Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network.

BACKGROUND: Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. METHOD: We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. RESULTS: We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR - Patients at risk of readmission and ACG - Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. CONCLUSIONS: Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don't change

Ultrastructural localization of adenosine triphosphatase activity in lymphocytes activated in vitro by phytohaemagglutinin

The ultrastructural localization of Ca 2+, Mg2+ -activated ATPase was studied in phytohaemagglutinin activated lymphocytes and in normal unstimulated lymphocytes. Cells, fixed in paraformaldehyde-glutaraldehyde, were incubated in a medium containing 3 mM A TP, 5 mM CaCl2 and 2.4 mM Pb(N03h in 0.1 M tris buffer at pH 8.5, the optimum pH for histochemical demonstration of this enzyme. Reaction product was localized in the endoplasmic reticulum, nuclear membrane, Golgi apparatus and mitochondria and on the membrane surrounding large electron-dense bodies. Cytoplasmic vesicles and the plasma membrane were negative. Activity in unstimulated lymphocytes showed a similar localization but the amount of endoplasmic reticulum was much less than in activated lymphocytes. The pH of the medium was critical for the localization of the enzyme. At pH 7.5, the cytoplasmic reaction was almost completely inhibited but a dense precipitate was present on the outer surface of the plasma membrane. The reaction was stimulated by either Ca2+ or Mg2+ and was greatly decreased in the absence of these cations or in the presence of p-chloromercuribenzoate or N-ethylmaleimide. Oligomycin inhibited selectively the reaction in mitochondria but not the reaction at other sites. While the reaction in mitochondria showed complete substrate specificity, a mild reaction was obtained at the other sites with uridine diphosphate or sodium p-glycophosphate as substrate. A TP was, however, the preferential substate.peer-reviewe

INVOLVEMENT OF MUSLIM ORGANIZATIONS IN EDUCATIONAL AND SPORTS ACTIVITIES IN NIGERIA

Background: The primary aim of the current research was to explore the involvements of Muslim organizations in Nigeria particularly in the field of education and sports. The major problem was addressed that how much Muslim organizations working in Nigeria were contributing to education and provision of sports activities. Methods: This research employed a qualitative method. The eleven participants being administrative members of two organizations were declared as sample size. The tool used in the existing research contains interviews and documents analyses. Descriptive statistics and NVivo-10 both were employed to analyze the collected information as statistical approach. Results: Results of two Muslim organizations (Jama’atu Nasir Islam and NASFAT) showed which have made reliable and significant most especially in the field of education and sports. The existing study indicated that one of two organizations portrayed more quality activities of education and sports than the other. Conclusion: In summary, results of the research revealed that both Islamic organizations were aimed to uplift life standards of the community in Nigeria via promoting education and sports activities. These two of the organizations agreed to promote education and sports activities through building of new schools, converts to the religion of Islam, Financial assistance to needy, propagation of sports facilities, building of sports arenas, and Promotion of sports activities at grassroots level

RAI’s First Annual Postgraduate Conference

The Royal Anthropological Institute’s first annual one-day postgraduate conference was hosted by the Department of Anthropology at Durham University on 20 September 2011. In their opening remarks, Bob Simpson, and Stephen M Lyon referred to the RAI’s vision for this annual conference, where 30 postgraduate students from more than 17 universities and institutes presented their research. Stephen Lyon then introduced the use of the Anthropological Index Online in anthropological research. RAI’s Film Officer, Susanne Hammacher and Education and Communication Officer, Nafisa Fera introduced the range of RAI’s activities, inviting participants to take an active role. Both sessions showed how the RAI can help to increase the visibility of students’ research in the discipline. In an interactive session with journal editors (Stephen M. Lyon of History and Anthropology, Claudia Merli of Durham Anthropology Journal, and Simone Gritter and Ely Rosenblum of the online multimedia journal ART/E/FACT), students gained information about getting published in anthropological journals

