Repositioning the Boundaries between Public and Private Healthcare Providers in the English NHS

Background and Objectives: Neoliberal ‘reform’ has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. This paper examines the relationships between ownership, organisational structure and managerial regime within an elaboration of Donabedian’s reasoning about organisational structures. Using new data from England it considers: 1. How do the internal managerial g regimes of differently owned healthcare providers differ, or not? 2. In what respects did any such differences arise from differences in ownership or for other reasons? Methods: An observational systematic qualitative comparison of differently-owned providers was the strongest feasible research design. We systematically compared a maximum-variety sample (by ownership) of community health services (CHS); out-of-hours primary care (OOH); hospital planned orthopaedics and ophthalmology providers (N=12 cases). The framework of comparison was the ownership theory mentioned above. Findings: The relationships between ownership (one one hand) and organisation structures and managerial regimes (on the other), differed at different organisational levels. Top-level governance structures diverged by organisational ownership and objectives among the case-study organisations. All the case-study organisations irrespective of ownership had hierarchical, bureaucratic structures and managerial regimes for coordinating everyday service production, but to differing extents. In doctor-owned organisations the doctors’, but not other occupations’, work was controlled and coordinated in a more-or-less democratic, self-governing ways. Conclusion: Ownership does make important differences to healthcare providers’ top-level governance structures and accountabilities; and to work coordination activity, but with different patterns at different organisational levels. These findings have implications for understanding the legitimacy, governance and accountability of healthcare organisations, the distribution and use of power within them, and system-wide policy interventions, for instance to improve care coordination; and for the correspondingly required foci of healthcare organisational research

The Vehicle, 1961, Vol. 3 no. 2

Vol. 3, No. 2 Table of Contents The Voting CattleLinda Kay Campbellpage 5 But For the Passage of TimeDon Shepardsonpage 14 LoveJon Woodspage 16 Infinite JourneyJames E. Martinpage 19 The Clover ChainRichard W. Blairpage 20 SnowballSusan Daughertypage 24 Sureness Is NeverDon Shepardsonpage 26 ConceptionChristine McCollpage 34 Comedy: Relief and GriefTom McPeakpage 35 The Unspoken WordChristine McCollpage 35 CharmBenjamin Polkpage 36 Screaming SpiderTom McPeakpage 39 Just Once in an Early SpringE.J.B.page 39 HummingbirdPauline B. Smithpage 40 Willow TreesPauline B. Smithpage 40 MaturityChristine McCollpage 41 The New YearLinda Campbellpage 41 The StormMary-Jean Pitratpage 42 Ebony IvoryJean Danenbargerpage 42 The Fireball MailAllen Engelbrightpage 43 ExpectationChristine McCollpage 44 CatastropheChristine McCollpage 44 SophisticationBenjamin Polkpage 45 On Playing BridgeMyrna Jo Handleypage 46 SonnetMignon Stricklandpage 48https://thekeep.eiu.edu/vehicle/1009/thumbnail.jp

The Vehicle, 1961, Vol. 3 no. 2

Vol. 3, No. 2 Table of Contents The Voting CattleLinda Kay Campbellpage 5 But For the Passage of TimeDon Shepardsonpage 14 LoveJon Woodspage 16 Infinite JourneyJames E. Martinpage 19 The Clover ChainRichard W. Blairpage 20 SnowballSusan Daughertypage 24 Sureness Is NeverDon Shepardsonpage 26 ConceptionChristine McCollpage 34 Comedy: Relief and GriefTom McPeakpage 35 The Unspoken WordChristine McCollpage 35 CharmBenjamin Polkpage 36 Screaming SpiderTom McPeakpage 39 Just Once in an Early SpringE.J.B.page 39 HummingbirdPauline B. Smithpage 40 Willow TreesPauline B. Smithpage 40 MaturityChristine McCollpage 41 The New YearLinda Campbellpage 41 The StormMary-Jean Pitratpage 42 Ebony IvoryJean Danenbargerpage 42 The Fireball MailAllen Engelbrightpage 43 ExpectationChristine McCollpage 44 CatastropheChristine McCollpage 44 SophisticationBenjamin Polkpage 45 On Playing BridgeMyrna Jo Handleypage 46 SonnetMignon Stricklandpage 48https://thekeep.eiu.edu/vehicle/1009/thumbnail.jp

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Age evaluation and causation of rock-slope failures along the western margin of the Antrim Lava Group (ALG), Northern Ireland, based on cosmogenic isotope (36Cl) surface exposure dating.

The temporal pattern of postglacial rock-slope failure in a glaciated upland area of Ireland (the western margin of the Antrim Lava Group) was evaluated using both 36Cl exposure dating of surface boulders on run-out debris and 14C dating of basal organic soils from depressions on the debris. The majority of the 36Cl ages (~ 21–15 ka) indicate that major failures occurred during or immediately following local deglaciation (~ 18–17 ka). Other ages (~ 14–9 ka) suggest some later, smaller-scale failures during the Lateglacial and/or early Holocene. The 14C ages (2.36–0.15 cal ka BP) indicate the very late onset of organic accumulation and do not provide close limiting age constraints. Rock-slope failure during or immediately following local deglaciation was probably in response to some combination of glacial debuttressing, slope steepening and paraglacial stress release. Later failures may have been triggered by seismic activity associated with glacio-isostatic crustal uplift and/or permafrost degradation consequent upon climate change. The 36Cl ages support the findings of previous studies that show the deglacial - Lateglacial period in northwest Ireland and Scotland to have been one of enhanced rock-slope failure

