4,428 research outputs found

    Undergraduate Catalog of Studies, 2023-2024

    Get PDF

    The PREVENT Study: Preventing hospital admissions attributable to gout

    Get PDF
    BackgroundGout is the most common form of inflammatory arthritis, affecting 1 in 40 people in the UK. Despite highly effective treatments, hospital admissions for gout flares have doubled in England over the last 20 years. Many of these admissions may have been prevented if optimal gout management had been delivered to patients.Objectives1. Describe the epidemiology of gout management in primary and secondary care in the UK.2. Develop an intervention package for implementation during hospitalisations for gout flares, with the aim of improving care and reducing hospitalisations.3. Implement and evaluate this intervention in people hospitalised for gout.MethodsI used population-level health datasets (CPRD, OpenSAFELY, NHS Digital Hospital Episode Statistics) to evaluate outcomes for people with incident gout diagnoses over a 20-year period. I used multivariable regression and survival modelling to analyse factors associated with outcomes, including: i) initiation of urate-lowering therapies (ULT); ii) attainment of serum urate targets; and iii) hospitalisations for gout flares.With extensive stakeholder input, I developed an evidence-based intervention package to optimise hospital gout care. This incorporated the findings of a systematic literature review and process mapping of the admitted patient journey in a cohort of hospitalised gout patients. My intervention consisted of a care pathway, based upon British (BSR), European (EULAR) and American (ACR) gout management guidelines, which encouraged ULT initiation prior to discharge, followed by a nurse-led, post-discharge review to facilitate handover to primary care. I implemented this intervention in patients hospitalised for gout flares at King’s College Hospital over a 12-month period, and evaluated outcomes including ULT initiation, urate target attainment and re-admission rates.ResultsIn the UK, between 2004 and 2020, I showed that only 29% of patients with gout were initiated on ULT within 12 months of diagnosis, while only 36% attained urate targets. No significant improvements in these outcomes were observed after publication of updated BSR and EULAR gout management guidelines. Comorbidities, including chronic kidney disease, heart failure and obesity, associated with increased odds of ULT initiation but decreased odds of attaining urate targets. For patients who were diagnosed with gout during the COVID-19 pandemic, I showed that ULT initiation improved modestly, relative to before the pandemic, while urate target attainment trends were similar. Underlying these trends was a 31% decrease in incident gout diagnoses in England during the first year of the pandemic.Using linked primary and secondary care data, I showed that the risk of hospitalisations for gout flares is greatest within the first 6 months after diagnosis. ULT initiation is associated with more hospitalisations for flares within the first 6 months of diagnosis, but a reduced risk of hospitalisations beyond 12 months; particularly when urate targets are attained.After process mapping the admitted patient journey and systematically appraising the evidence base, I developed and implemented a multi-faceted intervention at King’s College Hospital, with the aim of improving hospital gout care. Following implementation of this intervention, the proportion of hospitalised gout patients who initiated ULT increased from 49% to 92%; more patients achieved serum urate targets; and there were 38% fewer repeat hospitalisations for gout flares.ConclusionsAt a population level, ULT initiation and urate target attainment remain sub-optimal for people with gout in the UK, despite updated management guidelines. Initiation of ULT is associated with long-term reductions in hospitalisations for flares; however, only a minority of patients hospitalised for gout flares are initiated on ULT. After designing and implementing a strategy to optimise hospital gout care, over 90% of patients were initiated on ULT, urate target attainment improved, and repeat hospitalisations decreased. My findings suggest that improved primary-secondary care integration is essential if we are to reverse the epidemic of gout hospitalisations

    Strategy Tripod Perspective on the Determinants of Airline Efficiency in A Global Context: An Application of DEA and Tobit Analysis

    Get PDF
    The airline industry is vital to contemporary civilization since it is a key player in the globalization process: linking regions, fostering global commerce, promoting tourism and aiding economic and social progress. However, there has been little study on the link between the operational environment and airline efficiency. Investigating the amalgamation of institutions, organisations and strategic decisions is critical to understanding how airlines operate efficiently. This research aims to employ the strategy tripod perspective to investigate the efficiency of a global airline sample using a non-parametric linear programming method (data envelopment analysis [DEA]). Using a Tobit regression, the bootstrapped DEA efficiency change scores are further regressed to determine the drivers of efficiency. The strategy tripod is employed to assess the impact of institutions, industry and resources on airline efficiency. Institutions are measured by global indices of destination attractiveness; industry, including competition, jet fuel and business model; and finally, resources, such as the number of full-time employees, alliances, ownership and connectivity. The first part of the study uses panel data from 35 major airlines, collected from their annual reports for the period 2011 to 2018, and country attractiveness indices from global indicators. The second part of the research involves a qualitative data collection approach and semi-structured interviews with experts in the field to evaluate the impact of COVID-19 on the first part’s significant findings. The main findings reveal that airlines operate at a highly competitive level regardless of their competition intensity or origin. Furthermore, the unpredictability of the environment complicates airline operations. The efficiency drivers of an airline are partially determined by its type of business model, its degree of cooperation and how fuel cost is managed. Trade openness has a negative influence on airline efficiency. COVID-19 has toppled the airline industry, forcing airlines to reconsider their business model and continuously increase cooperation. Human resources, sustainability and alternative fuel sources are critical to airline survival. Finally, this study provides some evidence for the practicality of the strategy tripod and hints at the need for a broader approach in the study of international strategies

