Measuring hospital efficiency using DEA an investigation into the relationship between scale and efficiency within the South African private hospital environment

Includes abstract.Includes bibliographical references.This paper investigates the relationship between scale and efficiency through the application of Data Envelopment Analysis (DEA) to a set of South African private hospitals over the three year period from 2007 to 2009. As part of the investigation, this paper provides a description of the current research into scale and efficiency with a focus on definition and measurement. It also provides an introduction to DEA as a tool for measuring the relationship between hospital scale and efficiency. Based on the underlying set of private hospitals, this investigation found that scale efficiency improvements are likely to be possible

Exploring interspecies sensemaking: dog tracking semiotics and multispecies ethnography

The domestic use of tracking technology with pets is on the rise, yet is under-researched. We investigate how tracking practices reconfigure human-dog relationships changing both humans and dogs. We question the sensemaking mechanisms by which both humans and dogs engage in context-based meaningful exchanges via the technology’s mediation. We show how an indexical semiotic perspective could inform the development of interspecies technology. Finally, we discuss the methodological issues raised by doing research with animals and propose an interspecies semiotics which integrates animal companions and animal researchers’ accounts into ethnographic observation

Extended and cumulative effects of experimentally induced intergroup conflict in a cooperatively breeding mammal

Conflict between rival groups is rife in nature. While recent work has begun exploring the behavioural consequences of this intergroup conflict, studies have primarily considered just the 1–2 h immediately after single interactions with rivals or their cues. Using a habituated population of wild dwarf mongooses (Helogale parvula), we conducted week-long manipulations to investigate longer-term impacts of intergroup conflict. Compared to a single presentation of control herbivore faeces, one rival-group faecal presentation (simulating a territorial intrusion) resulted in more within-group grooming the following day, beyond the likely period of conflict-induced stress. Repeated presentations of outsider cues led to further changes in baseline behaviour by the end of the week: compared to control weeks, mongooses spent less time foraging and foraged closer to their groupmates, even when there had been no recent simulated intrusion. Moreover, there was more baseline territorial scent-marking and a higher likelihood of group fissioning in intrusion weeks. Consequently, individuals gained less body mass at the end of weeks with repeated simulated intrusions. Our experimental findings provide evidence for longer-term, extended and cumulative, effects of an elevated intergroup threat, which may lead to fitness consequences and underpin this powerful selective pressure

Enabling Longitudinal Respiration Monitoring Using Vapor-Coated Conducting Textiles

Wearable sensors allow for portable, long-term health monitoring in natural environments. Recently, there has been an increase in demand for technology that can reliably monitor respiration, which can be indicative of cardiac diseases, asthma, and infection by respiratory viruses. However, to date, the most reliable respiration monitoring system involves a tightly worn chest belt that is not conducive to longitudinal monitoring. Herein, we report that accurate respiration monitoring can be effected using a fabric-based humidity sensor mounted within a face mask. Our humidity sensor is created using cotton fabrics coated with a persistently p-doped conjugated polymer, poly(3,4-ethylenedioxythiophene):chloride (PEDOT-Cl), using a previously reported chemical vapor deposition process. The vapor-deposited polymer coating displays a stable, rapid, and reversible change in conductivity with an increase in local humidity, such as the humidity changes experienced within a face mask as the wearer breathes. Thus, when integrated into a face mask, the PEDOT-Cl-coated cotton humidity sensor is able to transduce breaths into an electrical signal. The humidity sensor-incorporated face mask is able to differentiate between deep and shallow breathing, as well as breathing versus talking. The sensor-incorporated face mask platform also functions both while walking and sitting, providing equally high signal quality in both indoor and outdoor contexts. Additionally, we show that the face mask can be worn for long periods of time with a negligible decline in the signal quality

Scientific methodologies for the assessment of combined effects of chemicals - a survey and literature review

