Accounting for healthcare in the Newcastle Infirmary during the 19th century

PhD ThesisAccounting played a critical role in the management of the Newcastle Infirmary during the 19th century. In a class-based society, the poor relied upon the generosity of the wealthy for their healthcare at a time when poverty itself was seen as a sin, an act against God. These wealthy donors established and maintained hospitals, such as the Newcastle Infirmary, and were responsible for the governance, management and admission of patients. Their aim was to be seen to use resources efficiently and to treat the “deserving poor” to restore them to productive members of society. Throughout the century new buildings, medical advances and increasingly highly specialised staff had to be financed to cope with increasing demand. In the last quarter of the century, paid administrators were employed to manage the Infirmary as finance came less from the wealthy few and more from individual workers and separate charitable bodies. This thesis demonstrates how the management of the Newcastle Infirmary used accounting as a moral practice to allow treatment for patients who were outside the rules, which were a guide to the admission and treatment of patients, and to justify expenditure on large capital projects on nothing more than acts of faith. In turn, accounting was used as a tool to hold managers accountable for their actions and as a vehicle for communicating that accountability to the changing providers of finance. This thesis adds to the literature on accounting within early voluntary hospitals by identifying the balance of contributions of costing systems to planning and decision making and the impact of finance on governance and holding managers accountable for their performance and the successful treatment of patients

Preliminary Assessment of Climatic Sensitivity of Riparian Old-Growth Eastern Hemlock

Eastern hemlock is a long-lived, slow growing climax species in North America currently undergoing a major decline in population due to a combination of effects derived from hemlock woolly adelgid (HWA) as well as changing climate patterns. Data was collected in an old-growth, riparian hemlock forest within the West Virginia University Research Forest to understand the effect of monthly climate factors (mean temperature, mean precipitation, and climate moisture index (CMI)) on hemlock radial growth. Results indicated that March mean temperature and May CMI of the current growth year are positively associated with hemlock growth whereas prior year summer conditions of each climate variable resulted in negative correlations. Spring temperature as well as winter precipitation of the current year also lessened hemlock growth. Many of the significant relationships ascertained by this study were well supported by other studies; however, increased June precipitation and CMI resulting in a reduction in growth may be explained by summer storm damage or root anoxia, resulting in lessened growth1,2. Also, previous studies conducted south of the study area found winter precipitation to positively affect growth; this incongruence is explainable by differences in precipitation types and how heavy snow could contribute to hemlock damage2. Through the establishment of these relationships, it may be better understood how riparian, old-growth hemlock stands within central Appalachia will respond to changing monthly climate patterns

Estimating the reproduction number, R0, from individual-based models of tree disease spread

Tree populations worldwide are facing an unprecedented threat from a variety of tree diseases and invasive pests. Their spread, exacerbated by increasing globalisation and climate change, has an enormous environmental, economic and social impact. Computational individual-based models are a popular tool for describing and forecasting the spread of tree diseases due to their flexibility and ability to reveal collective behaviours. In this paper we present a versatile individual-based model with a Gaussian infectivity kernel to describe the spread of a generic tree disease through a synthetic treescape. We then explore several methods of calculating the basic reproduction number R0, a characteristic measurement of disease infectivity, defining the expected number of new infections resulting from one newly infected individual throughout their infectious period. It is a useful comparative summary parameter of a disease and can be used to explore the threshold dynamics of epidemics through mathematical models. We demonstrate several methods of estimating R0 through the individual-based model, including contact tracing, inferring the Kermack–McKendrick SIR model parameters using the linear noise approximation, and an analytical approximation. As an illustrative example, we then use the model and each of the methods to calculate estimates of R0 for the ash dieback epidemic in the UK

Towards understanding the myometrial physiome: approaches for the construction of a virtual physiological uterus

Premature labour (PTL) is the single most significant factor contributing to neonatal morbidity in Europe with enormous attendant healthcare and social costs. Consequently, it remains a major challenge to alleviate the cause and impact of this condition. Our ability to improve the diagnosis and treatment of women most at risk of PTL is, however, actually hampered by an incomplete understanding of the ways in which the functions of the uterine myocyte are integrated to effect an appropriate biological response at the multicellular whole organ system. The level of organization required to co-ordinate labouring uterine contractile effort in time and space can be considered immense. There is a multitude of what might be considered mini-systems involved, each with their own regulatory feedback cycles, yet they each, in turn, will influence the behaviour of a related system. These include, but are not exclusive to, gestational-dependent regulation of transcription, translation, post-translational modifications, intracellular signaling dynamics, cell morphology, intercellular communication and tissue level morphology. We propose that in order to comprehend how these mini-systems integrate to facilitate uterine contraction during labour (preterm or term) we must, in concert with biological experimentation, construct detailed mathematical descriptions of our findings. This serves three purposes: firstly, providing a quantitative description of series of complex observations; secondly, proferring a database platform that informs further testable experimentation; thirdly, advancing towards the establishment of a virtual physiological uterus and in silico clinical diagnosis and treatment of PTL

A shared population of epidemic methicillin-resistant Staphylococcus aureus 15 circulates in humans and companion animals.

