered for ship operations, aleatory uncertainty, which represents the randomness of the system itself including conditions and working factors, and epistemic uncertainty, which represents the lack of knowledge about the system including human factors. This paper explores the challenges of a decision making risk modelling tool for Specific Activity Risk Management as well as for Corporate Risk Management and develops a systematic way for quantification and valuation of risk levels through a ranking and an auditing method of shipping activities and implemented SQEOH management systems core elements respectively. The paper concludes to the proposal of an Integrated Risk Management System (IRMS) plan based on a) auditing of a weighted matrix of 20 Critical Core Elements (CCE) for Corporate Risk Management (CRM) which will identify weak risk level areas and enhance effectively and cost efficiently control options of Maritime Management for reducing level of risk at all stages, and b) by risk correlation and ranking of the shipping activities as a Specific Activity (SAR) risk assessment with associated causes categories and risk index level so as an integrated auditing and ranking system is created for maritime risk management (lAS MAR). The main merit of this work is the development of a risk management plan in a systematic way based on identified shipping activities with associated causes and hazards and core elements of implemented management system standards for quality (ISO 9001), safety of crew (ISM, OHSAS 18001) and ship (ISM), environmental protection (ISO 14001) and occupational health (OHSAS 18001) in order to model the correlated uncertainties for the assessment of Corporate risk (CRM) and Specific Activity risk (SIR) in a hierarchical, sequential and iterative process which will improve results of risk priorities and risk based decision making process (RBOM) in relation to consequences for severity level to Property, Human life and Environment. Possibility and actuality of cause correlation with risk indexes improves the quality characteristics of risk assessment and provide an alternative reliable interpretation of traditional determination of likelihood or frequency index by taking causes parameters in to consideration in order to be able to compare and evaluate them to select the best alternative. The developed system is a tool that assists ship managers (decision makers) in managing their risks of maritime activities systematically in real world and reduces their potential losses for specific activities or in corporate management level or combined. Its use by Ship managers, operators and employees will improve considerably "risk awareness and safety culture" and will develop sufficient knowledge and understanding of how to create an inventory of Shipping activities could lead to an incident in terms of perceived risk, to identify associated hazards (HAZIO) and finally to evaluate and manage the risks and prioritize the risk control options (RCO) in order avoid /eliminate/ mitigate consequences and to predict causes categories which are important mainly contributing to accidents in marine transportation systems resulting severe environmental damage and large-scale loss of life. This new culture introduced promotes in general the duty of care in safety, quality, environmental, occupational health and safety issues to ship and shore personnel. IASMAR was developed as a method of decision modelling that would be compatible with maritime implemented and activity, task and goal oriented management system for which specific critical activity and corporate risk management integrated and provide a feasible and effective decision making process timely supported for improving cost saving, adopting new requirements and handling successfully liabilities for crew and ship's property. It is also a self assessment plan based on core elements affecting risk awareness and management implementation in combination with corporate experience and performance levels for problem solving of preventive or mitigating plans and providing a risk based decision modelling in action and in real world for demonstrating continuous improvement in implemented management systems. IASMAR is a plan, which quantifies and predicts the area and causation chain of an undesired event resulting from loss control or oversights and omissions within the management system. The correlation between the determined risk success score, the risk reduction level and the possibility of an event clearly defines the use in prediction of incidents and consequently the risk reduction. Various stakeholders are interested for that and its benefits such as Ship-owners, Charterers, Insurance companies, Financial organisations, P+I clubs, Port authorities, Flag states and suppliers. The lASMAR project-rating index developed under the guidance and within the forthcoming implementation of Formal Safety Assessment (FSA) and possibility theory