Admission Decision-Making in Hospital Emergency Departments: the Role of the Accompanying Person

In resource-stretched emergency departments, people accompanying patients play key roles in patients' care. This article presents analysis of the ways health professionals and accompanying persons talked about admission decisions and caring roles. The authors used ethnographic case study design involving participant observation and semi-structured interviews with 13 patients, 17 accompanying persons and 26 healthcare professionals in four National Health Service hospitals in south-west England. Focused analysis of interactional data revealed that professionals’ standardization of the patient-carer relationship contrasted with accompanying persons' varied connections with patients. Accompanying persons could directly or obliquely express willingness, ambivalence and resistance to supporting patients’ care. The drive to avoid admissions can lead health professionals to deploy conversational skills to enlist accompanying persons for discharge care without exploring the meanings of their particular relations with patients. Taking a relationship-centered approach could improve attention to accompanying persons as co-producers of healthcare and participants in decision-making

Studies on Polytetrafluoroethylene Latices. Part 2. Coagulation by Hydrolysable Electrolytes

The colloidal stability of polytetrafluoroethylene (PTFE) latices has been examined as a function of pH at different concentrations of aluminium nitrate. The basic behaviour observed can be subdivided into three pH domains, lower than· pH 3.3, pH 3.3 to 5.2 and pH 5.2 to 7.5. In the lowest pH region, coagulation of the latex appeared to occur as a consequence of compression of the electrical double layer by a 3 : 1 electrolyte. In the pH region 3.3 to 5.2 cationic polynuclear aluminium ions were formed which adsorbed on the particles and neutralised the charge on the negative latex particles. Charge reversal and restabilization of the latices as cationic particles, however, was not observed. The appeared to be a consequence of the relatively high charge reversal concentration and the possible weak adsorption of polynuclear species on the PTFE surface. Coagulation in the pH region 5.2 to 7.5 appeared to be the consequence of several mechanisms operating together

Living arrangements and elderly care : the case of Hong Kong

Hong Kong has been a British Colony for more than one and a half centuries. The British has provided a legal-administrative framework under which the Chinese live and work (Chan and Lee, 1995), The Census showed that ninety-eight percent of the Territory\u27s total population are ethnically Chinese. In 1991, nearly one half of HongKong\u27s residents were immigrants from the Chinese Mainland and two thirds of the remaining were Hong Kong born off-springs of immigrants from the mainland. Although expatriotes from other countries are accountable for the remainder 2% of the population, a great majority of expatriotes are from overseas Chinese communities in southeast Asia: Singapore, Malaysia, Thailand, Philippines, Vietnam, Cambodia, and Burma. It cannot be overstated that Hong Kong has a fairly homogenous cultural values that can be described as “Chinese”, the beliefs with respect to filial piety and honouring one\u27s ancestors still play a significant role in shaping and regulating the local Chinese social life and familial behavior

Thin structured rigid body for acoustic absorption

This is the final version of the article. Available from the publisher via the DOI in this record.We present a thin acoustic metamaterial absorber, comprised of only rigid metal and air, that gives rise to near unity absorption of airborne sound on resonance. This simple, easily fabricated, robust structure comprising a perforated metal plate separated from a rigid wall by a deeply subwavelength channel of air is an ideal candidate for a sound absorbing panel. The strong absorption in the system is attributed to the thermo-viscous losses arising from a sound wave guided between the plate and the wall, defining the subwavelength channel.The authors wish to acknowledge financial support from DSTL and QinetiQ

The long-term health and wellbeing impacts of Healthy New Towns: a six-month feasibility study of Healthy New Town demonstrator sites in England

BACKGROUND: Major public health challenges in England include high levels of health risk behaviour and associated diseases. In the context of an ageing population and falls in spending on adult social care, these challenges place huge pressure on health services. There is evidence to show that living environments can shape health, wellbeing and behaviour. However, there is an urgent need to understand how this evidence can be brought together to deliver healthy environments in local urban settings. The HNT programme was commissioned by NHS England in 2015 and is supported by Public Health England. HNTs are 10 major housing developments that aim to improve population health by applying healthy built environment design principles, increasing residents' use of healthy spaces, promoting community activation and cohesion to improve mental health and reduce social isolation, and creating new models for integrating health and social care. The programme provides a natural experiment in which to investigate the effects on health, wellbeing and inequalities of large-scale interventions targeting the wider social determinants of health. RESEARCH QUESTIONS: 1. What are the similarities and differences in the Healthy New Town (HNT) programme developments, activities and processes, contexts and expected impacts and outcomes across the HNT sites? 2. How feasible is the use of existing HNT evaluation data and data from routine sources as the baseline for a longer-term study to assess impact on health, wellbeing and behavioural outcomes, programme processes and mechanisms and Social Return on Investment? AIMS AND OBJECTIVES: 1) To produce participatory systems maps for 5 HNT sites, illustrating processes and expected outcomes from HNT activities and developing a theoretical framework for longer-term research. 2) To scope and synthesise available qualitative data produced through existing local evaluations and to test the feasibility of using this data to ground a longer-term qualitative study of HNT processes. 3) To define primary and secondary outcome measures for assessment of HNT effectiveness and Social Return on Investment, using existing HNT datasets and routinely available data. 4) To test the feasibility of expanding the research programme to include the 5 HNT sites that are not currently in the HNT Evaluation Collaborative to improve study power and representativeness. METHODS The proposed research involves workstreams to: a) use participatory systems mapping with stakeholders in each HNT to produce a theoretical framework for a longer term study on the HNT programme; b) scope and synthesise existing qualitative data from local HNT evaluations to understand local processes and intervention mechanisms; c) scope and standardise local and routinely available data to establish a baseline and feasibility for a longer term study of health and economic outcomes; d) build relationships and recruit 5 further HNTs into the proposed research. TIMELINE FOR DELIVERY The proposed research will be conducted between 1st November 2018 and 30th April 2019 to enable completion while HNT site leads are still in post. ANTICIPATED IMPACT AND DISSEMINATION The proposed research will produce a theoretical framework for the HNT programme, designed to guide further research on the health impacts of HNTs. Findings will be disseminated through peer-reviewed publications and presentations and local audiences including residents, local government and Public Health England

