Does expanding primary healthcare improve hospital efficiency? Evidence from a panel analysis of avoidable hospitalisations in 5506 municipalities in Brazil, 2000-2014.

BACKGROUND: Hospitals account for the major share of health expenditure. Primary healthcare may improve efficiency at the hospital level by reducing avoidable admissions. We examined whether rapid expansion of primary healthcare in the context of Brazil's Family Health Strategy (FHS) was associated with a reduction in avoidable hospitalisations. METHODS: We constructed panel data for 5506 municipalities over 2000-2014. Our primary outcome was the rate of avoidable hospitalisations, defined with reference to the official list of ambulatory care sensitive conditions (ACSC). The exposure variable was FHS coverage. We used first-difference models at the municipality level, controlling for municipality characteristics and confounding trends. We ran similar models for each of the 19 diseases in the list of ACSCs. FINDINGS: FHS coverage expanded from 14% to 64% of the population between 2000 and 2014. Over the same period, the rate of avoidable hospitalisations fell from 17 to 10 per 1000 population. Results from the econometric analysis show that the FHS at full coverage was associated with an increase of 0.6 (95% CI 0.3 to 0.9; p<0.001) in the rate of avoidable hospital admissions. Expansion of the FHS was associated with an increase of 866 (95% CI 762 to 970; p<0.001) in the rate of primary care consultations. The FHS was not significantly associated with a reduction in hospitalisations for any of the 19 conditions. CONCLUSIONS: While high-quality primary healthcare can deliver considerable health benefits to the population, it may not always be effective in addressing inefficiencies at the hospital level due to avoidable admissions

PLANIFICACIÓN DE MATERIALES MANIPULADORES EN EL CONTEXTO DEL ESTUDIO DE LECCIONES EN LA FORMACIÓN CONTINUA DE PROFESORES PARA LA ALFABETIZACIÓN MATEMÁTICA INCLUSIVA

With the goal of exploring aspects of planning based on Lesson Study methodology to fit into the stages of developing, aligning, or adapting, and applying manipulative materials for inclusive mathematical literacy, we offer a continuous training for teachers. We propose a workflow that provides, at each stage of planning, theoretical foundations related to the curricula and the specific subjects of mathematics, as well as practical guidelines for the moments of planning and adaptation of manipulative materials with the help of a specialist in special education. From the results, we report on the work developed by two groups, respectively dealing with the concepts of fractions and number construction, targeting Early Years and Early Childhood Education students. We understand that the workflow provided participating teachers with autonomy and confidence, culminating in the elaboration, alignment, and adaptation of potentially inclusive manipulative materials that were used by the entire class, a characteristic we consider essential in materials with this focus. Teachers were provided with new knowledge about mathematical content, curriculum, and ways of approaching the classroom that can lead to improvements in teaching and learning in their future professional practice.With the goal of exploring aspects of planning based on Lesson Study methodology to fit into the stages of developing, aligning, or adapting, and applying manipulative materials for inclusive mathematical literacy, we offered a continuing education training for teachers. Guided by the research question: what aspects of teacher training on manipulative materials in the context of inclusive mathematical literacy did [or did not] contribute to teacher learning? We proposed a workflow that, at each stage of planning, provides theoretical foundations related to the curricula and specific topics of mathematics, as well as practical guidelines for the moments of planning and adaptation of manipulative materials with the help of a specialist in special education. These steps comprised our data production for the research. From the results, we report on the work developed by two teacher groups, respectively dealing with the concepts of fractions and number construction, targeting Early Years and Early Childhood Education students. We understand that the workflow provided participating teachers with autonomy and confidence, culminating in the elaboration, alignment, and adaptation of potentially inclusive manipulative materials that were used by the entire class, a characteristic we consider essential for materials with this focus. The participating teachers were provided with new knowledge about mathematical content, curriculum, and ways of approaching the classroom that can improve teaching and learning in their future professional practice.Con el objetivo de investigar aspectos de planificación, basados ​​en la metodología Lesson Study, para su inserción en las etapas de desarrollo, dirección o adaptación y aplicación de materiales manipulativos para la Alfabetización Matemática Inclusiva, ofrecemos formación docente continua. Proponemos un flujo de trabajo que prevé, en cada etapa de la planificación, producir fundamentos teóricos en relación con los planes de estudio, materias específicas de Matemáticas, y también, con pautas prácticas para la planificación y adaptación de materiales manipulables con la ayuda de un profesional de Educación Especial. A partir de los resultados, se reporta el trabajo desarrollado por dos grupos que abordaron, respectivamente, los conceptos de fracciones y construcción de números, dirigidos a estudiantes de Educación Infantil y Educación Infantil. Entendemos que el flujo de trabajo generó autonomía y confianza en los docentes participantes, culminando en la elaboración, dirección y adaptación de materiales manipulativos potencialmente inclusivos, los cuales fueron utilizados por toda la clase, característica que consideramos esencial en materiales con este enfoque. Se brindaron nuevos conocimientos a los docentes sobre contenidos matemáticos, planes de estudio y posibles enfoques en el aula, que pueden, a través de sus futuras prácticas profesionales, conducir a mejoras en el proceso de enseñanza y aprendizaje

