736 research outputs found
Can guidelines improve referral to elective surgical specialties for adults? A systematic review
Aim To assess effectiveness of guidelines for referral for
elective surgical assessment.
Method Systematic review with descriptive synthesis.
Data sources Medline, EMBASE, CINAHL and Cochrane
database up to 2008. Hand searches of journals and
websites.
Selection of studies Studies evaluated guidelines for
referral from primary to secondary care, for elective
surgical assessment for adults.
Outcome measures Appropriateness of referral (usually
measured as guideline compliance) including clinical
appropriateness, appropriateness of destination and of
pre-referral management (eg, diagnostic investigations),
general practitioner knowledge of referral
appropriateness, referral rates, health outcomes and
costs.
Results 24 eligible studies (5 randomised control trials,
6 cohort, 13 case series) included guidelines from UK,
Europe, Canada and the USA for referral for
musculoskeletal, urological, ENT, gynaecology, general
surgical and ophthalmological conditions. Interventions
varied from complex (âone-stop shopsâ) to simple
guidelines. Four randomized control trials reported
increases in appropriateness of pre-referral care
(diagnostic investigations and treatment). No evidence
was found for effects on practitioner knowledge. Mixed
evidence was reported on rates of referral and costs
(rates and costs increased, decreased or stayed the
same). Two studies reported on health outcomes finding
no change.
Conclusions Guidelines for elective surgical referral can
improve appropriateness of care by improving prereferral
investigation and treatment, but there is no
strong evidence in favour of other beneficial effects
A review of health impact assessment frameworks
Background: Consideration of health impacts of non-health sector policies
has been encouraged in many countries, with health impact assessment (HIA)
increasingly used worldwide for this purpose. HIA aims to assess the potential impacts
of a proposal and make recommendations to improve the potential health outcomes
and minimize inequalities. Although many of the same techniques can be used, such
as community consultation, engagement or profiling, HIA differs from other community
health approaches in its starting point, purpose and relationship to interventions.
Many frameworks have been produced to aid practitioners in conducting HIA.
Objective: To review the many HIA frameworks in a systematic and comparative way.
Study design: Systematic review.
Method: The literature was searched to identify published frameworks giving
sufficient guidance for those with the necessary skills to be able to undertake an HIA.
Results: Approaches to HIA reflect their origins, particularly those derived from Environmental
Impact Assessment (EIA). Early HIA resources tended to use a biomedical
model of health and examine projects. Later developmentswere designed for usewith
policy proposals, and tended to use a socio-economic or environmental model of
health. There aremore similarities than differences in approaches to HIA, with convergence
over time, such as the distinction between ânarrowâ and âbroadâ focus HIA disappearing.
Consideration of health disparities is integral to most HIA frameworks but
not universal. A few resources focus solely on inequalities. The extent of community
participation advocated varies considerably.
Conclusion: It is important to select an HIA framework designed for a comparable
context, level of proposal and available resources
Impacts of a conditional cash transfer scheme on health in Colombia
Conditional cash transfer schemes (CCTS) are increasingly popular interventions aiming to improve the welfare of the worst off: Families receive regular cash as long as they comply with behavioral conditions concerning uptake of preventive healthcare and schooling. Literature Review, however, finds that associated health impacts are often small or inconsistent and are occasionally adverse. The aim of this thesis is to advance understanding of the impact of CCTS on health and on health equity. It does this by examining the effect of Familias, the Colombian scheme, on outcomes little discussed in the literature, namely rates of obesity in women and in children (an unintended outcome), and womenâs healthcare knowledge. It sets findings within a conceptual framework that sees health as being co-produced between individuals and society. Co-production requires investment in individualsâ human capital, material resources and creation of fairer socioeconomic environments, somewhat resembling the underpinning philosophy and structure of CCTS. Multiple regression on a range of individual, household and community level covariates using an intention-to-treat protocol on prospectively collected data with matched controls finds that Familias is associated with increased odds of obesity in women (O.R.=1.41, 95% C.I. 1.09, 1.82; p=0.01) and odds of overweight or obesity in girls aged 2-7 at baseline (O.R.=2.13, 95% C.I. 1.23, 3.69; p<0.01). Furthermore, Familias fails to improve healthcare knowledge, a marker of human capital, in women despite being a core objective of the programme (logit coefficient= -0.20, 95% C.I. -0.41, 0.01; p=0.06). Given these negative findings, a number of policy recommendations are made emphasising the importance of social determinants of health: balancing imposition of behavioural requirements with the realisation of rights to high-quality public services, considering the potential for universalising aspects of the schemes and exploring a greater role for the health sector in CCTS design, operation and evaluation
The American Founding Documents and Democratic Social Change: A Constructivist Grounded Theory
