Assessing patients' experience of integrated care: a survey of patient views in the North West London Integrated Care Pilot

Despite the importance of continuity of care and patient engagement, few studies have captured patients' views on integrated care. This study assesses patient experience in the Integrated Care Pilot in North West London with the aim to help clinicians and policymakers understand patients' acceptability of integrated care and design future initiatives

Urban mobility and inequalities. Some perspectives from different disciplines

Urban mobility is one of the key aspects of urban planning and development. It plays an important role in the achievement of a resilient, inclusive and sustainable city. However, the complex interrelations of urban mobility, transportation and other city dimensions implies the need of an interdisciplinary approach to understand and plan it. In this brief paper, we discuss the social aspects of urban mobility and inequality and how it has been addressed in the literature. We also show different ways of gathering data relevant for the understanding of urban mobility, their sizes, scopes, and nature. Finally, we aim to promote an interdisciplinary debate based on our academic literature review about the relationship of urban mobility with social variables such as poverty

Multidisciplinary group performance—measuring integration intensity in the context of the North West London Integrated Care Pilot

Introduction: Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from individual to multidisciplinary decision-making, and from a focus on individual patients to a focus on patient groups. We have developed a method for coding MDG transcripts to identify whether they are or are not vehicles for delivering the anticipated efficiency improvements across various providers and apply it to a test case in the North West London Integrated Care Pilot. Methods: We defined ‘integrating’ as the process within the MDG meeting that enables or promotes an improved collaboration, improved understanding, and improved awareness of self and others within the local healthcare economy such that efficiency improvements could be identified and action taken. Utterances within the MDGs are coded according to three distinct domains grounded in concepts from communication, group decision-making, and integrated care literatures—the Valence, the Focus, and the Level. Standardized weighted integrative intensity scores are calculated across ten time deciles in the Case Discussion providing a graphical representation of its integrative intensity. Results: Intra- and Inter-rater reliability of the coding scheme was very good as measured by the Prevalence and Bias-adjusted Kappa Score. Standardized Weighted Integrative Intensity graph mirrored closely the verbatim transcript and is a convenient representation of complex communication dynamics. Trend in integrative intensity can be calculated and the characteristics of the MDG can be pragmatically described. Conclusion: This is a novel and potentially useful method for researchers, managers and practitioners to better understand MDG dynamics and to identify whether participants are integrating. The degree to which participants use MDG meetings to develop an integrated way of working is likely to require management, leadership and shared values

Pricing electricity inflexible contracts : profitability and impact of charges and taxes

Orientador: Paulo de Barros CorreiaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia MecanicaResumo: A precificação de contratos de energia elétrica no mercado brasileiro é um tema cuja dificuldade decorre principalmente por ser um mercado novo, sem um longo histórico de preços. Esta dissertação oferece uma contribuição situada em dois focos: a precificação de contratos de compra e venda de energia elétrica inflexíveis (opção e termo) no Ambiente de Contratação Livre e o impacto de encargos e tributos na rentabilidade destes contratos. Diferentes tipos de contratos têm sido utilizados no mercado livre de energia. Os contratos (termo e opção) inflexíveis foram selecionados por serem os mais frequentemente praticados no mercado. O modelo de latisse binomial é a principal ferramenta de precificação usada neste trabalho. Esta técnica é bastante conhecida no mercado financeiro para a precificação de contratos de opções. Aqui esta técnica será utilizada para calcular o valor esperado do Preço de Liquidação de Diferenças-PLD, valor esperado do Encargo de Serviço do Sistema-ESS, valor esperado de um contrato-a-termo e o valor esperado de um contrato de opção. No contexto deste trabalho, precificação compreende determinar medidas de benefício e risco unitário (R$/MWh), pois as decisões de contratação são instruídas pelo preço da energia negociada (R$/MWh), do que pelo volume financeiro total do contrato (R$). Além da avaliação do benefício bruto, também é feita uma estimativa do impacto dos encargos e tributos sobre o contrato. Serão apresentados os principais tributos e encargos que incidem nas operações de compra e venda de energia. Dentre os encargos e tributos devidos pelos consumidores, o ESS será avaliado como um ativo de risco, devido à sua difícil previsão, pois é definido mensalmente pela CCEE e apresenta volatilidade considerável.Abstract: This dissertation addresses the pricing of electrical energy contracts in the Brazilian market, a topic whose difficulty stems mainly because it is a very recent market without a long historic of prices. It offers a contribution situated in two points: the pricing of purchase and sell contracts of inflexible electrical energy (options and forwards) in the Free Hiring Environment; the impact of charges and taxes on the profitability of these contracts. Different types of contracts have been used in the free market of energy. The inflexible contracts (options and forwards) were selected because they are most often practiced in the market. The binomial latisse model is the main tool of pricing used in this work. This technique is well known in the financial market for the option contracts pricing. Here it will be used to ca1culate the expected value of Spot Price - PLD, expected value of the Service System Cost - ESS, the expected value of a forward contract and the expected value of an option contract. In this work context, pricing includes the determination of benefit measures and unit risk (R$/MWh) because hiring decisions are instructed by the negotiated price of energy (R$/ MWh), than the total financial volume of the contract (R$). In addition to the crude benefit evaluation, it is also made an estimation of charges and taxes impact on the contract. It will be presented the main taxes and charges that focus on purchase and sell of energy. Among the charges and taxes owed by consumers, the ESS will be evaluated as a risk asset because of its difficulty of prediction as it is set monthly by the CCEE and presents 'considerable volatility.MestradoMestre em Planejamento de Sistemas Energético