LEADERSHIP STYLE DISCOVERY IN PERFORMANCE COACHING WITHIN SOCIAL CONTEXT

Background: The purpose of the existing research was to examine the relationships of leadership styles, coaching strategies, and social support with sport achievements of players. Methods: The study was used a correlation design. The population of the research was consisted of 830 female players of Islamia university of Bahawalpur and Government College University Faisalabad. The data was collected through survey questionnaires with sample size of 240 respondents. Adopted and modified questionnaires were employed with the permission of parent authors. Various statistical techniques were utilized on collected data for the purpose of data analyses. The descriptive statistics was used to measure the demographic information through mean, standard deviation, and percentages, whereas, Pearson’s correlation analysis and multiple regression analysis were employed to test the hypotheses. Results: The leadership styles, coaching strategies, and social support as predictors factors significantly influenced on the sport achievements of players. The findings revealed positive and highly significant relationships of leadership styles (autocratic and democratic), coaching strategies (social support and positive feedback), social support (parents, siblings, peers and sport teachers) with sport performance of players. Conclusion: Therefore, social support is also needed to players by their parents, siblings, peers, and sports teachers not only to get sport achievements but also for their appreciations either on their elite or worst performance. The implication of the existing research suggested that coaches as leaders should prepare the athletes utilizing their expertise and boost them with their coaching strategies as well to gain their achievement level best in sports

Laparoscopic versus open transhiatal oesophagectomy for oesophageal cancer

Surgery is the preferred treatment for resectable oesophageal cancers, and can be performed in different ways. Transhiatal oesophagectomy (oesophagectomy without thoracotomy, with a cervical anastomosis) is one way to resect oesophageal cancers. It can be performed laparoscopically or by open method. With other organs, laparoscopic surgery has been shown to reduce complications and length of hospital stay compared to open surgery. However, concerns remain about the safety of laparoscopic transhiatal oesophagectomy in terms of post-operative complications and oncological clearance compared with open transhiatal oesophagectomy

Assessment of cardiovascular risk in primary care.

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Reciprocal fit concept in mission statement research

There is a stalemate in mission-performance research. While past studies focus on strategic alignment, recent studies attempt to move the mission-performance research forward using the reciprocal fit concept. This concept provides explanatory power in predicting performance of the firm. However, there is a lack of research into the reciprocal fit concept. The concept needs further clarification. This study aims to elucidate the concept of reciprocal fit by: (1) investigating the theoretical underpinning of the fit concepts; (2) identifying the conditions of reciprocal fit; and (3) find empirical evidence supporting this reciprocal fit. The originality of this study is in the knowledge contribution of the reciprocal fit concept and the integration of resource-based view and reciprocal determination theory as the underpinning theories supporting the concept

Equilibrium configurations of hard spheres in a cylindrical harmonic potential

A line of hard spheres confined by a transverse harmonic potential, with hard walls at its ends, exhibits a variety of buckled structures as it is compressed longitudinally. Here we show that these may be conveniently observed in a rotating liquid-filled tube (originally introduced by Lee et al. (Adv. Mater., 29 (2017) 1704274) to assemble ordered three-dimensional structures at higher compressions). The corresponding theoretical model is transparent and easily investigated numerically, as well as by analytic approximations. Hence we explore a wide range of predicted structures occurring via bifurcation, of which the stable ones are also observed in our experiments. Qualitatively similar structures have previously been found in trapped ion systems

Columnar structures of soft spheres::Metastability and hysteresis

Previously we reported on the stable (i.e. minimal enthalpy) structures of soft monodisperse spheres in a long cylindrical channel. Here, we present further simulations, which significantly extend the original phase diagram up to D/d = 2.714 (ratio of cylinder and sphere diameters), where the nature of densest sphere packing changes. However, macroscopic systems of this kind are not confined to the ideal equilibrium states of this diagram. Consequently, we explore some of the structural transitions to be expected as experimental conditions are varied; these are in general hysteretic. We represent these transitions in a stability diagram for a representative case. Illustrative videos are included in the supplemental material.Comment: Published in Phys Rev E 98, 043303 (2018) https://doi.org/10.1103/PhysRevE.98.04330