Is Hospital in the Home as safe and effective as inpatient care?

When Activity-Based Funding (ABF) for public hospitals begins on 1 July this year, it should make it easier for hospitals to establish Hospital in the Home (HITH) services. The pricing framework underpinning the ABF system stipulates that public hospital services should be priced in a way that facilitates the timely roll-out of evidence-based innovations in the most appropriate care setting. HITH services have been operating in some Australian hospitals for nearly 20 years. However before starting up a service of their own, many hospital managers will want to know if HITH is safe, and for which patients. This paper briefly outlines the evidence on the safety, quality and costs of HITH services. A list of resources is provided for those who want to know more. What does the evidence say? Many health services provide care in patients’ homes. To qualify as a HITH service it must provide active treatment by health care professionals in patients’ homes for conditions that otherwise would require hospital in-patient care. Examples of acute treatments delivered in the home include blood transfusions, intravenous antibiotic treatments for infections, and anticoagulation for patients with deep venous thrombosis and pulmonary emboli. Some HITH services (early - discharge HITH) also provide subacute treatment such as rehabilitation at home after orthopaedic injuries and procedures. The range of conditions that are treatable at home continues to expand as technology and confidence in HITH improves. Cochrane Reviews are generally regarded as an authoritative source of research evidence. A systematic review of the evidence on HITH was conducted by the Cochrane Collaboration in 2008 (it was updated in 2011 and no changes were made to the conclusions). After searching the main medical databases, the Cochrane reviewers found 10 randomised controlled trials (RCTs) that compared HITH with inpatient care; RCTs are generally thought to produce high quality evidence. Data from five of the RCTs on admission - substitution HITH services were broadly comparable, so they were pooled and used to conduct a more high-powered statistical analysis, a meta-analysis

Sunshine Boulevard, in the middle of nowhere: Einfamilienhäuser und Carports - die Werbebilder der Fertigteilproduktion in Deutschland

Seit Mitte des 20. Jahrhunderts ist das suburbane, freistehende Einfamilienhaus mit Auto ein Ausweis von Stabilität, Familialität, gutem Leben und Konsum. Die vorliegende Forschung analysiert die Printwerbung von Fertighaus- und Carportherstellern in Deutschland. Das Sample umfasst zehn Kataloge der Jahre 2014 bis 2016 von insgesamt vier Fertighaus- und drei Carportherstellern. Die Firmen wenden in ihren Werbekatalogen folgende Strategien an: 1. Die angebotenen Häuser werden von der weißen Mittelschicht bewohnt. In Bezug auf dargestellte Aktivitäten und räumliche Situationen zeigen sie eine stereotype Geschlechterordnung. 2. Die Fertighaushersteller statten ihre Häuser und Gärten mit teuren Designklassikern der Moderne aus und konterkarieren damit die Utopie der Fertigteilproduktion, wie sie u.a. vom Bauhaus proklamiert wurde: Der Gedanke, gute Gestaltung zu demokratisieren und zu popularisieren wird hier zu reinem Dekor, das Häusern Exklusivität verleihen soll. 3. Die Kataloge präsentieren das Haus von der Rückseite, also dem Garten, ohne Nachbarschaften oder andere Gebäude in Sicht. Mit Adressen wie "Kastanienallee" findet eine Abgrenzung zu urbanen Wohnsituationen statt. Insgesamt wird ein Leben präsentiert, dass in jeglicher Hinsicht freistehend ist: ohne nachbarschaftlichen Kontext, ohne städtische Anbindung und auch ohne Straßen, die das häusliche Leben mit der Außenwelt verbinden. Werbung vermittelt immer etwas über menschliches Begehren, in diesem Fall: Eine Visualisierung von Privatheit, die ohne ein öffentliches Leben als Gegenüber auskommt

An Intensive, Interdisciplinary Treatment Program for Persons with Aphasia

Traditionally, much of individual aphasia therapy has been focused on attempts to remediate underlying linguistic deficits. While many treatments have been shown to improve discrete language functions (Robey et al, 1998), those newly learned skills do not always transfer readily to non-trained environments. Over the past two decades, a growing number of aphasiologists have begun to focus their attention on social approaches to aphasia assessment and treatment (Elman, 2007). One such approach, group treatment, serves as a natural and dynamic vehicle to improve social communication, which has been shown to improve discrete language skills in persons with aphasia (pwa), (Elman & Bernstein-Ellis, 1999). Group treatment frequently co-occurs with individual therapy, but is rarely used as a formal mechanism to train generalization. Another area of broad discussion in aphasia rehabilitation is the concept of treatment intensity. Basso (2005) reported that pwa who received a higher number of therapy sessions improved more than those who received a lower number of therapy sessions. Bhogal et al (2003) found that treatment provided on a more intense level (>8.8 hours/week) for a shorter period of time resulted in stronger improvements compared to treatment provided on a less intense level over a longer period of time. A final issue is that individuals with stroke-induced aphasia often present with concomitant motor, cognitive and dietary/cardiac issues. Thus it seems that an interdisciplinary approach incorporating physical, occupational and nutritional therapy would also be beneficial. This paper explores the speech-language effects of a treatment program, which attempts to incorporate evidenced-based treatment, in an intensive, interdisciplinary format. Pilot data from an initial cohort completed June 2011 as well as multiple-baseline data from a second cohort completed June 2012 is presented