Existing social disparities in the United States are inconsistent with the promise of democracy; therefore, there was a need for critical conceptualization of the first principles that undergird American democracy and the genesis of democratic social change in America. This constructivist grounded theory study aimed to construct a grounded theory that provides an understanding of the process of American democratic social change as it emerged from the nationâs founding documents. A post hoc polytheoretical framework including Foucaultâs, Bourdieuâs, and Marx and Engelsâs theories of power was used to understand power dynamics. The research question focused on understanding the process of democratic social change in America. The sample comprised the Articles of Confederation, the U.S. Declaration of Independence, The Federalist Papers, and the U.S. Constitution. The documents were retrieved from the National Archives and Library of Congress. The data analysis plan incorporated successive comparison, situational and dramaturgical analysis, deconstruction, and perspective taking as strategies. The result was the construction of a democratic social change process theory preceded by five grounded theories: (a) first principles of democracy, (b) first principles of democracy conceptual framework, (c) socio-ethical principles of democracy, (d) demoralizing process, and (e) either-or approach to democracy. Positive social change implications include applying a democratic social change process to future social change endeavors across domains and levels of analysis, a normative framework for a republican form of government, and a tool to analyze and minimize the latent consequences of social justice policies
funcX: A Federated Function Serving Fabric for Science
Exploding data volumes and velocities, new computational methods and
platforms, and ubiquitous connectivity demand new approaches to computation in
the sciences. These new approaches must enable computation to be mobile, so
that, for example, it can occur near data, be triggered by events (e.g.,
arrival of new data), be offloaded to specialized accelerators, or run remotely
where resources are available. They also require new design approaches in which
monolithic applications can be decomposed into smaller components, that may in
turn be executed separately and on the most suitable resources. To address
these needs we present funcX---a distributed function as a service (FaaS)
platform that enables flexible, scalable, and high performance remote function
execution. funcX's endpoint software can transform existing clouds, clusters,
and supercomputers into function serving systems, while funcX's cloud-hosted
service provides transparent, secure, and reliable function execution across a
federated ecosystem of endpoints. We motivate the need for funcX with several
scientific case studies, present our prototype design and implementation, show
optimizations that deliver throughput in excess of 1 million functions per
second, and demonstrate, via experiments on two supercomputers, that funcX can
scale to more than more than 130000 concurrent workers.Comment: Accepted to ACM Symposium on High-Performance Parallel and
Distributed Computing (HPDC 2020). arXiv admin note: substantial text overlap
with arXiv:1908.0490
Pensions and the health of older people in South Africa: Is there an effect?
This paper critically reviews evidence from low and middle income countries that pensions are associated with better health outcomes for older people. It draws on new, nationally representative survey data from South Africa to provide a systematic analysis of pension effects on health and quality of life. It reports significant associations with the frequency of health service utilisation, as well as with awareness and treatment of hypertension. There is, however, no association with actual control of hypertension, self-reported health or quality of life. The paper calls for a more balanced and integrated approach to social protection for older people
Protein Synthesis by Day 16 Bovine Conceptuses during the Time of Maternal Recognition of Pregnancy
Interferon Tau (IFNT), the conceptus-derived pregnancy recognition signal in cattle, significantly modifies the transcriptome of the endometrium. However, the endometrium also responds to IFNT-independent conceptus-derived products. The aim of this study was to determine what proteins are produced by the bovine conceptus that may facilitate the pregnancy recognition process in cattle. We analysed by mass spectrometry the proteins present in conceptus-conditioned media (CCM) after 6 h culture of Day 16 bovine conceptuses (n = 8) in SILAC media (arginine- and lysine-depleted media supplemented with heavy isotopes) and the protein content of extracellular vesicles (EVs) isolated from uterine luminal fluid (ULF) of Day 16 pregnant (n = 7) and cyclic (n = 6) cross-bred heifers on day 16. In total, 11,122 proteins were identified in the CCM. Of these, 5.95% (662) had peptides with heavy labelled amino acids, i.e., de novo synthesised by the conceptuses. None of these proteins were detected in the EVs isolated from ULF. Pregnancy-associated glycoprotein 11, Trophoblast Kunitz domain protein 1 and DExD-Box Helicase 39A were de novo produced and present in the CCM from all conceptuses and in previously published CCM data following 6 and 24 h. A total of 463 proteins were present in the CCM from all the conceptuses in the present study, and after 6 and 24 h culture in a previous study, while expression of their transcripts was not detected in endometrium indicating that they are likely conceptus-derived. Of the proteins present in the EVs, 67 were uniquely identified in ULF from pregnant heifers; 35 of these had been previously reported in CCM from Day 16 conceptuses. This study has narrowed a set of conceptus-derived proteins that may be involved in EV-mediated IFNT-independent embryoâmaternal communication during pregnancy recognition in cattle
Enhancement of electroporation facilitated immunogene therapy via T-reg depletion
Regulatory T cells (T-regs) can negatively impact tumor antigen-specific immune responses after infiltration into tumor tissue. However, depletion of T-regs can facilitate enhanced anti-tumor responses, thus augmenting the potential for immunotherapies. Here we focus on treating a highly aggressive form of cancer using a murine melanoma model with a poor prognosis. We utilize a combination of T-reg depletion and immunotherapy plasmid DNA delivered into the B16F10 melanoma tumor model via electroporation. Plasmids encoding murine granulocyte macrophage colony-stimulating factor and human B71 were transfected with electroporation into the tumor and transient elimination of T-regs was achieved with CD25-depleting antibodies (PC61). The combinational treatment effectively depleted T-regs compared to the untreated tumor and significantly reduced lung metastases. The combination treatment was not effective in increasing the survival, but only effective in suppression of metastases. These results indicate the potential for combining T-reg depletion with immunotherapy-based gene electrotransfer to decrease systemic metastasis and potentially enhance survival
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