8,006 research outputs found

    Investigating the widely held belief that men and women with learning disabilities receive poor quality healthcare when admitted to hospital: a single-site study of 30-day readmission rates.

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    BACKGROUND: This study aims to use 30-day readmission rates to investigate the presumption that men and women with learning disabilities (LDs, known internationally as intellectual disabilities) receive poorer quality hospital care than their non-disabled peers. METHOD: A 12-month retrospective audit was conducted using Hospital Episode Statistics (HES) at a single acute hospital in the East of England. This identified all in-patient admissions; admissions where the person concerned was recognised as having a LD; and all emergency readmissions within 30 days of discharge. Additionally, the healthcare records of all patients identified as having a LD and readmitted within 30 days as a medical emergency were examined in order to determine whether or not these readmissions were potentially preventable. RESULTS: Over the study period, a total of 66 870 adults were admitted as in-patients, among whom 7408 were readmitted as medical emergencies within 30 days of discharge: a readmission rate of 11%. Of these 66 870 patients, 256 were identified as having a LD, with 32 of them experiencing at least one emergency readmission within 30 days: a readmission rate of 13%. When examined, the healthcare records pertaining to these 32 patients who had a total of 39 unique 30-day readmissions revealed that 69% (n = 26) of these readmissions were potentially preventable. CONCLUSION: Although overall readmission rates were similar for patients with LDs and those from the general population, patients with LDs had a much higher rate of potentially preventable readmissions when compared to a general population estimate from van Walraven et al. This suggests that there is still work to be done to ensure that this patient population receives hospital care that is both safe and of high quality.This research was funded by a grant from the Addenbrooke's Charitable Trust (CK), while the preparation of this paper was funded by the Health Foundation (AH, MR) and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England (AH, MR, AW) at Cambridgeshire and Peterborough NHS Foundation Trust.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1111/jir.1219

    Silly Questions and Arguments for the Implicit, Cinematic Narrator

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    My chapter aims to advance the debate on a problem often raised by philosophers who are skeptical of implied narrators in movies. This is the concern that positing such elusive narrators gives rise to absurd imaginings (Gaut 2004: 242; Carroll 2006: 179-180). Friends of the implied cinematic narrator reply that the questions critics raise about the workings of the implied cinematic narrator are "silly ones" to ask. I examine how the "absurd imaginings" problem arises for all the central arguments for the elusive cinematic narrator and discuss why the questions critics pose about this narrator are legitimate ones to ask

    Challenging Perceptions of Disability through Performance Poetry Methods: The "Seen but Seldom Heard" Project.

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    This paper considers performance poetry as a method to explore lived experiences of disability. We discuss how poetic inquiry used within a participatory arts-based research framework can enable young people to collectively question society’s attitudes and actions towards disability. Poetry will be considered as a means to develop a more accessible and effective arena in which young people with direct experience of disability can be empowered to develop new skills that enable them to tell their own stories. Discussion of how this can challenge audiences to critically reflect upon their own perceptions of disability will also be developed

    Target product profiles for protecting against outdoor malaria transmission.

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    BACKGROUND\ud \ud Long-lasting insecticidal nets (LLINs) and indoor residual sprays (IRS) have decimated malaria transmission by killing indoor-feeding mosquitoes. However, complete elimination of malaria transmission with these proven methods is confounded by vectors that evade pesticide contact by feeding outdoors.\ud \ud METHODS\ud \ud For any assumed level of indoor coverage and personal protective efficacy with insecticidal products, process-explicit malaria transmission models suggest that insecticides that repel mosquitoes will achieve less impact upon transmission than those that kill them outright. Here such models are extended to explore how outdoor use of products containing either contact toxins or spatial repellents might augment or attenuate impact of high indoor coverage of LLINs relying primarily upon contact toxicity.\ud \ud RESULTS\ud \ud LLIN impact could be dramatically enhanced by high coverage with spatial repellents conferring near-complete personal protection, but only if combined indoor use of both measures can be avoided where vectors persist that prefer feeding indoors upon humans. While very high levels of coverage and efficacy will be required for spatial repellents to substantially augment the impact of LLINs or IRS, these ambitious targets may well be at least as practically achievable as the lower requirements for equivalent impact using contact insecticides.\ud \ud CONCLUSIONS\ud \ud Vapour-phase repellents may be more acceptable, practical and effective than contact insecticides for preventing outdoor malaria transmission because they need not be applied to skin or clothing and may protect multiple occupants of spaces outside of treatable structures such as nets or houses

    Universal restrictions to the conversion of heat into work derived from the analysis of the Nernst theorem as a uniform limit

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    We revisit the relationship between the Nernst theorem and the Kelvin-Planck statement of the second law. We propose that the exchange of entropy uniformly vanishes as the temperature goes to zero. The analysis of this assumption shows that is equivalent to the fact that the compensation of a Carnot engine scales with the absorbed heat so that the Nernst theorem should be embedded in the statement of the second law. ----- Se analiza la relaci{\'o}n entre el teorema de Nernst y el enunciado de Kelvin-Planck del segundo principio de la termodin{\'a}mica. Se{\~n}alamos el hecho de que el cambio de entrop{\'\i}a tiende uniformemente a cero cuando la temperatura tiende a cero. El an{\'a}lisis de esta hip{\'o}tesis muestra que es equivalente al hecho de que la compensaci{\'o}n de una m{\'a}quina de Carnot escala con el calor absorbido del foco caliente, de forma que el teorema de Nernst puede derivarse del enunciado del segundo principio.Comment: 8pp, 4 ff. Original in english. Also available translation into spanish. Twocolumn format. RevTe

    Progressive age-associated activation of JNK associates with conduction disruption in the aged atrium.

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    Connexin43 (Cx43) is critical for maintaining electrical conduction across atrial muscle. During progressive aging cardiac conduction slows and becomes susceptible to disruption, predisposing to arrhythmias. Changes in Cx43 protein expression, or its phosphorylation status, can instigate changes in the conduction of the cardiac action potential. Our study investigated whether increased levels of activated c-jun N-terminal kinase (JNK) is the mechanism responsible for the decline of Cx43 protein and intercellular communication during progressive aging. We examined right atrial muscle from guinea pigs between 1 day and 38 months of age. The area of the intercalated disc increased with age concurrent with a 75% decline in total C43 protein expression and spatial re-organisation of the remaining protein. An age-dependent increase in activated-JNK correlated with a rise in phosphorylated Cx43. The data also correlated with slowing of the action potential conduction velocity across the right atria from 0.38±0.01 m/s at 1 month of age to 0.30±0.01 m/s at 38 months of age. The JNK activator anisomycin increased levels of activated JNK in myocytes and reduced Cx43 protein expression paralleling the aging effect The JNK inhibitor SP600125, was found to eradicate almost all trace of Cx43 protein from the intercalating discs. We conclude that in vivo activation of JNK increases with age leading to the loss of Cx43 protein from atrial myocytes. This progressive loss results in impaired conduction and is likely to contribute to the increasing risk of atrial arrhythmias with advancing age

    Report of the Working Group on `W Mass and QCD' (Phenomenology Workshop on LEP2 Physics, Oxford, April 1997)

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    The W Mass and QCD Working Group discussed a wide variety of topics relating to present and future measurements of M(W) at LEP2, including QCD backgrounds to W+W- production. Particular attention was focused on experimental issues concerning the direct reconstruction and threshold mass measurements, and on theoretical and experimental issues concerning the four jet final state. This report summarises the main conclusions.Comment: 43 pages LaTeX and 15 encapsulated postscript figures. Uses epsfig and ioplppt macros. Full Proceedings to be published in Journal of Physics
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