UNLABELLED: Methicillin-resistant Staphylococcus aureus (MRSA) is a global human health problem causing infections in both hospitals and the community. Companion animals, such as cats, dogs, and horses, are also frequently colonized by MRSA and can become infected. We sequenced the genomes of 46 multilocus sequence type (ST) 22 MRSA isolates from cats and dogs in the United Kingdom and compared these to an extensive population framework of human isolates from the same lineage. Phylogenomic analyses showed that all companion animal isolates were interspersed throughout the epidemic MRSA-15 (EMRSA-15) pandemic clade and clustered with human isolates from the United Kingdom, with human isolates basal to those from companion animals, suggesting a human source for isolates infecting companion animals. A number of isolates from the same veterinary hospital clustered together, suggesting that as in human hospitals, EMRSA-15 isolates are readily transmitted in the veterinary hospital setting. Genome-wide association analysis did not identify any host-specific single nucleotide polymorphisms (SNPs) or virulence factors. However, isolates from companion animals were significantly less likely to harbor a plasmid encoding erythromycin resistance. When this plasmid was present in animal-associated isolates, it was more likely to contain mutations mediating resistance to clindamycin. This finding is consistent with the low levels of erythromycin and high levels of clindamycin used in veterinary medicine in the United Kingdom. This study furthers the "one health" view of infectious diseases that the pathogen pool of human and animal populations are intrinsically linked and provides evidence that antibiotic usage in animal medicine is shaping the population of a major human pathogen. IMPORTANCE: Methicillin-resistant Staphylococcus aureus (MRSA) is major problem in human medicine. Companion animals, such as cats, dogs, and horses, can also become colonized and infected by MRSA. Here, we demonstrate that a shared population of an important and globally disseminated lineage of MRSA can infect both humans and companion animals without undergoing host adaptation. This suggests that companion animals might act as a reservoir for human infections. We also show that the isolates from companion animals have differences in the presence of certain antibiotic resistance genes. This study furthers the "one health" view of infectious diseases by demonstrating that the pool of MRSA isolates in the human and animal populations are shared and highlights how different antibiotic usage patterns between human and veterinary medicine can shape the population of bacterial pathogens.This work was supported by a Medical Research Council Partnership grant (G1001787/1) held between the Department of Veterinary Medicine, University of Cambridge (M.A.H.), the School of Clinical Medicine, University of Cambridge (S.J.P.), the Moredun Research Institute, and the Wellcome Trust Sanger Institute (J.P. and S.J.P). S.J.P. receives support from the NIHR Cambridge Biomedical Research Centre. M.T.G.H., S.R.H. and J.P. were funded by Wellcome Trust grant no. 098051.This is the final published version distributed under a Creative Commons Attribution License 2.0, which can also be found on the publisher's website at: http://mbio.asm.org/content/5/3/e00985-13.full.pdf+htm

Lewy Body Dementia Association\u27s Research Centers of Excellence Program: Inaugural Meeting Proceedings.

The first Lewy Body Dementia Association (LBDA) Research Centers of Excellence (RCOE) Investigator\u27s meeting was held on December 14, 2017, in New Orleans. The program was established to increase patient access to clinical experts on Lewy body dementia (LBD), which includes dementia with Lewy bodies (DLB) and Parkinson\u27s disease dementia (PDD), and to create a clinical trials-ready network. Four working groups (WG) were created to pursue the LBDA RCOE aims: (1) increase access to high-quality clinical care, (2) increase access to support for people living with LBD and their caregivers, (3) increase knowledge of LBD among medical and allied (or other) professionals, and (4) create infrastructure for a clinical trials-ready network as well as resources to advance the study of new therapeutics

Measuring the Intrapersonal Component of Psychological Empowerment: Confirmatory Factor Analysis of the Sociopolitical Control Scale

The Sociopolitical Control Scale (SPCS) is a widely used measure of the intrapersonal component of psychological empowerment. Confirmatory factor analyses (CFA) were conducted with data from two samples to test the hypothesized structure of the SPCS, the potential effects of method bias on the measure's psychometric properties, and whether a revised version of the scale (SPCS‐R) yielded improved model fit. Sample 1 included 316 randomly selected community residents of the Midwestern United States. Sample 2 included 750 community residents of the Northeastern U.S. Results indicated that method bias from the use of negatively worded items had a significant effect on the factor structure of the SPCS. CFA of the SPCS‐R, in which negatively worded items were rephrased so that all statements were positively worded, supported the measure's hypothesized two‐factor structure (i.e., leadership competence and policy control). Subscales of the SPCS‐R were found reliable and related in expected ways with measures of community involvement. Implications of the study for empowerment‐based research and practice are described, and strategies to further develop the SPCS are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/117223/1/ajcp9070.pd

Integration of environment and nutrition in life cycle assessment of food items: opportunities and challenges

This report is the outcome of a consensus-building project to agree on best practices for environmental and nutritional Life Cycle Assessment (nLCA) methodology, and identify future research needs. The project involved 30 nutritional and environmental LCA researchers from 18 countries. It focused on the assessment of food items (as opposed to meals or diets).Best practice recommendations were developed to address the intended purpose of an LCA study and related modeling approach, choice of an appropriate functional unit, assessment of nutritional value, and reporting nLCA results. An nLCA study should report the quantities of as many essential nutrients as possible and aim to provide information on the nutritional quality and/or health impacts in addition to nutrient quantities. Outstanding issues requiring further research attention include: defining a minimum number of nutrients to be considered in an nLCA study; treatment of nutrients to limit; use of nutrient indexes; further development of Impact Assessment methods; representation of nutritional changes that may occur during subsequent distribution and food preparation in cradle-to-gate nLCA studies; and communication of data uncertainty and variability. More data are required for different regions (particularly developing countries); for the processing, distribution, retail, and consumption life cycle stages; and for food loss and waste. Finally, there is a need to extend nLCA methodology for the assessment of meals and diets, to consider further how to account for the multi-functionality of food in a sustainability framework, and to set nLCA studies within the context of environmental limits.These results provide a robust basis for improving nLCA methodology and applying it to identify solutions that minimize the trade-offs between nourishing populations and safeguarding the environment