Infant Mortality Trends Among Georgia Residents, 1995-2003: Targeting Healthy People’s 2010 Goals

Population-based trends in infant mortality among Georgia Residents between 1995 and 2003 were assessed on characteristics such as race, birth weight, neonatal and post-neonatal periods, and cause of death. A statistical analysis was conducted to show that the Georgia infant mortality rate (IMR) remained constant throughout the study period and averaged 8.67 per 1,000 live births. The analysis revealed racial disparities, with an IMR ranging from 6.03 in white infants to 13.76 in black infants, with less than one percent (0.86%) change, on average, among the differences between black and white mortality rates across the nine-year period. The disparities were also evident in infants with low birth weight (LBW) and very low birth weight (VLBW). Black infants born with LBW (12.9%) and VLBW (9.98%) have more than twice the rate of infant mortality compared to white infants born with LBW (6.64%) and VLBW (1.12%). Mortality in the neonatal period accounted for more than half (67.96%) of all infant deaths and exhibited considerable ethnic differences. Among all groups, black male neonates (10.7) have the highest mortality rates. The average neonatal mortality rate across the entire study period is 5.89 (SD=0.20); the average postneonatal mortality rate across the entire study period is 2.78 (SD=0.22). The five leading causes of death among Georgian infants in descending order were: birth defects, prematurity and low birth weight, Sudden Unexplained Infant Deaths (SUID), other perinatal conditions and respiratory conditions with racial differences in the ordering

Unpacking the joy of movement – ‘it’s almost never the same’

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Tensions and tractions of moving together and alone in physical education

Author's accepted version (postprint).This is an Accepted Manuscript of an article published by Routledge (Taylor & Francis) in Sport, Education and Society on 19/01/2020.Available online: https://www.tandfonline.com/doi/full/10.1080/13573322.2020.1712654A wide variety of activities, instructional teaching styles and physical activity for health characterise PE practices today. However, for children, PE is about more than performing activities or being physically active for health. Children experience moving in the context of PE in varying and ambivalent ways, which indicates that qualitative aspects of movement (how to move) and the movement context (where to move and with whom) matter to them. To gain understanding of movement qualities in PE and PE as a movement context, this article explores what happens with and between children when they move in PE and how children’s movements and interactions relate to the context in which they move. The analysis starts with observational material from four primary schools in western Norway and an affect theoretical perspective is used. Through an in-depth analysis of 10–11-year-old children playing a game of sheep and wolverines, the article demonstrates how multiple actions and multiple dimensions of movement emerge simultaneously and how children’s own movements and the activity emerge and develop through reciprocal interactions. The activity framework forms how children move or is expected to move, while children’s actual movements make the activity what it is. Playing together co-exists and alternates with playing alone and playing in multiple ways. The flux of the game involves both an opportunity for something different to the present moment to become and for the accumulation of permanent patterns. The findings indicate a need to further discuss and explore the balances and imbalances between the individuals and the collective and the individuals, descriptions, rules and instructions in the context of PE.acceptedVersio

The impact of the Luton social prescribing programme on energy expenditure: a quantitative before-and-after study

The objective of this study was to assess the change in energy expenditure levels of service users after participation in the Luton social prescribing programme. Uncontrolled before-and-after study. This study was set in the East of England (Luton). Service users with complete covariate information and baseline measurements (n=146) were included in the analysis. Social prescribing, which is an initiative that aims to link patients in primary care with sources of support within the community sector to improve their health, well-being and care experience. Service users were referred to 12 sessions (free of charge), usually provided by third sector organisations. Energy expenditure measured as metabolic equivalent (MET) minutes per week. Using a Bayesian zero-inflated negative binomial model to account for a large number of observed zeros in the data, 95% posterior intervals show that energy expenditure from all levels of physical activities increased post intervention (walking 41.7% (40.31%, 43.11%); moderate 5.0% (2.94%, 7.09%); vigorous 107.3% (98.19%, 116.20%) and total 56.3% (54.77%, 57.69%)). The probability of engaging in physical activity post intervention increased, in three of four MET physical activity levels, for those individuals who were inactive at the start of the programme. Age has a negative effect on energy expenditure from any physical activity level. Similarly, working status has a negative effect on energy expenditure in all but one MET physical activity level. No consistent pattern was observed across physical activity levels in the association between gender and energy expenditure. This study shows that social prescribing may have the potential to increase the physical activity levels of service users and promote the uptake of physical activity in inactive patient groups. Results of this study can inform future research in the field, which could be of use for commissioners and policy makers

The Messiness of Children’s Voices : An Affect Theory Perspective

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