CARE-PACT: a new paradigm of care for acutely unwell residents in aged care facilities

Describes the Comprehensive Aged Residents Emergency and Partners in Assessment, Care and Treatment (CARE-PACT) program: a hospital substitutive care and demand management project that aims to improve, in a fiscally efficient manner, the quality of care received by residents of aged care facilities. Background Ageing population trends create a strong imperative for healthcare systems to develop models of care that reduce dependence on hospital services. People living in residential aged care facilities (RACFs) currently have high rates of presentation to emergency departments. The care provided in these environments may not optimally satisfy the needs of frail older persons from RACFs.   Objective To describe the Comprehensive Aged Residents Emergency and Partners in Assessment, Care and Treatment (CARE-PACT) program: a hospital substitutive care and demand management project that aims to improve, in a fiscally efficient manner, the quality of care received by residents of aged care facilities when their acute healthcare needs exceed the scope of the aged care facility staff and general practitioners to manage independently of the hospital system.   Discussion The project delivers high-quality gerontic nursing and emergency specialist assessment, collaborative care planning, skills sharing across the care continuum and an individualised, resident-focused approach

Investigation of the visual reference requirements for pilot control of gliding parachutes for land landing of spacecraft

Test program for determining visual reference requirements for pilot control of gliding parachutes used in landing spacecraft on lan

The Labor Supply of Nurses and Nursing Assistants in the United States

Health care administrators and public policy makers are currently much concerned with the labor supply of nurses and nursing assistants. Hospitals and nursing homes, complaining of labor shortages, request public assistance to enable them to pay higher wages. Before committing public funds, policy makers want up-to-date estimates of the wage elasticities of labor supply for nurses and nursing assistants. Constructing a framework within which these elasticities can be estimated requires consideration of the nature and possible origins of the reported shortages. Based on annual time-series data for the US, 1988-2002, the study has derived posterior distributions for short- and long-run own wage elasticities of labor supply by Registered Nurses (RN) and nursing aides, orderlies, and attendants (NAOA). This analysis suggests that increased public assistance to health care providers, designed to raise wages, probably would not reduce reported shortages arising from monopsony power but would nonetheless appreciably increase employment of RNs and NAOAs.

hapassoc: Software for Likelihood Inference of Trait Associations with SNP Haplotypes and Other Attributes

Complex medical disorders, such as heart disease and diabetes, are thought to involve a number of genes which act in conjunction with lifestyle and environmental factors to increase disease susceptibility. Associations between complex traits and single nucleotide polymorphisms (SNPs) in candidate genomic regions can provide a useful tool for identifying genetic risk factors. However, analysis of trait associations with single SNPs ignores the potential for extra information from haplotypes, combinations of variants at multiple SNPs along a chromosome inherited from a parent. When haplotype-trait associations are of interest and haplotypes of individuals can be determined, generalized linear models (GLMs) may be used to investigate haplotype associations while adjusting for the effects of non-genetic cofactors or attributes. Unfortunately, haplotypes cannot always be determined cost-effectively when data is collected on unrelated subjects. Uncertain haplotypes may be inferred on the basis of data from single SNPs. However, subsequent analyses of risk factors must account for the resulting uncertainty in haplotype assignment in order to avoid potential errors in interpretation. To account for such uncertainty, we have developed hapassoc, software for R implementing a likelihood approach to inference of haplotype and non-genetic effects in GLMs of trait associations. We provide a description of the underlying statistical method and illustrate the use of hapassoc with examples that highlight the flexibility to specify dominant and recessive effects of genetic risk factors, a feature not shared by other software that restricts users to additive effects only. Additionally, hapassoc can accommodate missing SNP genotypes for limited numbers of subjects.

Macroeconomic Adjustment and Foreign Trade of Centrally Planned Economies

This empirical study stresses the underlying macroeconomic forces which determine foreign trade flows in CPEs. The general specification includes a planners' demand equation for the volume of imports, a planners' supply equation for the volume of exports, and a rest-of-world demand equation for the export price level. The planners' behavioural equations include variables for activity levels, trade balance constraints, prices, and domestic excess demand. The import price is exogenous. This simultaneous equation model is estimated on annual data from the mid-1950s to the mid-1970s, for Czechoslovakia, the GDR, Hungary, and Poland. Maximum likelihood estimation in a nested hypothesis testing framework allows selection of restricted versions of the general model for each country. Estimated price elasticities accord with the underlying theory, and the excess demand variables perform well.

Sweet talk: communication practices and perceptions at an urban clinic for Gestational Diabetes Mellitus

A report on a study project presented to The Discipline of Speech Pathology School of Human and Community Development Faculty of Humanities University of the Witwatersrand In fulfilment of the requirements For the degree M.A. Speech Pathology 1 June, 2015Background: Gestational Diabetes Mellitus (GDM) is a complex condition that is prevalent in South Africa. South Africa poses a uniquely diverse population and this diversity has the potential to compound communicative interactions, particularly within the healthcare context. Previous research has identified links between communication practices and patients’ health outcomes and attitudes towards conditions and treatment. However, these links have not been explored in the field of GDM in South Africa. Furthermore, little attention has been given to issues related to patients’ lifeworlds, empowerment, nursing, stigma and information-giving in the context of GDM in South Africa. Aim: This study aims to explore the communication practices and perceptions of nurses and patients at an urban GDM clinic in South Africa. Methods: Qualitative methods of inquiry were used, including ethnographic observations, focus groups (4 groups with a total of 19 patients), semi-structured interviews (12 interviews) and video recordings of nurse-patient interactions (6 recorded interactions). Purposive sampling was adopted. Data analysis included thematic analysis and an interactional analysis of the nurse-patient interactions at the clinic. Findings: Multiple themes, facilitators and barriers to communication emerged, including communication difficulties between nurses and patients, patient dissatisfaction with communication at the clinic, uncertainty about GDM and living with the condition, negative attitudes and preconceptions among nurses, intraprofessional conflict and environmental barriers. Findings suggested limited communication at the clinic, due to inadequate information giving, cultural and linguistic mismatch, a lack of skills and knowledge amongst nurses, resource shortages, differing nurse-patient agendas and negative attitudes of nurses and patients. A paradox between patient reports and observations at the clinic also emerged. All of these factors appeared to affect the satisfaction, lifeworld, empowerment and attitudes of the patients attending the clinic, as well as nurses’ job satisfaction. These findings highlighted important implications related to staff training, collaboration and practice at the site, future research into communication practices at the clinic and the effect of possible interventions and research into living with GDM in South Africa. Implications for policy relating to GDM and communication practices will be discussed. Conclusion: This study highlights the importance of communication in facilitating positive health outcomes, attitudes, satisfaction and treatment adherence, especially in such a diverse population. The findings inform important implications related to communication training at the GDM clinic and other similar contexts in South Africa, as well as other pertinent recommendations