    UMSL Bulletin 2023-2024

    Get PDF
    The 2023-2024 Bulletin and Course Catalog for the University of Missouri St. Louis.https://irl.umsl.edu/bulletin/1088/thumbnail.jp

    An evaluation of a violence reduction partnership network:mixed methods network analysis

    Get PDF
    Purpose: The purpose of this paper was to report on the evaluation of the network and resources for violence prevention and reduction in the chosen area of focus. This area had experiences deprivation, significant implications due to Covid-19 restrictions and a lack of outdoor recreation space. Design/methodology/approach: Network analysis methodologies are increasingly being used in criminological research and evaluations to assess the structures of social and economic networks. This study explored, using a mixed-methods network analysis methodology, the nature of the established violence reduction network in a specific geographical location in West Midlands. Findings: A breadth of network activity is taking place across the community; however, the network analysis highlighted gaps in terms of specialist provision for early years and support from those with lived experience. It was perceived that a lack of continuity, in terms of changes in key roles, has affected the network. Funding mechanisms were perceived ineffective, and not encouraging of development of localisation services. Relationships between network members were predominantly positive with organisations having good communication and accessing support from one another; however, identifying shared goals and better collective working would benefit the network. Originality/value: This study pioneers using an innovative, mixed methods network analysis to explore a public health approach to violence prevention and reduction. Quantitative data collection and analysis allowed for assessment of the networks capacity and density, whereas qualitative data provided insights and detailed accounts of how the network functions.</p

    UMSL Bulletin 2022-2023

    Get PDF
    The 2022-2023 Bulletin and Course Catalog for the University of Missouri St. Louis.https://irl.umsl.edu/bulletin/1087/thumbnail.jp

    A Critical Review Of Post-Secondary Education Writing During A 21st Century Education Revolution

    Get PDF
    Educational materials are effective instruments which provide information and report new discoveries uncovered by researchers in specific areas of academia. Higher education, like other education institutions, rely on instructional materials to inform its practice of educating adult learners. In post-secondary education, developmental English programs are tasked with meeting the needs of dynamic populations, thus there is a continuous need for research in this area to support its changing landscape. However, the majority of scholarly thought in this area centers on K-12 reading and writing. This paucity presents a phenomenon to the post-secondary community. This research study uses a qualitative content analysis to examine peer-reviewed journals from 2003-2017, developmental online websites, and a government issued document directed toward reforming post-secondary developmental education programs. These highly relevant sources aid educators in discovering informational support to apply best practices for student success. Developmental education serves the purpose of addressing literacy gaps for students transitioning to college-level work. The findings here illuminate the dearth of material offered to developmental educators. This study suggests the field of literacy research is fragmented and highlights an apparent blind spot in scholarly literature with regard to English writing instruction. This poses a quandary for post-secondary literacy researchers in the 21st century and establishes the necessity for the literacy research community to commit future scholarship toward equipping college educators teaching writing instruction to underprepared adult learners

    Language-as-skill Approach in Foreign Language Education: A Phenomenological Study

    Get PDF
    The purpose of this qualitative phenomenological study was to understand foreign language educators\u27 lived experience of language-as-skill that focuses on language use. The central research question explored the foreign language educators\u27 experiences and perspectives on the concept of language acquisition as a type of skill acquisition. In addition, the researcher investigated foreign language educators\u27 language-as-knowledge and language-as-skill methodologies. This study also aimed to discover how the language-as-skill with advanced technology could be a way to address the contemporary challenges in foreign language education for learners and improve learners\u27 communicative competence to thrive in a globalized world with diversity. A transcendental phenomenological study design was selected to explicate the essence of human understanding. At this stage in the research, skill acquisition views Language learning as other cognitive skills development, such as how people learn to play the piano or drive a car. The theory guiding this study was DeKeyser\u27s skill acquisition theory, which explained the relationship between skill development and Language acquisition. In this study, 10 foreign language teachers from a local language training school became participants in semi-structured interviews, classroom observations, and document analysis. Data that were collected from the interviews, documentation, and observations were reviewed, grouped, coded, and reported as faithfully as possible to the participants\u27 experiences and perceptions of this phenomenological study
    • …
    corecore