Nutrition process improvements for adult inpatients with inborn errors of metabolism using the i-PARIHS framework

This project aimed to implement consensus recommendations and innovations that improve dietetic services to promote timely referral to optimise nutritional management for adult inpatients with inborn errors of metabolism (IEM).The i-PARIHS framework was used to identify service gaps, implement innovations and evaluate the innovations within this single-site study. The constructs of this framework are: (i) review of the evidence; (ii) recognising patients and staff knowledge and attitudes; (iii) acknowledging the local context; and (iv) the facilitators role. This included a literature review and metabolic centre service comparisons to investigate dietetic referral and foodservice processes to inform the innovation. A 12-month chart audit (6 months retrospective and prospective of implemented innovation, respectively) to evaluate newly established dietetic referral and IEM nutrition provision procedures was also completed.The innovations implemented encompassed a clinical alert triggering urgent referral, nutrition sick day plans and metabolic diet and formula prescription via an 'alert' tab in electronic records. Eleven metabolic protein-restricted diets and nine formula recipes were introduced. Prior to the innovations, only 53% (n = 19/36) of inpatients with IEM were assessed by the dietitian and received appropriate nutrition within 24 hours. Following implementation of the innovations, 100% (n = 11/11) of inpatients with IEM received timely dietetic assessment and therapeutic nutrition.Implementation of innovations developed using the i-PARIHS framework is effective in timely notification of the metabolic dietitian of referrals. This ensures optimal nutritional management during admissions which is required in this group of high-risk patients

Couching in Nigeria: prevalence, risk factors and visual acuity outcomes.

PURPOSE: Couching is an ancient treatment for cataract which is still practiced in some of the poorer developing countries, particularly in sub-Saharan Africa. The purpose of this study is to describe risk factors for couching and visual acuity outcomes in a nationally representative sample of adults aged 40 years and above in Nigeria. METHODS: Probability in proportion size methods were used to identify a representative sample. Of the 15,375 adults enumerated, 13,582 were interviewed and examined. Examination included logMar acuities, slit lamp examination and dilated fundoscopy with digital fundus imaging. RESULTS: Almost half of the 583 eyes undergoing a procedure for cataract had been couched (249 eyes, 42.7%). Individuals living in rural areas (P = 0.033) and in the two underserved northern administrative zones (P = 0.33; P = 0.002) were more likely to have been couched. Visual outcomes were poor according to World Health Organization categories, with 55.8% of people and 73.1% of eyes having a presenting visual acuity of less than 3/60 and only 9.7% and 2.4% of people and eyes respectively having a good outcome (6/18 or better). None were wearing an aphakic correction, and with correction acuities improved but 42.6% of eyes were still blind (< 3/60). CONCLUSIONS: Couching is still widely practiced in Nigeria and visual outcomes are very poor. The population needs to be made aware of the risks associated with the procedure, and services for high quality, affordable cataract surgery need to be expanded, particularly in rural areas and in the north of the country

An Evaluation of Alternative Equity Indices - Part 2: Fundamental Weighting Schemes

In this paper we explore an alternative approach for determining constituent weights for equity indices. This approach makes use of alternative definitions of company size, and is referred to as Fundamental Indexation (Arnott et al (2005)). Based upon a data set that comprises the largest 1,000 US stocks for each year in our sample, our results show that between 1968 and 2011 the fundamental index alternatives that we consider have out-performed a comparable index constructed on the basis of the market capitalisation of the index constituents in risk-adjusted terms. Our Monte Carlo experiments show that this superior risk-adjusted performance cannot be attributed easily to luck. We also find that although the superior performance is achieved with higher constituent turnover than required using the Market-cap approach to index construction, the turnover is lower, and in some cases much lower, than required by some of the heuristic and optimised index construction techniques that we explored in our last paper. Finally, we find that although the application of a simple market-timing rule does not enhance the returns on these fundamentally-weighted indices very significantly, it does reduce the volatility of their returns and their maximum drawdown quite considerably

An Evaluation of Alternative Equity Indices - Part 1: Heuristic and Optimised Weighting Schemes

There is now a dazzling array of alternatives to the market-cap approach to choosing constituent weights for equity indices. Using data on the 1,000 largest US stocks every year from 1968 to the end of 2011 we compare and contrast the performance of a set of alternative indexing approaches. The alternatives that we explore can be loosely categorised into two groups. First, a set of weighting techniques that Chow et al (2011) describe as “heuristic.” The second set are based upon “optimisation techniques,” since they all require the maximisation or minimisation of some mathematical function subject to a set of constraints to derive the constituent weights. We find that all of the alternative indices considered here would have produced a better risk-adjusted performance than could have been achieved by having a passive exposure to a market capitalisation-weighted index. However, the most important result of our work stems from our ten million Monte Carlo simulations. We find that choosing constituent weights randomly, that is, applying weights that could have been chosen by monkeys, would also have produced a far better risk-adjusted performance than that produced by a cap-weighted scheme

Trend Following and Momentum Strategies for Global REITs

In this study, we investi- gate whether the risk-Adjusted returns of a global REIT portfolio would be enhanced by adopting a trend following global strategy (which is an abso- lute concept sometimes known as absolute mo- mentum), a momentum-based strategy (which is a relative concept and requires individual country al- locations), or indeed a combination of the two. e examine the results in terms of both a dedicated global REIT exposure, and the impact on a multi- asset portfolio. We find that the main improve- ments arise when the broad index is replaced with one of the four trend following strategies. The port- folios deliver similar returns but volatility is re- duced by up to a quarter to the 8%-9% range, the Sharpe ratios increase by 0.1 to 0.5 with the main benefit being the reduction in the maximum draw- down to under 30% compared to 43% when the broad index was used. We thus find that a com- bined momentum and trend following a global REIT strategy can be beneficial for both a dedicated REIT portfolio and adding REITs to a multi-Asset portfolio

