Financialisation of Care: Investment and organising in the UK and US

PhDThis research investigates the relationship between the crises of care and finance, and efforts to ensure that care is valued more highly. It explores why investment funds have acquired care homes, how they realise value, and the implications for workers and residents. It also examines the factors that have limited financialisation, including the activities of social and labour movements. These developments are studied through empirical case studies of three major UK care companies, and analysis of the strategies of selected movements in the UK and US. The research involved 64 interviews, observation and document analysis. A geographical perspective helps to illuminate uneven investment in real estate, the quality of the care homes produced, and the spatial dimensions of organising within globalised care systems. The research finds that financial ownership of care companies has been driven by their real estate assets, the availability of debt financing, and specific business models. Corporate debt has also enabled governments to displace and depoliticise responsibility for funding care. However, finance has not replaced labour as a source of value: care remains labour intensive and value can be extracted from low-status, poorly organised workers and clients. The thesis deploys feminist care ethics to analyse the effects of financial ownership and crisis on labour and residents, including evictions that result from care home closures and the production of new, ‘hotel-like’ facilities. Financialisation has, though, been limited by a lack of material resources in care and political opposition. In contesting financialised care, movements have used stories to locate economic agency; to address political, experiential and affective divides; and to promote alternative social relations of interdependence. Organising is crucial to creating space for such stories. Overall, financialisation has been enabled by the undervaluing of care, but it has also been limited by social values and relationships associated with care.Economic and Social Research Council (ESRC), grant number ES/J500124/1, from 2014-17

University of Maine NSF-ADVANCE Project Outcomes Report

The University of Maine ADVANCE IT project proposes a three-pronged approach to institutional gender equity for STEM women faculty. Specific goals and objectives include increasing the percentage of women in the STEM disciplines, supporting professional development activities, addressing recruitment, retention and advancement of women faculty and engaging other campuses in the University of Maine System, as well as the faculty union, through the dissemination of information regarding ADVANCE outcomes. Intellectual Merit. The proposed activities are rooted in a conceptual framework that focuses on faculty job satisfaction, which plays a major role in retention. This project also presents a unique perspective to institutional transformation in that it takes into consideration the faculty union and its impact on faculty advancement and job satisfaction. Broader Impact. The University of Maine ADVANCE IT project , because of its emphasis on seven other institutions in the state of Maine, has the capacity to impact women faculty beyond the proposing institution. It is expected that project results will be broadly disseminated across Maine and to other institutions through traditional means including national presentations and scholarly journal articles. As such, the University of Maine will contribute new knowledge to the field of institutional transformation

Prevalence and Predictors of Vitamin D Deficiency among African Immigrants Living in Australia

Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentrations <50 nmol/L) is a public health issue in Australia and internationally. Those with darker skin require a greater dose of ultraviolet B radiation from sunlight than those with paler skin to synthesise adequate amounts of vitamin D. Using data from the 2011–2013 Australian Health Survey, we investigated the prevalence and predictors of vitamin D deficiency in African immigrants aged ≥18 years living in Australia (n = 236). Serum 25(OH)D was measured using a liquid chromatography–tandem mass spectrometry method that is certified to international reference measurement procedures. Poisson regression was used to investigate independent predictors of vitamin D deficiency. A total of 36% of adults were vitamin D deficient (35% of men, 37% of women). The prevalence ratio (PR) of vitamin D deficiency decreased by 2% per year of age (PR 0.98; 95% CI (0.97, 0.99); p = 0.004) and was 1.6 times higher in those with low/sedentary, compared to moderate/high, physical activity levels (PR 1.64; 95% CI (1.12, 2.39); p = 0.011). The greatest risk was for those assessed during winter/spring compared with summer/autumn (PR 1.89; 95% CI (1.33, 2.64); p < 0.001). Culturally appropriate messaging on safe sun exposure and dietary vitamin D is warranted in order to promote vitamin D sufficiency in African immigrants living in Australia.R.M.L. is supported by an Australian National Health and Medical Research Council Senior Research Fellowship. L.J.B. is supported by a Multiple Sclerosis Research Australia Postdoctoral Fellowship and a Curtin University Research Fellowship. E.D. would like to acknowledge the Australian Government Research Training Program Scholarship in supporting this research. The Australian Health Survey was conducted by the Australian Bureau of Statistics (ABS) with funding provided through the ABS health survey programme, the Department of Health and the National Heart Foundation of Australia

The Iowa Homemaker vol.22, no.7

Keeping Up With Today, Virginia Brainard, page 2 Dear Homemaker Staff, Ensign Eleanor White, page 3 American Schools Hit Wartime Stride, Joyce Curley, page 5 Vicky Dame Fashion… and You, Mary Lou Springer, page 6 What’s New in Home Economics, Helen Horton, page 8 Who’s Who on the Campus, Grace Brown, page 10 We Recommend, Eileen Dudgeon, page 11 I’m a Homemaking Jill-of-all-trades, Anna Keppy, page 12 Notions Department, Marian Loofe, page 14 Across Alumnae Desks, Mary Ellen Sullivan, page 1

Bridging Alone: Religious Conservatism, Marital Homogamy, and Voluntary Association Membership

This study characterizes social insularity of religiously conservative American married couples by examining patterns of voluntary associationmembership. Constructing a dataset of 3938 marital dyads from the second wave of the National Survey of Families and Households, the author investigates whether conservative religious homogamy encourages membership in religious voluntary groups and discourages membership in secular voluntary groups. Results indicate that couples’ shared affiliation with conservative denominations, paired with beliefs in biblical authority and inerrancy, increases the likelihood of religious group membership for husbands and wives and reduces the likelihood of secular group membership for wives, but not for husbands. The social insularity of conservative religious groups appears to be reinforced by homogamy—particularly by wives who share faith with husbands

A mixed-methods feasibility study of a new digital health support package for people after stroke : The Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention

Background Evidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial. Methods We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0–4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7–14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions. Results Between November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals. Conclusion The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018); Universal Trial Number: U1111-1206-723

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570