British outlook on America, 1800-1850

The British Outlook on America offers an interesting field for study and one in which there is a vast amount of material both in books and periodicals. This subject has been treated in such works as The English Traveller in America 1785-1835 (1922) by Jane Louise Mesiok and American Social History as Recorded by British Travellers (1934) by Allan Nevins. In this study, however, the material for most of the observations and conclusions is taken from the leading English periodicals, while the two books mentioned are based more upon the books of travel. The period of 1800 to 1850 was selected for several reasons. This first half of the nineteenth century brought out many antagonistic writings by the English and sharp retorts from the Americans. Also, the great party periodicals originated during the first decades of this century. These magazines probably influenced the reading public and molded the opinions of the British more than the books of travel. The study has been ended in 1850 largely because after that date the slavery issue overshadowed all others, and the British tended to lose interest in other aspects of American life.--Preface

Addressing occupational stress among health staff in non-government controlled Northern Syria: Supporting resilience in a dangerous workplace

Introduction: Syrian medical staff working in non-government controlled areas of Syria operate in situations that expose them to great personal danger, while they must often face the same challenges as the people they help. Supporting the wellbeing of these staff is crucial to the operation of health services for internally displaced Syrians given the large-scale destruction of healthcare infrastructure. Methods: Findings from a staffcare programme designed by a grassroots Syrian psychosocial organisation in Southern Turkey and implemented in a medical nongovernment organisation in Idlib in Northern Syria are presented. An iterative and collaborative process employed individual, team and organisational level consultation to identify occupational stresses within the workplace. A six-month programme involved group sessions across eight sites with 56 staff working in three primary health clinics, two mobile teams and one sexual and reproductive health clinic, serving eight internally displaced persons camps in Idlib. Results: Following the programme, staff reported significant reductions in role ambiguity, and improvements in the nature of their work, personal relationships with colleagues and superiors and physical conditions in the workplace. There were no significant differences in reported organisational structure or job satisfaction. Discussion: This evaluation of a grassroots programme, designed to address the expressed needs of displaced staff, suggests that reductions in daily living stresses can be achieved even in the context of ongoing crisis

Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study

Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction.Method: Principally a structured review of current and planned activities.Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through instigating stewardship programmes as well as improving adverse drug reaction reporting and associated activities.Conclusion: Overall, there are an appreciable number of ongoing activities within the public healthcare system in South Africa attempting to ensure and sustain universal healthcare. It is too early to assess their impact, which will be the subject of future research

Editorial: Thredbo 17 conference

This volume of Research in Transportation Economics collects the workshop reports as well as the best papers presented at the 17th International Conference on Competition and Ownership in Land Passenger Transport (the Thredbo Series) held in Sydney, Australia, in 2022 (after a brief hiatus due to the COVID-19 pandemic and with plans to go to Japan put on hold). The 17th conference in the series followed in the footsteps of previous conferences by bringing together academics, government officials, consultants, policymakers, politicians, students, and public transport operators to review trends and challenges in ownership and competition issues in public transport. It was attended by 125 delegates from 25 countries, with 78 papers presented. The conference included seven workshops. A summary of the history of the conference series, including the themes covered, can be seen in Table 1 at the end of this editorial

The competencies of registered nurses working in care homes: a modified Delphi study

BACKGROUND: Registered Nurses (RNs) working in UK care homes receive most of their training in acute hospitals. At present the role of care home nursing is underdeveloped and it is seen as a low status career. We describe here research to define core competencies for RNs working in UK care homes. METHODS: A two-stage process was adopted. A systematic literature review and focus groups with stakeholders provided an initial list of competencies. The competency list was modified over three rounds of a Delphi process with a multi-disciplinary expert panel of 28 members. RESULTS: Twenty-two competencies entered the consensus process, all competencies were amended and six split. Thirty-one competencies were scored in round two, eight were agreed as essential, one competency was split into two. Twenty-four competencies were submitted for scoring in round three. In total, 22 competencies were agreed as essential for RNs working in care homes. A further ten competencies did not reach consensus. CONCLUSION: The output of this study is an expert-consensus list of competencies for RNs working in care homes. This would be a firm basis on which to build a curriculum for this staff group

Correlation between serum enzymes, isozyme patterns and histologically detectable organ damage

Serum enzyme levels and isozyme profile were utilized as a measure of hepatotoxic response to carbon tetrachloride, mercuric chloride, diethanolamine and thioacetamide. The sensitivity of these measurements was compared with the degree of morphological damage to the liver or kidney as assessed by light and electron microscopy. Morphological damage was present at dosage levels considerably below those necessary to induce detectable enzyme alterations. Generally, advanced degenerative change, including necrosis, had occurred in both the liver and kidney before enzyme alterations were seen.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/33745/1/0000261.pd

Using contractual incentives in district nursing in the English NHS: results from a qualitative study

© 2018 The author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Since 2008, health policy in England has been focusing increasingly on improving quality in healthcare services. To ensure quality improvements in community nursing, providers are required to meet several quality targets, including an incentive scheme known as Commissioning for Quality and Innovation (CQUIN). This paper reports on a study of how financial incentives are used in district nursing, an area of care which is particularly difficult to measure and monitor

Associations with photoreceptor thickness measures in the UK Biobank.

