Measuring the productivity of residential long-term care in England: methods for quality adjustment and regional comparison

Productivity trend information is valuable in developing policy and for understanding changes in the ‘value for money’ of the care system. In this paper, we consider approaches to measuring productivity of adult social care (ASC), and particularly care home services. Productivity growth in the public sector is traditionally measured by comparing change in total output to change in total inputs, but has not accounted for changes in service quality and need. In this study, we propose a method to estimate ‘quality adjusted’ output based on indicators of the Adult Social Care Outcomes Toolkit (ASCOT), using data collected in the annual adult social care survey (ASCS). When combined with expenditure and activity data for 2010 to 2012, we found that this approach was feasible to implement with current data and that it altered the productivity results compared with non-adjusted productivity metrics. Overall, quality-adjusted productivity grew in most regions between 2010 and 2011 and remained unchanged for most regions from 2011 to 2012

Rigorous Formulation of Duality in Gravitational Theories

In this paper we evince a rigorous formulation of duality in gravitational theories where an Einstein like equation is valid, by providing the conditions under which the Hodge duals (with respect to the metric tensor g) of T^a and R_b^a may be considered as the torsion and curvature 2-forms associated with a connection D', part of a Riemann-Cartan structure (M,g',D'), in the cases g = g' and g does not equal g', once T^a and R_b^a are the torsion and curvature 2-forms associated with a connection D part of a Riemann-Cartan structure (M,g,D). A new form for the Einstein equation involving the dual of the Riemann tensor of D is also provided, and the result is compared with others appearing in the literature.Comment: 15 page

Magnetic interactions in cubic-, hexagonal- and trigonal barium iron oxide fluoride, BaFeO2F

57Fe Mössbauer spectra have been recorded from the hexagonal (6H)- and trigonal (15R)- modifications of BaFeO2F and are compared with those previously recorded from the cubic form of BaFeO2F. The spectra, recorded over a temperature range from 15 to 650K show that all of the iron in all the compounds is in the Fe3+ state. Spectra from the 6H- and 15R- modifications were successfully fitted with components that were related to the Fe(1) and Fe(2) structural sites in the 6H variant and to the Fe(1), Fe(2) and Fe(3) structural sites in the 15R form. The magnetic ordering temperatures were determined as 597±3K for 6H-BaFeO2F and 636±3K for 15R-BaFeO2F. These values are surprisingly close to the value of 645±5K determined for the cubic form. The magnetic interactions in the three forms are compared with a view to explaining this similarity of magnetic ordering temperature. Keywords : Mossbauer barium iron oxide fluorid

Effects of a lactobacillus reuteri BR11 mutant deficient in the cystine-transport system in a rat model of inflammatory bowel disease

The final publication is available at link.springer.comBACKGROUND Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract associated with altered composition of the gut microbiota. Lactobacillus reuteri BR11 (BR11) has recently been reported to reduce the severity of experimental IBD because of its probiotic properties possibly attributed to a mechanism of thiol production via its unique cysteine/cystine-transport system. AIM We compared BR11 and a BR11 mutant deficient in the cystine-uptake system (PNG201), for their capacity to reduce the severity of experimental colitis. METHODS Male Sprague–Dawley rats (n = 8 per group) were gavaged (1 ml/day) with skim milk, BR11 or PNG201 (1 × 109 CFU/ml) for 12 days. Rats consumed either water or 2% dextran sulfate sodium in drinking water from days 6 to 12 to induce colitis. Metabolism data, disease activity index, intestinal mucin profile, and histological analyses were assessed and compared by ANOVA. RESULTS Assessed histologically, DSS administration resulted in significant colonic deterioration, including loss of crypt area and increased damage severity. BR11 administration only partially alleviated the DSS effects, with a minor improvement in crypt area (P 0.05) against the DSS control for any of the end-points. However, the mutant strain induced significantly greater (P < 0.05) histological severity compared with BR11-treated colitic animals, indicative of possible exacerbation of colitis. CONCLUSIONS The cystine-uptake system only minimally affects the biological effects of BR11, as evidenced by histological and macroscopic colitic changes.Haydn L. Atkins, Mark S. Geier, Luca D. Prisciandaro, Ashok K. Pattanaik, Rebecca E. A. Forder, Mark S. Turner, Gordon S. Howart

What are the Factors Influencing Service Provider Response to Working with Families Affected by Intimate Partner Violence and Abuse? A Qualitative Systematic Review of the Literature

\ua9 The Author(s) 2024.Purpose: Intimate partner violence and abuse (IPVA) is a major public health issue with long-term negative impacts on abused adults and affected children. Addressing this complex problem requires a multi-agency response, but barriers to effective joint working remain. This review aimed to understand the factors that influence multi-agency response to families who experience IPVA and to their children. Method: We undertook a qualitative systematic review of international literature via five electronic databases and supplemented the review by citation searches, online searches of grey literature, and hand searches of relevant journals. We analyzed data thematically. Results: The 31 identified papers reported findings from 29 unique studies undertaken in six countries and drew on data from 1049 professionals across health care, social care, the police, courts, schools and voluntary organisations. The main factors influencing service provider response to IPVA were siloed approaches to IPVA, particularly the separation between adult and childrens services. This influenced assessment and response to risk. Risk was also a consideration when child-protection staff were expected to work with perpetrators in ‘family settings’, even in lower-risk cases. Multi-agency working facilitated information sharing between agencies, an understanding of each other’s remit, and building trust. Conclusion: Multi-agency collaboration needs to be supported by clear policies of interaction between agencies. Providers of child protection services, health, mental health, housing police and probation need to be supported by specialist training in IPVA, not only in high-risk cases, but also to relieve pressure on an already overstretched workforce