Making adult safeguarding personal

Purpose To ascertain what efforts Adult Safeguarding Leads (ASLs), generic advocates, and Independent Mental Capacity Advocates (IMCAs) are making to involve service users in decisions about protective measures, and to investigate whether the Adult Safeguarding Service is delivering outcomes, which are valued by its users. Design/methodology/approach semi-structured interviews with a sample of key stakeholders. Findings Findings: ASLs are making efforts to involve service users in the complex and demanding process of safeguarding. These efforts, however, are shaped by their understandings of the difference between ‘residential’ and ‘community’ settings. Research limitations/implications The study is based in a single county council, albeit in a large county, and involves a limited number of service users Practical implications Clarification is needed of what it may mean to adopt a person-centred approach to adult safeguarding, and the responsibilities of ASLs when individuals with capacity to make decisions about this aspect of their lives are unwilling to engage with the safeguarding process. Originality/value The findings improve our understanding of how ASLs understand their responsibilities towards the users of their services and endeavour to involve them in the adult safeguarding process. Based on this understanding, those with responsibility for managing Adult Safeguarding services should be better able to support improvements in professional practice.SJ’s contribution was funded by The Health Foundation. Support for MR, AJH and ICHC was provided initially by the NIHR CLAHRC for Cambridgeshire & Peterborough), and subsequently by The Health Foundation (MR) and the NIHR CLAHRC East of England (AJH and ICHC). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.This is the accepted manuscript. The final version is available at http://www.emeraldinsight.com/doi/abs/10.1108/JAP-11-2014-0031

Heads We Win, Tails You Lose. Why Don't More Fund Managers Offer Symmetric Performance Fees?

In this paper we use Monte Carlo simulation techniques to gauge the impact of three mutual fund fee structures on the utility of investors and fund managers: a fee fixed as a proportion of AUM; an asymmetric performance-based fee; and a symmetric performance-based fee. Our study identifies a clear 'incentive mismatch' between the best interests of investors and managers, more specifically, there is no single structure that simultaneously maximises both the investors’ and the managers’ utility. In fact, the results show that the most prevalent fee structure currently in the UK market (a fixed fee as a proportion of AUM) is generally the best structure for the manager and the worst for the investor! To verify the robustness of our results, we stress-test the model parameters, however, none of these model variations change the base results and our main conclusion. The results in this paper give rise to a natural question: "Since investors would prefer symmetric performance-based fees, why don't more fund managers offer such fees?

The appearance, motion, and disappearance of three-dimensional magnetic null points

N.A.M. acknowledges support from NASA grants NNX11AB61G, NNX12AB25G, and NNX15AF43G; NASA contract NNM07AB07C; and NSF SHINE grants AGS-1156076 and AGS-1358342 to SAO. C.E.P. acknowledges support from the St Andrews 2013 STFC Consolidated grant.While theoretical models and simulations of magnetic reconnection often assume symmetry such that the magnetic null point when present is co-located with a flow stagnation point, the introduction of asymmetry typically leads to non-ideal flows across the null point. To understand this behavior, we present exact expressions for the motion of three-dimensional linear null points. The most general expression shows that linear null points move in the direction along which the magnetic field and its time derivative are antiparallel. Null point motion in resistive magnetohydrodynamics results from advection by the bulk plasma flow and resistive diffusion of the magnetic field, which allows non-ideal flows across topological boundaries. Null point motion is described intrinsically by parameters evaluated locally; however, global dynamics help set the local conditions at the null point. During a bifurcation of a degenerate null point into a null-null pair or the reverse, the instantaneous velocity of separation or convergence of the null-null pair will typically be infinite along the null space of the Jacobian matrix of the magnetic field, but with finite components in the directions orthogonal to the null space. Not all bifurcating null-null pairs are connected by a separator. Furthermore, except under special circumstances, there will not exist a straight line separator connecting a bifurcating null-null pair. The motion of separators cannot be described using solely local parameters because the identification of a particular field line as a separator may change as a result of non-ideal behavior elsewhere along the field line.Publisher PDFPeer reviewe

What impact does a change of fund manager have on mutual fund performance?

Using a unique database of UK fund manager changes over the period from 1997 to 2011, we examine the impact of such changes on fund performance. We find clear evidence to suggest that a manager change does affect the benchmark-adjusted performance of UK mutual funds. In particular we find a significant deterioration in the benchmark-adjusted returns of funds that were top performers before the manager exit and, conversely, a significant improvement in the average benchmark-adjusted returns of funds that were poor performers before the manager exit. Our use of the Carhart's (1997) four-factor model reveals that the improvement in average post manager exit performance is accompanied by a reduction in market risk, a slight reduction in exposure to small cap stocks, and an increase in exposure to value and momentum stocks. Overall, our results suggest that UK fund management companies have been relatively successful in replacing bad managers with better managers, but relatively unsuccessful at finding equivalent replacements for their top performing managers. We believe that regulators should therefore try to ensure that all efforts are made by fund management companies to inform all of their investors about a change in management