Exposure of humans and wildlife to chemicals via food, consumer products, the environment etc. can imply exposure to an infinite number of different combinations of chemicals in mixtures. It is practically impossible to test all these possible mixtures experimentally and it is therefore needed to find smart strategies to assess the potential hazards using new tools that rely less on in vivo testing and incorporate instead alternative experimental and computational tools. In this report the current state of the art for the application of these alternative tools for assessing the hazard of chemical mixtures is briefly reviewed. The focus is hereby on the adverse outcome pathway (AOP) concept, in vitro methods, omics techniques, in silico approaches such as quantitative structure activity relationships (QSARs) and read-across, toxicokinetic and dynamic energy budget (DEB) modelling, and on integrated approaches to testing and assessment (IATA). Furthermore, an expert survey was performed to collect up to date information and experience on the current use of different approaches for assessing human and environmental health risks from exposure to chemical mixtures, with a view to informing the development of a consistent assessment approach. An online survey was performed among experts in the field of combined exposure assessment in the period of January to March 2014, addressing both, human health and environmental risk assessment. Fifty-eight experts from 21 countries, different stakeholder groups and sectors of legislation participated in the survey. The main sectors where most experience is already gained in assessing mixtures are in the area of plant protection products and chemicals. These were also rated highest regarding the priority for performing mixture assessments. Experts have experience with the whole mixture as well as the component-based approaches applying them to both, intentional and unintentional mixtures. Mostly concentration addition (CA) based methods are used for predicting mixture effects. Regarding the use of novel and alternative tools in the risk assessment of mixtures, expert opinions are split between those applying them (often more in a research context) and those that generally think these tools are valuable but their use is currently limited because of lack of guidance, lack of data, or lack of expertise. A general need for clear guidance for combined exposure assessments was identified. Overall, a high potential in applying novel tools and scientific methodologies for the assessment of chemical mixtures can be identified. They allow deriving meaningful information on individual mixture components or whole mixtures, enabling a better understanding of the underlying mechanisms of mixture effects. Their main strengths lie in their integrated use and smart combination to put different aspects regarding the hazard from combined exposure to multiple chemicals into context. In order to benefit from these tools in the hazard assessment of mixtures, more guidance on their use is needed to facilitate a more widespread application.JRC.I.5-Systems Toxicolog

Regulatory assessment of chemical mixtures: Requirements, current approaches and future perspectives

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Neurofeedback of visual food cue reactivity: a potential avenue to alter incentive sensitization and craving

FMRI-based neurofeedback transforms functional brain activation in real-time into sensory stimuli that participants can use to self-regulate brain responses, which can aid the modification of mental states and behavior. Emerging evidence supports the clinical utility of neurofeedback-guided up-regulation of hypoactive networks. In contrast, down-regulation of hyperactive neural circuits appears more difficult to achieve. There are conditions though, in which down-regulation would be clinically useful, including dysfunctional motivational states elicited by salient reward cues, such as food or drug craving. In this proof-of-concept study, 10 healthy females (mean age = 21.40 years, mean BMI = 23.53) who had fasted for 4 h underwent a novel ‘motivational neurofeedback’ training in which they learned to down-regulate brain activation during exposure to appetitive food pictures. FMRI feedback was given from individually determined target areas and through decreases/increases in food picture size, thus providing salient motivational consequences in terms of cue approach/avoidance. Our preliminary findings suggest that motivational neurofeedback is associated with functionally specific activation decreases in diverse cortical/subcortical regions, including key motivational areas. There was also preliminary evidence for a reduction of hunger after neurofeedback and an association between down-regulation success and the degree of hunger reduction. Decreasing neural cue responses by motivational neurofeedback may provide a useful extension of existing behavioral methods that aim to modulate cue reactivity. Our pilot findings indicate that reduction of neural cue reactivity is not achieved by top-down regulation but arises in a bottom-up manner, possibly through implicit operant shaping of target area activity

Social workers and acquired brain injury: A systematic review of the current evidence-base

Social work plays an important role in the assessment and treatment of people with acquired brain injury. Acquired brain injury is a complex and highly prevalent condition which can impact on cognitive, emotional and social domains. As acquired brain injury is a hidden disability it can be misdiagnosed or classified as another condition entirely. We sought to systematically explore the evidence base to examine how social workers have been prepared to work with their clients with brain injury. Employing six electronic databases (Social Policy & Practice, Web of Science, Scopus, PubMed, PsycINFO, CINAHL Plus) we reviewed 1071 papers. After applying eligibility criteria 17 papers were included in this review. We utilised standardised data extraction and quality appraisal tools to assess all included papers. Following appraisal, 9 papers were judged as possessing high methodological quality whilst 8 were judged as medium. Employing narrative synthesis, we identified four themes which captured the key findings of these papers. Themes were named as (i) advocacy and social work (ii) training and multidisciplinary team working (iii) inclusion of social networks and (iv) societal barriers. In order to meet their statutory responsibilities to practice safely, social workers must receive training in how to identify ABI and develop understanding of its consequences and subsequent need for provision. Social workers are also in a unique position to advocate for their clients and should make every effort to ensure their needs are met