Regulation of biological paternity investigation: comparative perspective

O objetivo deste artigo analisar comparativamente a legisla o relativa investiga o de paternidade biológica de crianças nascidas fora do casamento no brasil e em países europeus, com base em pesquisa de documentos legislativos pela internet e na consulta de bibliografia jurídica no mbito do direito da família. Foi elaborada uma tipologia legislativa verdade biológica absoluta e verdade biológica relativa atendendo s seguintes variáveis: formas de atribui o da paternidade (voluntária/ordem do tribunal); tipo de consentimento exigido para realiza o do teste genético (voluntário/forçado); autor da investiga o (estado/outros); e limite temporal da investiga o (existência de prazos processuais/ausência de prazo processual). A verdade biológica absoluta ocorre quando a investigação de paternidade decorre obrigatoriamente, podendo ser ordenado e forçado pelo tribunal o recurso ao teste genético. observou-se a prevalência da verdade biológica relativa. Em todos os países analisados verificou-se que o recurso ao teste genético preponderante no estabelecimento das relações de filiação. Mesmo em países em que necessário o consentimento para a realização de teste de DNA existem modalidades de submiss o mais subtis, que incluem a aplicação de multas ou a gera o da presunção da paternidade com base na recusa em realizar exame genético.The aim of this article is to do a comparative analysis relative to the investigation of biological paternity of children born out of wedlock in Brazil and european countries, based on the research of legislative documents through the internet and the consultation of legal bibliography in the area of family law. The legislative typology was made - absolute biological truth and relative biological truth according to the following variables: forms of paternal attribution (voluntary/court ordered), type of demanded consent for the performance of the genetic test (voluntary/forced), author of the investigation (state/other) and the time limit of the investigation (existence of process deadlines/no process deadlines). The absolute biological truth occurs when the investigation of paternity is compulsory and the court might order and force the submission to a genetic test. The dominating trend is relative biological truth. In all analysed countries it has been verified that the resource to genetic testing is preponderant when establishing affiliation relations. Even in countries where it's not possible to force an individual to the submission of a genetic exam, there are more subtle ways of submission, that include the application of fines or the assumption of paternity based on a refusal to perform the genetic exam.info:eu-repo/semantics/publishedVersio

Dutch translation and cross-cultural validation of the Adult Social Care Outcomes Toolkit (ASCOT)

Background: The Adult Social Care Outcomes Toolkit was developed to measure outcomes of social care in England. In this study, we translated the four level self-completion version (SCT-4) of the ASCOT for use in the Netherlands and performed a cross-cultural validation. Methods: The ASCOT SCT-4 was translated into Dutch following international guidelines, including two forward and back translations. The resulting version was pilot tested among frail older adults using think-aloud interviews. Furthermore, using a subsample of the Dutch ACT-study, we investigated test-retest reliability and construct validity and compared response distributions with data from a comparable English study. Results: The pilot tests showed that translated items were in general understood as intended, that most items were reliable, and that the response distributions of the Dutch translation and associations with other measures were comparable to the original English version. Based on the results of the pilot tests, some small modifications and a revision of the Dignity items were proposed for the final translation, which were approved by the ASCOT development team. The complete original English version and the final Dutch translation can be obtained after registration on the ASCOT website (http://www.pssru.ac.uk/ascot). Conclusions: This study provides preliminary evidence that the Dutch translation of the ASCOT is valid, reliable and comparable to the original English version. We recommend further research to confirm the validity of the modified Dutch ASCOT translation

Flexible and affordable methods of paying for long-term care insurance

With the expected dramatic increase in the number of older people requiring care, and the tightening of public funding, individuals will be increasingly expected to contribute to, and plan for, their own care in later life. However, history shows us that people are very reluctant to save for their care to the extent that there are no longer any providers of traditional pre-funded long-term care insurance products in the UK to help address this problem. In this paper, we consider a product which is a disability-linked annuity that provides benefit payments towards the cost of both domiciliary and residential nursing care. We investigate different ways in which individuals can purchase this product with the goal of minimising the impact on their living standards, hence making the purchase of the product more palatable. As well as the traditional methods of purchasing insurance out of income and savings, we show that this product can also be purchased by making use of assets such as residential property. This flexibility would allow individuals to have control over the timing of their payments to fit around their lifestyle, particularly those with low retirement incomes. It follows that some people will be more attracted to particular payment methods than others and a framework is presented which segments people according to individual circumstances. A model is developed showing how the annuity works and how premiums are calculated