Context Based Knowledge Management in Healthcare: An EA Approached

While an enterprise architectural approach is appropriate for business and IT alignment it also has potential with respect to the design and implementation of healthcare applications by effective representation of healthcare processes. Our research is to develop an enterprise architectural framework for managing contextual knowledge by exploiting object location deduction technologies in healthcare processes that involve the movement of patients. Such a framework is intended to facilitate healthcare managers in adopting location deduction technologies for patient care resulting in improvements in clinical process management and healthcare services

An Incentives Approach to Improving the Unemployment Compensation System

Overpayments may account for up to 15 percent of all payments made under the unemployment compensation system. Burgess and Kingston propose that this overpayment serves as a clue to the more serious problems residing in the system. The authors focus on the lack of incentives (or the existence of disincentives) for improvement within the UC program structure for all participants - claimants, employers, and state UC agencies. Other issues they explore include the excessive complexity of the system and the difficulty of effectively monitoring claimant compliance with eligibility criteria.https://research.upjohn.org/up_press/1116/thumbnail.jp

Adult family violence coming out of the shadows

© [2023, Emerald Publishing Limited]. This AAM is provided for your own personal use only. It may not be used for resale, reprinting, systematic distribution, emailing, or for any other commercial purpose without the permission of the publisher.We consider what is known regarding the characteristics and context of adult family violence; and what practitioners and organisations in the United Kingdom might learn from the literature. Approach - We review literature on adult family violence and parricide and include illustrative cases from a study of domestic homicide review reports involving older adults. Findings - Adult family violence most often involves mothers killed by their adult sons. Mental health issues, alcohol/ substance misuse, and criminality are common themes for perpetrators. Caregiving responsibilities is a theme for both victims and perpetrators. Our research identified two main categories of adult family homicide: perpetrators with major psychotic illness, and victims-perpetrators in complex relational contexts. Practical implications - We consider how practitioners respond to situations of adult family violence and learning for policy-makers, agencies and practitioners. Originality - This paper summarises what is known, argues that more research is needed, and suggests practical ways forward for policy-makers, relevant agencies and practitioners

Development of Viral Vectors for Use in Cardiovascular Gene Therapy

Cardiovascular disease represents the most common cause of mortality in the developed world but, despite two decades of promising pre-clinical research and numerous clinical trials, cardiovascular gene transfer has so far failed to demonstrate convincing benefits in the clinical setting. In this review we discuss the various targets which may be suitable for cardiovascular gene therapy and the viral vectors which have to date shown the most potential for clinical use. We conclude with a summary of the current state of clinical cardiovascular gene therapy and the key trials which are ongoing

A study of intracoronary gene transfer using stents coated with plasmid vectors

Percutaneous coronary intervention with stent deployment is the dominant form of revascularisation for patients with coronary artery disease. Although drug-eluting stents have reduced the incidence of instent restenosis, they are associated with late problems related to delayed vascular healing including late stent thrombosis. The use of gene-eluting stents offers the potential to deliver localised gene therapy to the vascular wall with the aim of both reducing restenosis and promoting endothelialisation. Two candidate genes were investigated. Connective tissue growth factor (CTGF) promotes smooth muscle cell apoptosis and stimulates endothelial growth in vitro, and has an integral role in wound healing. Fibromodulin (FMOD) is involved in collagen metabolism and is a key mediator of scarless wound healing. Both genes have previously been shown to suppress restenosis in an ex vivo vein graft model. Plasmids containing these two genes were constructed with an expression cassette specially designed to maximise transgene expression in vascular smooth muscle cells. These plasmids were coated onto coronary stents with a polymer and the effects of these gene-eluting stents were investigated in an in vivo pig coronary artery model. Previous work by our group has suggested that systemic -blockade can affect the degree of transgene expression from viral vectors, and experiments were also performed to investigate the effect of β-blockers on plasmid-mediated gene expression. At 28 days there was no significant difference in angiographic late loss or neointimal hyperplasia between the groups treated with stents coated with FMOD or CTGF and the group treated with stents coated with the marker gene lacZ. This lack of efficacy appeared to be as a result of extremely poor transgene expression rather than due to a genuine failure of the transgenes to elicit a relevant biological effect. There was no difference in in vivo gene expression demonstrated as a result of β-blockade, but again this result was probably due to limited transgene expression. The potential causes of poor transgene expression in this study are reviewed and future directions for research on plasmid-mediated gene therapy are considered.EThOS - Electronic Theses Online ServiceBritish Heart FoundationGBUnited Kingdo

A narrative review of literature on the use of health and social care by older trans adults: what can United Kingdom services learn?

This article has been accepted for publication and will appear in a revised form, subsequent to peer review and/or editorial input by Cambridge University Press, in Ageing & Society published by Cambridge University Press. Copyright The Author(s), 2021.We carried out a narrative review and thematic analysis of literature on the physical healthcare, mental healthcare and social care of trans older adults to ascertain what is known about older trans adults’ contacts with and use of health and social care. Thirty papers were found: a majority originated in the United States. Five themes were identified: experience of discrimination/ prejudice and disrespect; health inequalities; socioeconomic inequalities; positive practice; and staff training and education. The first three themes present challenges for providers and service users. Experiences of discrimination/ prejudice and disrespect over the course of their lives powerfully influence how older trans adults engage with care services and practitioners. Health and socio-economic inequalities suggest that older trans adults are likely to have greater need of services and care. The remaining two themes offer opportunities for service improvement. We conclude that more research is needed, that there is a strong argument for taking a life course perspective in a spirit of cultural humility, and that contextual societal factors influence service users and providers. We identify positive trans-inclusive practices which we commend to services. More needs to be done now to make older adult services appropriate and welcoming for trans service users