Spectral-domain OCT (SD-OCT) provides high resolution images enabling identification of individual retinal layers. We included 32,923 participants aged 40-69 years old from UK Biobank. Questionnaires, physical examination, and eye examination including SD-OCT imaging were performed. SD OCT measured photoreceptor layer thickness includes photoreceptor layer thickness: inner nuclear layer-retinal pigment epithelium (INL-RPE) and the specific sublayers of the photoreceptor: inner nuclear layer-external limiting membrane (INL-ELM); external limiting membrane-inner segment outer segment (ELM-ISOS); and inner segment outer segment-retinal pigment epithelium (ISOS-RPE). In multivariate regression models, the total average INL-RPE was observed to be thinner in older aged, females, Black ethnicity, smokers, participants with higher systolic blood pressure, more negative refractive error, lower IOPcc and lower corneal hysteresis. The overall INL-ELM, ELM-ISOS and ISOS-RPE thickness was significantly associated with sex and race. Total average of INL-ELM thickness was additionally associated with age and refractive error, while ELM-ISOS was additionally associated with age, smoking status, SBP and refractive error; and ISOS-RPE was additionally associated with smoking status, IOPcc and corneal hysteresis. Hence, we found novel associations of ethnicity, smoking, systolic blood pressure, refraction, IOPcc and corneal hysteresis with photoreceptor thickness

A systematic review of the cost-effectiveness of anti-VEGF drugs for the treatment of diabetic retinopathy

Background Non-proliferative and proliferative diabetic retinopathy (DR) are common complications of diabetes and a major cause of sight loss. Anti-vascular endothelial growth factor (anti-VEGF) drugs represent a treatment option for people with DR and are routinely used to treat various other eye conditions. Anti-VEGF drugs are, however, expensive relative to current care options and it is unclear whether this additional cost would be justified in DR, where immediate risks of sight loss are low compared to those for patients with more aggressive ophthalmological conditions. Objective To systematically review the existing evidence supporting the cost-effectiveness of alternative treatments for DR considering a UK decision-making perspective. Methods A systematic review of all comparative cost-effectiveness studies was conducted evaluating any treatment for DR. Included studies were synthesised narratively and evaluated with reference to UK decision-making. Studies were grouped by population, non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Results The review identified five studies in the PDR population, all of which examined the cost-effectiveness of anti-VEGF treatments compared to pan-retinal photocoagulation (PRP). Results of these studies suggest that anti-VEGF treatments offer some additional benefits in terms of preserved visual acuity, but also incur substantial additional costs relative to PRP. Most authors expressed reservations about the additional costs outweighing the limited benefits, especially in certain patient subgroups without pre-existing oedema. The majority of the identified evidence considered a US perspective, it is unclear how these results would translate to a UK setting. Two studies were identified in the NDPR population. There was limited evidence to support the early use of anti-VEGF treatment. One UK study, however, suggested that early treatment of NPDR with PRP is cost-effective compared to delayed PRP. Conclusions Overall, there is a dearth of cost-effectiveness evidence considering the UK context. The identified studies raised doubts about the cost-effectiveness of anti-VEGF treatments for PDR. No conclusions can be made regarding the cost-effectiveness of anti-VEGF for NPDR. Future research should focus on developing rigorous model-based cost-effectiveness analyses integrating all available evidence

Anti-VEGF drugs compared with laser photocoagulation for the treatment of diabetic retinopathy : a systematic review and meta -analysis

Background Diabetic retinopathy is a major cause of sight loss in people with diabetes. The most severe form, proliferative diabetic retinopathy (PDR), carries a high risk of vision loss risk, vitreous haemorrhage, macular oedema and other harms. Panretinal photocoagulation (PRP) is the primary treatment for PDR. Anti-vascular endothelial growth factor (anti-VEGF) drugs are used to treat various eye conditions and may be beneficial for people with diabetic retinopathy. Objective To investigate the efficacy of anti-VEGF therapy for the treatment of diabetic retinopathy when compared to PRP. Methods A systematic review and network meta-analysis of all published randomised controlled trials comparing anti-VEGF (alone or in combination) to PRP in people with diabetic retinopathy. Trials where the primary focus was treatment of macular oedema or vitreous haemorrhage were excluded. Results A total of 14 trials were included: 3 of aflibercept, 5 of bevacizumab and 6 of ranibizumab. Two trials were of patients with non-proliferative diabetic retinopathy ); all others were in PDR. Overall anti-VEGF was better than PRP at preventing vison loss, measured as best corrected visual acuity (BCVA), at up to two years follow-up (BCVA mean difference in logMAR -0.064, 95% confidence interval (CI) -0.122 to -0.015). There was no clear evidence of any difference between the anti-VEGFs, but potential for bias and differences in trial complicated the comparison. Anti-VEGF was superior to PRP at preventing macular edema (Relative risk 0.29, 95% CI 0.18 to 0.49) and vitreous haemorrhage (Relative risk 0.77, 95% CI 0.61 to 0.99). There was no evidence that the effectiveness of anti-VEGF varied over time, but one trial found no benefit of anti-VEGF over laser therapy after 5 years. Conclusions Anti-VEGF injection appears to be superior to using laser photocoagulation, but the benefit in preservation of eyesight appears to be modest. Long-duration observational studies are needed to examine how anti-VEGF may be beneficial in the long term