Economic Inclusion in Grand Rapids

This report presents an updated review of progress toward economic inclusion in the Grand Rapids, Mich.area. It summarizes the changes between data reported by Dr. Mark White of the Center for Regional Analysisat George Mason University and the Center for Regional Economic Competitiveness in Addressing Economic Inclusion in Grand Rapids (2016) and the most recently available data obtained from public sources — primarily comparing data from 2014 to 2018. Data are displayed in various geographic groupings and disaggregated by demographic characteristics for comparison. This report, sponsored by the W.K. Kellogg Foundation (WKKF), is intended to aid ongoing strategy development for promoting inclusive growth in the Grand Rapids area

Alternating Signed Bipartite Graphs and Difference-1 Colourings

We investigate a class of 2-edge coloured bipartite graphs known as alternating signed bipartite graphs (ASBGs) that encode the information in alternating sign matrices. The central question is when a given bipartite graph admits an ASBG-colouring; a 2-edge colouring such that the resulting graph is an ASBG. We introduce the concept of a difference-1 colouring, a relaxation of the concept of an ASBG-colouring, and present a set of necessary and sufficient conditions for when a graph admits a difference-1 colouring. The relationship between distinct difference-1 colourings of a particular graph is characterised, and some classes of graphs for which all difference-1 colourings are ASBG-colourings are identified. One key step is Theorem 3.4.6, which generalises Hall's Matching Theorem by describing a necessary and sufficient condition for the existence of a subgraph $H$ of a bipartite graph in which each vertex $v$ of $H$ has some prescribed degree $r(v)$

I trade, therefore I am : legal personhood in the European Union

The piecemeal, case by case construction of EU citizenship has created a patchwork of personhoods rather than a unitary status - a patchwork with significant gaps through which people deemed economically inactive are allowed to fall. This paper argues that it is necessary to assess the integrity and effects of a market-centric, economic citizenship. The free movement legal landscape is riven with welfare rights "cliff edges," as changes in circumstance tip claimants from full equal welfare entitlement to none. Examples drawn from the UK include the welfare restrictions placed on Zambrano-reliant families, and the care and pregnancy gaps in Directive 2004/38. Market citizenship and the worker-commodity paradigm have not disappeared, but have been obscured and fortified through the moral language of citizenship and responsibility. The impact upon our ideas of fairness and society is evident in the Union's activation agenda for national welfare regimes. This paper argues that we should recognize the ideological ramifications of accepting the premises of market citizenship, assess its consequences, and ask whether an alternative approach is possible to challenge Member State minimal implementation, to better commit to the protection of each others' nationals and to promote EU level social justice

Alternating sign matrices of finite multiplicative order

We investigate alternating sign matrices that are not permutation matrices, but have finite order in a general linear group. We classify all such examples of the form P+T, where P is a permutation matrix and T has four non-zero entries, forming a square with entries 1 and −1 in each row and column. We show that the multiplicative orders of these matrices do not always coincide with those of permutation matrices of the same size. We pose the problem of identifying finite subgroups of general linear groups that are generated by alternating sign matrices

Alternating sign matrices of finite multiplicative order

We investigate alternating sign matrices that are not permutation matrices, but have finite order in a general linear group. We classify all such examples of the form , where P is a permutation matrix and T has four non-zero entries, forming a square with entries 1 and −1 in each row and column. We show that the multiplicative orders of these matrices do not always coincide with those of permutation matrices of the same size. We pose the problem of identifying finite subgroups of general linear groups that are generated by alternating sign matrices

'A hard-won capability': the experiences of parents managing their babies' medicines after discharge from a neonatal unit.:'A hard-won capability'

IntroductionParents of babies who required neonatal care are responsible for managing their medicines after they are discharged home. There is wide variation in the information and amount of preparation given to parents prior to assuming this challenging task. The aim of the Parent co-Designed Drug Information for parents and Guardians Taking Neonates home (PADDINGToN) study was to explore parents' experiences of managing their babies' medicines post discharge from a neonatal unit and to use this information to develop suitable resources for future families.MethodsA qualitative participatory interpretative approach using a mixture of remote and face-to-face small group interviews or one-to-one interviews was used. Parents were recruited using social media advertisements and convenience sampling from five study sites (four neonatal units in England and one in Ireland). Parents from other neonatal units were invited to take part through social media advertisement. The interviews were audio-recorded and inductive reflexive thematic analysis was used to analyze the data.Results17 parents (14 mothers, 3 fathers) participated. One over-arching theme, 'A hard won capability', and four major interpretive themes were generated from the analysis of the data: Being in NICU and the prospect of going home: emotional and practical challenges; Living the reality of being at home: the uncertainty associated with giving medicines; Being at home: battling the system and a lack of support/knowledge; and Suggesting ways forward: parents' lived insights into improving information and resources.ConclusionDespite the challenges they faced, parents developed strategies for safely and reliably managing medicines administration and they assimilated knowledge, built their confidence and achieved a capability in medicines administration. Their experiences have been used to build a suite of medicines administration resources to support future parents.</jats:sec