Time to full enteral feeds in hospitalised preterm and very low birth weight infants in Nigeria and Kenya

Background: Preterm (born < 37 weeks’ gestation) and very low birthweight (VLBW; <1.5kg) infants are at the greatest risk of morbidity and mortality within the first 28 days of life. Establishing full enteral feeds is a vital aspect of their clinical care. Evidence predominantly from high income countries shows that early and rapid advancement of feeds is safe and reduces length of hospital stay and adverse health outcomes. However, there are limited data on feeding practices and factors that influence the attainment of full enteral feeds among these vulnerable infants in sub-Saharan Africa. Aim: To identify factors that influence the time to full enteral feeds, defined as tolerance of 120ml/kg/day, in hospitalised preterm and VLBW infants in neonatal units in two sub-Saharan African countries. Methods: Demographic and clinical variables were collected for newborns admitted to 7 neonatal units in Nigeria and Kenya over 6-months. Multiple linear regression analysis was conducted to identify factors independently associated with time to full enteral feeds. Results: Of the 2280 newborn infants admitted, 484 were preterm and VLBW. Overall, 222/484 (45.8%) infants died with over half of the deaths (136/222; 61.7%) occurring before the first feed. The median (inter-quartile range) time to first feed was 46 (27, 72) hours of life and time to full enteral feeds (tFEF) was 8 (4.5,12) days with marked variation between neonatal units. Independent predictors of tFEF were time to first feed (unstandardised coefficient B 1.69; 95% CI 1.11 to 2.26; p value <0.001), gestational age (1.77; 0.72 to 2.81; <0.001), the occurrence of respiratory distress (-1.89; -3.50 to -0.79; <0.002) and necrotising enterocolitis (4.31; 1.00 to 7.62; <0.011). Conclusion: The use of standardised feeding guidelines may decrease variations in clinical practice, shorten tFEF and thereby improve preterm and VLBW outcomes

Parental Genome Dosage Imbalance Deregulates Imprinting in Arabidopsis

In mammals and in plants, parental genome dosage imbalance deregulates embryo growth and might be involved in reproductive isolation between emerging new species. Increased dosage of maternal genomes represses growth while an increased dosage of paternal genomes has the opposite effect. These observations led to the discovery of imprinted genes, which are expressed by a single parental allele. It was further proposed in the frame of the parental conflict theory that parental genome imbalances are directly mirrored by antagonistic regulations of imprinted genes encoding maternal growth inhibitors and paternal growth enhancers. However these hypotheses were never tested directly. Here, we investigated the effect of parental genome imbalance on the expression of Arabidopsis imprinted genes FERTILIZATION INDEPENDENT SEED2 (FIS2) and FLOWERING WAGENINGEN (FWA) controlled by DNA methylation, and MEDEA (MEA) and PHERES1 (PHE1) controlled by histone methylation. Genome dosage imbalance deregulated the expression of FIS2 and PHE1 in an antagonistic manner. In addition increased dosage of inactive alleles caused a loss of imprinting of FIS2 and MEA. Although FIS2 controls histone methylation, which represses MEA and PHE1 expression, the changes of PHE1 and MEA expression could not be fully accounted for by the corresponding fluctuations of FIS2 expression. Our results show that parental genome dosage imbalance deregulates imprinting using mechanisms, which are independent from known regulators of imprinting. The complexity of the network of regulations between expressed and silenced alleles of imprinted genes activated in response to parental dosage imbalance does not support simple models derived from the parental conflict hypothesis

Prospective observational study of the challenges in diagnosing common neonatal conditions in Nigeria and Kenya

Objectives: Accurate and timely diagnosis of common neonatal conditions is crucial for reducing neonatal deaths. In low/middle-income countries with limited resources, there is sparse information on how neonatal diagnoses are made. The aim of this study was to describe the diagnostic criteria used for common conditions in neonatal units (NNUs) in Nigeria and Kenya. Design: Prospective observational study. Standard case report forms for suspected sepsis, respiratory disorders, birth asphyxia and abdominal conditions were co-developed by the Neonatal Nutrition Network (https://www.lstmed.ac.uk/nnu) collaborators. Clinicians completed forms for all admissions to their NNUs. Key data were displayed using heatmaps. Setting: Five NNUs in Nigeria and two in Kenya comprising the Neonatal Nutrition Network. Participants: 2851 neonates, which included all neonates admitted to the seven NNUs over a 6-month period. Results: 1230 (43.1%) neonates had suspected sepsis, 874 (30.6%) respiratory conditions, 587 (20.6%) birth asphyxia and 71 (2.5%) abdominal conditions. For all conditions and across all NNUs, clinical criteria were used consistently with sparse use of laboratory and radiological criteria. Conclusion: Our findings highlight the reliance on clinical criteria and extremely limited use of diagnostic technologies for common conditions in NNUs in sub-Saharan Africa. This has implications for the management of neonatal conditions which often have overlapping clinical features. Strategies for implementation of diagnostic pathways and investment in affordable and sustainable diagnostics are needed to improve care for these vulnerable infants

Psychology and aggression

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68264/2/10.1177_002200275900300301.pd