How can frontline expertise and new models of care best contribute to safely reducing avoidable acute admissions? A mixed-methods study of four acute hospitals

Background: Hospital emergency admissions have risen annually, exacerbating pressures on emergency departments (EDs) and acute medical units. These pressures have an adverse impact on patient experience and potentially lead to suboptimal clinical decision-making. In response, a variety of innovations have been developed, but whether or not these reduce inappropriate admissions or improve patient and clinician experience is largely unknown. Aims: To investigate the interplay of service factors influencing decision-making about emergency admissions, and to understand how the medical assessment process is experienced by patients, carers and practitioners. Methods: The project used a multiple case study design for a mixed-methods analysis of decision-making about admissions in four acute hospitals. The primary research comprised two parts: value stream mapping to measure time spent by practitioners on key activities in 108 patient pathways, including an embedded study of cost; and an ethnographic study incorporating data from 65 patients, 30 carers and 282 practitioners of different specialties and levels. Additional data were collected through a clinical panel, learning sets, stakeholder workshops, reading groups and review of site data and documentation. We used a realist synthesis approach to integrate findings from all sources. Findings: Patients’ experiences of emergency care were positive and they often did not raise concerns, whereas carers were more vocal. Staff’s focus on patient flow sometimes limited time for basic care, optimal communication and shared decision-making. Practitioners admitted or discharged few patients during the first hour, but decision-making increased rapidly towards the 4-hour target. Overall, patients’ journey times were similar, although waiting before being seen, for tests or after admission decisions, varied considerably. The meaning of what constituted an ‘admission’ varied across sites and sometimes within a site. Medical and social complexity, targets and ‘bed pressure’, patient safety and risk, each influenced admission/discharge decision-making. Each site responded to these pressures with different initiatives designed to expedite appropriate decision-making. New ways of using hospital ‘space’ were identified. Clinical decision units and observation wards allow potentially dischargeable patients with medical and/or social complexity to be ‘off the clock’, allowing time for tests, observation or safe discharge. New teams supported admission avoidance: an acute general practitioner service filtered patients prior to arrival; discharge teams linked with community services; specialist teams for the elderly facilitated outpatient treatment. Senior doctors had a range of roles: evaluating complex patients, advising and training juniors, and overseeing ED activity. Conclusions: This research shows how hospitals under pressure manage complexity, safety and risk in emergency care by developing ‘ground-up’ initiatives that facilitate timely, appropriate and safe decision-making, and alternative care pathways for lower-risk, ambulatory patients. New teams and ‘off the clock’ spaces contribute to safely reducing avoidable admissions; frontline expertise brings value not only by placing senior experienced practitioners at the front door of EDs, but also by using seniors in advisory roles. Although the principal limitation of this research is its observational design, so that causation cannot be inferred, its strength is hypothesis generation. Further research should test whether or not the service and care innovations identified here can improve patient experience of acute care and safely reduce avoidable admissions. Funding: The National Institute for Health Research (NIHR) Health Services and Delivery Research programme (project number 10/1010/06). This research was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula

Direct synthesis of multiplexed metal nanowire based devices using carbon nanotubes as vector templates

We present the synthesis of metal nanowires in a multiplexed device configuration using single‐walled carbon nanotubes (SWNTs) as nanoscale vector templates. The SWNT templates control the dimensionality of the wires, allowing precise control of their size, shape and orientation; moreover a solution processable approach enables their linear deposition between specific electrode pairs in electronic devices. Electrical characterizations demonstrate the successful fabrication of metal nanowire electronic devices, while multiscale characterization of the different fabrication steps reveals details of the structure and charge transfer between the material encapsulated and the carbon nanotube. Overall the strategy presented allows facile, low‐cost and direct synthesis of multiplexed metal nanowire devices for nanoelectronic applications