Description and process evaluation of pharmacists’ interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial)

Objective To undertake a process evaluation of pharmacists' recommendations arising in the context of a complex IT-enabled pharmacist-delivered randomised controlled trial (PINCER trial) to reduce the risk of hazardous medicines management in general practices. Methods PINCER pharmacists manually recorded patients’ demographics, details of interventions recommended, actions undertaken by practice staff and time taken to manage individual cases of hazardous medicines management. Data were coded and double entered into SPSS v15, and then summarised using percentages for categorical data (with 95% CI) and, as appropriate, means (SD) or medians (IQR) for continuous data. Key findings Pharmacists spent a median of 20 minutes (IQR 10, 30) reviewing medical records, recommending interventions and completing actions in each case of hazardous medicines management. Pharmacists judged 72% (95%CI 70, 74) (1463/2026) of cases of hazardous medicines management to be clinically relevant. Pharmacists recommended 2105 interventions in 74% (95%CI 73, 76) (1516/2038) of cases and 1685 actions were taken in 61% (95%CI 59, 63) (1246/2038) of cases; 66% (95%CI 64, 68) (1383/2105) of interventions recommended by pharmacists were completed and 5% (95%CI 4, 6) (104/2105) of recommendations were accepted by general practitioners (GPs), but not completed at the end of the pharmacists’ placement; the remaining recommendations were rejected or considered not relevant by GPs. Conclusions The outcome measures were used to target pharmacist activity in general practice towards patients at risk from hazardous medicines management. Recommendations from trained PINCER pharmacists were found to be broadly acceptable to GPs and led to ameliorative action in the majority of cases. It seems likely that the approach used by the PINCER pharmacists could be employed by other practice pharmacists following appropriate training

Health literacy: a cross-disciplinary study in American undergraduate college students

Our research aims to assess the health literacy of undergraduate college students. Past research on the health literacy of undergraduate students has revealed some gaps in the undergraduate health literacy. In this study, we employed the Newest Vital Sign Test to measure health literacy. We interviewed 235 undergraduate students from health majors (nursing and other health) and non-health majors. We hypothesised that due to the specificity of a health-related curriculum, nursing and other health-related majors would score higher in health literacy than non-health-related majors, and that nursing majors in particular would score higher than other health-related majors and non-health-related majors. We found support for our hypothesis, as nursing majors had a mean score of 3.57, while health and non-health majors had a mean score of 3.24 and 2.88 respectively when assessing their health literacy levels. We discuss our results with regard to the strategies for improving health literacy skills

Physiological deterioration in the Emergency Department: the SNAP40-ED study

Continuous novel ambulatory monitoring may detect deterioration in Emergency Department (ED) patients more rapidly, prompting treatment and preventing adverse events. Single-centre, open-label, prospective, observational cohort study recruiting high/medium acuity (Manchester triage category 2 and 3) participants, aged over 16 years, presenting to ED. Participants were fitted with a novel wearable monitoring device alongside standard clinical care (wired monitoring and/or manual clinical staff vital sign recording) and observed for up to 4 hours in the ED. Primary outcome was time to detection of deterioration. Two-hundred and fifty (250) patients were enrolled. In 82 patients (32.8%) with standard monitoring (wired monitoring and/or manual clinical staff vital sign recording), deterioration in at least one vital sign was noted during their four-hour ED stay. Overall, the novel device detected deterioration a median of 34 minutes earlier than wired monitoring (Q1, Q3 67,194; n=73, mean difference 39.48, p<0.0001). The novel device detected deterioration a median of 24 minutes (Q1, Q3 2,43; n=42) earlier than wired monitoring and 65 minutes (Q1, Q3 28,114; n=31) earlier than manual vital signs. Deterioration in physiology was common in ED patients. ED staff spent a significant amount of time performing observations and responding to alarms, with many not escalated. The novel device detected deterioration significantly earlier than standard care