Electrically conductive polyimides containing silver trifluoroacetylacetonate

Polyimides with enhanced electrical conductivity are produced by adding a silver ion-containing additive to the polyamic acid resin formed by the condensation of an aromatic dianhydride with an aromatic diamine. After thermal treatment the resulting polyimides had surface conductivities in the range of 1.7.times.10.sup.-3 4.5 .OMEGA..sup.-1 making them useful in low the electronics industry as flexible, electrically conductive polymeric films and coatings

Cascadia Fore Arc Seismic Survey: Open-Access Data Available

The Cascadia subduction zone (CSZ), where the Juan de Fuca and Gorda plates subduct obliquely beneath North America at a rate of about 35 millimeters per year, poses major geological hazards to population centers of the northwestern United States. Despite the importance of the subducting slab in these hazards, the plate boundary is poorly mapped and understood, especially offshore

Näher, öffentlicher, agiler : Bausteine einer resilienten Post-Corona-Stadt

Die Corona-Pandemie führt uns vor Augen, wie wichtig das unmittelbare Wohnumfeld ist. Den kommunalen Zusammenhalt und lokale Infrastrukturen zu stärken, macht unsere Städte krisenfester und nachhaltiger - auch für notwendige Transformationen im Zuge des Klimawandels

"Näher" - "Öffentlicher" - "Agiler": Eckpfeiler einer resilienten "Post-Corona-Stadt"

Welche Perspektiven haben zukunftsfähige und krisenfeste Städte nach der Corona-Pandemie? Antworten darauf skizzieren die Autorinnen und Autoren in dem vorliegenden Diskussionspapier. Ihre zentrale These: Städte der Zukunft müssen und werden "näher", "öffentlicher" und "agiler" sein. Dies erläutern sie anhand dieser drei Dimensionen und konkretisieren es anhand zahlreicher Beispiele

Preferential Transfer of Certain Plasma Membrane Proteins onto T and B Cells by Trogocytosis

T and B cells capture antigens via membrane fragments of antigen presenting cells (APC) in a process termed trogocytosis. Whether (and how) a preferential transfer of some APC components occurs during trogocytosis is still largely unknown. We analyzed the transfer onto murine T and B cells of a large panel of fluorescent proteins with different intra-cellular localizations in the APC or various types of anchors in the plasma membrane (PM). Only the latter were transferred by trogocytosis, albeit with different efficiencies. Unexpectedly, proteins anchored to the PM's cytoplasmic face, or recruited to it via interaction with phosphinositides, were more efficiently transferred than those facing the outside of the cell. For proteins spanning the PM's whole width, transfer efficiency was found to vary quite substantially, with tetraspanins, CD4 and FcRγ found among the most efficiently transferred proteins. We exploited our findings to set immunodiagnostic assays based on the capture of preferentially transferred components onto T or B cells. The preferential transfer documented here should prove useful in deciphering the cellular structures involved in trogocytosis

A Plan for a Long-Term, Automated, Broadband Seismic Monitoring Network on the Global Seafloor

Establishing an extensive and highly durable, long‐term, seafloor network of autonomous broadband seismic stations to complement the land‐based Global Seismographic Network has been a goal of seismologists for decades. Seismic signals, chiefly the vibrations from earthquakes but also signals generated by storms and other environmental processes, have been processed from land‐based seismic stations to build intriguing but incomplete images of the Earth’s interior. Seismologists have mapped structures such as tectonic plates and other crustal remnants sinking deep into the mantle to obtain information on their chemical composition and physical state; but resolution of these structures from land stations is not globally uniform. Because the global surface is two‐thirds ocean, increasing the number of seismic stations located in the oceans is critical for better resolution of the Earth’s interior and tectonic structures. A recommendation for a long‐term seafloor seismic station pilot experiment is presented here. The overarching instrumentation goal of a pilot experiment is performance that will lead to the installation of a large number of long‐term autonomous ocean‐bottom seismic stations. The payoff of a network of stations separated from one another by a few hundred kilometers under the global oceans would be greatly refined resolution of the Earth’s interior at all depths. A second prime result would be enriched understanding of large‐earthquake rupture processes in both oceanic and continental plates. The experiment would take advantage of newly available technologies such as robotic wave gliders that put an affordable autonomous prototype within reach. These technologies would allow data to be relayed to satellites from seismometers that are deployed on the seafloor with long‐lasting, rechargeable batteries. Two regions are presented as promising arenas for such a prototype seafloor seismic station. One site is the central North Atlantic Ocean, and the other high‐interest locale is the central South Pacific Ocean