4,174 research outputs found
Effective health care for older people resident in care homes: the optimal study protocol for realist review
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes. Methods/Design: A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service models of interest include those that focus on assessment and management of residentsâ health, those that use strategies to encourage closer working between visiting health care providers and care home staff, and those that address system-wide issues about access to assessment and treatment. These will include studies on continence, dignity, and speech and language assessment as well as interventions to promote person centred dementia care, improve strength and mobility, and nutrition. The impact of these interventions and their different mechanisms will be considered in relation to five key outcomes: residentsâ medication use, use of out of hoursâ services, hospital admissions (including use of Accident and Emergency) and length of hospital stay, costs and user satisfaction. An iterative three-stage approach will be undertaken that is stakeholder-driven and optimises the knowledge and networks of the research team. Discussion: This realist review will explore why and for whom different approaches to providing health care to residents in care homes improves access to health care in the five areas of interest. It will inform commissioning decisions and be the basis for further research. This systematic review protocol is registered on the PROSPERO database reference number: CRD42014009112NIHR Health Services & Delivery Research Programme. Project number 11/1021/0
The central structure of Broad Absorption Line QSOs: observational characteristics in the cm-mm wavelength domain
Accounting for ~20% of the total QSO population, Broad Absorption Line QSOs
are still an unsolved problem in the AGN context. They present wide troughs in
the UV spectrum, due to material with velocities up to 0.2 c toward the
observer. The two models proposed in literature try to explain them as a
particular phase of the evolution of QSOs or as normal QSOs, but seen from a
particular line of sight.
We built a statistically complete sample of Radio-Loud BAL QSOs, and carried
out an observing campaign to piece together the whole spectrum in the cm
wavelength domain, and highlight all the possible differences with respect to a
comparison sample of Radio-Loud non-BAL QSOs. VLBI observations at high angular
resolution have been performed, to study the pc-scale morphology of these
objects. Finally, we tried to detect a possible dust component with
observations at mm-wavelengths.
Results do not seem to indicate a young age for all BAL QSOs. Instead a
variety of orientations and morphologies have been found, constraining the
outflows foreseen by the orientation model to have different possible angles
with respect to the jet axis
Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies
Paul Garner and colleagues conducted a systematic review of 80 studies to compare
the quality of private versus public ambulatory health care in low- and
middle-income countries
The pre-main sequence binary HK Ori : Spectro-astrometry and EXPORT data
In this paper we present multi-epoch observations of the pre-main sequence
binary HK Ori. These data have been drawn from the EXPORT database and are
complemented by high quality spectro-astrometric data of the system. The
spectroscopic data appear to be very well represented by a combination of an A
dwarf star spectrum superposed on a (sub-)giant G-type spectrum. The radial
velocity of the system is consistent with previous determinations, and does not
reveal binary motion, as expected for a wide binary. The spectral, photometric
and polarimetric properties and variability of the system indicate that the
active object in the system is a T Tauri star with UX Ori characteristics. The
spectro-astrometry of HK Ori is sensitive down to milli-arcsecond scales and
confirms the speckle interferometric results from Leinert et al. The
spectro-astrometry allows with fair certainty the identification of the active
star within the binary, which we suggest to be a G-type T Tauri star based on
its spectral characteristics.Comment: MNRAS in press 8 pages 7 figure
Acceleration of generalized hypergeometric functions through precise remainder asymptotics
We express the asymptotics of the remainders of the partial sums {s_n} of the
generalized hypergeometric function q+1_F_q through an inverse power series z^n
n^l \sum_k c_k/n^k, where the exponent l and the asymptotic coefficients {c_k}
may be recursively computed to any desired order from the hypergeometric
parameters and argument. From this we derive a new series acceleration
technique that can be applied to any such function, even with complex
parameters and at the branch point z=1. For moderate parameters (up to
approximately ten) a C implementation at fixed precision is very effective at
computing these functions; for larger parameters an implementation in higher
than machine precision would be needed. Even for larger parameters, however,
our C implementation is able to correctly determine whether or not it has
converged; and when it converges, its estimate of its error is accurate.Comment: 36 pages, 6 figures, LaTeX2e. Fixed sign error in Eq. (2.28), added
several references, added comparison to other methods, and added discussion
of recursion stabilit
Endometrial Cancer Presenting as Acute Urinary Retention: a Case Report and Review of the Literature
This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens
Hypofractionated radiotherapy has the potential for second cancer reduction
<p>Abstract</p> <p>Background and Purpose</p> <p>A model for carcinoma and sarcoma induction was used to study the dependence of carcinogenesis after radiotherapy on fractionation.</p> <p>Materials and methods</p> <p>A cancer induction model for radiotherapy doses including fractionation was used to model carcinoma and sarcoma induction after a radiation treatment. For different fractionation schemes the dose response relationships were obtained. Tumor induction was studied as a function of dose per fraction.</p> <p>Results</p> <p>If it is assumed that the tumor is treated up to the same biologically equivalent dose it was found that large dose fractions could decrease second cancer induction. The risk decreases approximately linear with increasing fraction size and is more pronounced for sarcoma induction. Carcinoma induction decreases by around 10% per 1 Gy increase in fraction dose. Sarcoma risk is decreased by about 15% per 1 Gy increase in fractionation. It is also found that tissue which is irradiated using large dose fractions to dose levels lower than 10% of the target dose potentially develop less sarcomas when compared to tissues irradiated to all dose levels. This is not observed for carcinoma induction.</p> <p>Conclusions</p> <p>It was found that carcinoma as well as sarcoma risk decreases with increasing fractionation dose. The reduction of sarcoma risk is even more pronounced than carcinoma risk. Hypofractionation is potentially beneficial with regard to second cancer induction.</p
Endometrial Cancer Presenting as Acute Urinary Retention : a Case Report and Review of The Literature
This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens
Tracing the history of South-American neotropical savannas and seasonally dry forests evidences from comparative phylogeography
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