Self-oscillations in nonlinear torsional metamaterials

We study the nonlinear dynamics of torsional meta-molecules - sub-wavelength resonators with strong coupling between electromagnetic excitation and rotational deformation - and show that such structures may undergo self-oscillations. We develop a semi-analytical model to evaluate the electromagnetic-elastic coupling in such structures. By analysing the local stability of the system, we reveal two different mechanisms leading to self-oscillations. Contrary to many previously studied optomechanical systems, self-oscillations of torsional meta-molecules can be extremely robust against mechanical damping. Due to the chiral nature of the structure, a consequence of self-oscillations in this system is dynamic nonlinear optical activity, which can be actively controlled by a range of parameters such as the field strength and polarization of the incident wave. © IOP Publishing and Deutsche Physikalische Gesellschaft

Towards Structure-Property-Function Relationships for Eumelanin

We discuss recent progress towards the establishment of important structure-property-function relationships in eumelanins - key functional bio-macromolecular systems responsible for photo-protection and immune response in humans, and implicated in the development of melanoma skin cancer. We focus on the link between eumelanin's secondary structure and optical properties such as broad band UV-visible absorption and strong non-radiative relaxation; both key features of the photo-protective function. We emphasise the insights gained through a holistic approach combining optical spectroscopy with first principles quantum chemical calculations, and advance the hypothesis that the robust functionality characteristic of eumelanin is related to extreme chemical and structural disorder at the secondary level. This inherent disorder is a low cost natural resource, and it is interesting to speculate as to whether it may play a role in other functional bio-macromolecular systems.Comment: 19 pages, 8 figures, Invited highlight article for Soft Matte

Delivering reform in English healthcare: an ideational perspective

A variety of perspectives has been put forward to understand reform across healthcare systems. Recently, some have called for these perspectives to give greater recognition to the role of ideational processes. The purpose of this article is to present an ideational approach to understanding the delivery of healthcare reform. It draws on a case of English healthcare reform – the Next Stage Review led by Lord Darzi – to show how the delivery of its reform proposals was associated with four ideational frames. These frames built on the idea of “progress” in responding to existing problems; the idea of “prevailing policy” in forming part of a bricolage of ideas within institutional contexts; the idea of “prescription” as top-down structural change at odds with local contexts; and the idea of “professional disputes” in challenging the notion of clinical engagement across professional groups. The article discusses the implications of these ideas in furthering our understanding of policy change, conflict and continuity across healthcare settings

Measuring monopole and dipole polarizability of acoustic meta-atoms

© 2018 Author(s). We present a method to extract monopole and dipole polarizability from experimental measurements of two-dimensional acoustic meta-atoms. In contrast to extraction from numerical results, this enables all second-order effects and uncertainties in material properties to be accounted for. We apply the technique to 3D-printed labyrinthine meta-atoms of a variety of geometries. We show that the polarizability of structures with a shorter acoustic path length agrees well with numerical results. However, those with longer path lengths suffer strong additional damping, which we attribute to the strong viscous and thermal losses in narrow channels

Nonlinear response via intrinsic rotation in metamaterials

We propose and experimentally verify a way to achieve strong nonlinear coupling between the electromagnetic and elastic properties in metamaterials. This coupling is provided through a novel degree of freedom in metamaterial design: the internal rotation within structural elements. Our meta-atoms have high sensitivity to electromagnetic wave power, and the elastic and electromagnetic properties can be independently designed to optimize the response. We demonstrate a rich range of nonlinear phenomena including self-tuning and bistability, and provide a comprehensive experimental demonstration of the predicted effects. © 2013 American Physical Society