Revista Jurídica Digital UANDES
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The Signal in the Noise:robust detection of performance 'outliers' in health services
No full textTo make the increasing amounts of data about the performance of public sector organisations digestible by decision makers, composite indicators are commonly constructed, from which a natural step is rankings and league tables. However, how much credence should be given to the results of such approaches? Studying English NHS maternity services (N=130 hospital trusts), we assembled and used a set of 38 indicators grouped into four baskets of aspects of service delivery. In the absence of opinion on how the indicators should be aggregated, we focus on the uncertainty this brings to the composite results.We use a large two-stage Monte Carlo simulation to generate possible aggregation weights and examine the discrimination in the composite results. We find that positive and negative ‘outliers’ can be identified robustly, of particular value to decision makers for investigation for learning or intervention, however results in between should be treated with great caution
Prevalence of alcohol, smoking and illicit drug use amongst people with Intellectual Disabilities: review
No full textPeople with an intellectual disability (ID) make up an unknown proportion of those seeking substance use treatment. We reviewed existing evidence on prevalence estimates relating to tobacco use, drug and alcohol use, and misuse in ID. Ten electronic databases were searched to identify studies published 1980 to 2016 describing substance use and misuse prevalence estimates in ID. 39 studies were identified (UK, 13; US, 10; Australia, 4; Netherlands, 3; Sweden, 2; Belgium, 1; Finland, 1; India, 1; Ireland, 1; Serbia, 1; more than 1 country, 2). The review highlighted considerable methodological variance in the description and diagnosis of ID plus substantial between-study variation in how use, misuse and dependency were defined. Current alcohol use prevalence ranged from 1.9% to 55%; current tobacco use prevalence from 0% to 62.9%; and current cannabis use prevalence from 5% to 9.5%. The prevalence of substance use and misuse in ID is highly variable; studies included in this review were too heterogeneous to determine conclusively whether prevalence rates are higher, lower or equivalent in ID versus non-ID samples. The use of substances amongst people with ID requires greater consideration by researchers, service providers and commissioners
Not only with thy hands, But Also with Thy Minds:Salvaging Psychologically Damaged Soldiers in the Second World War
No full textThis essay breaks new ground in exploring the tensions in female nursing during the Second World War as the mental health needs of the injured was increasingly acknowledged. Advances in weaponry and transportation meant that the Second World War was a truly global war with mobile troops and enhanced capacity to maim and kill. A critical mass of female nursing sisters was posted to provide care for physical trauma, yet the nature of this uniquely modern war also required nurses to provide psychological support for troops readying for return to action. Most nursing sisters of the British Army had little or no mental health training, but there were male trained mental health nurses available. Publications of broadcasts by the Matron-in-Chief of the British Army Nursing Service detail the belief that the female nurse was the officer in charge of the ward when the patients had physical needs. However, that the nursing sister held this position when the patients’ requirements were of a psychological nature was at times tested and contested. Through personal testimony and contemporary accounts in the nursing and medical press this essay investigates how female nursing staff negotiated their position as the expert by the psychologically damaged combatants’ bedside. The essay identifies the resourcefulness of nurses to ensure access to all patient groups and also their determination to move the boundaries of their professional work to support soldiers in need
Promoting effect of Au on Pd/TiO2 catalyst for the selective catalytic reduction of NOx by H2
No full textAu promoted Pd/TiO2 catalysts with different Pd loading were investigated for the selective catalytic reduction of NOx by hydrogen (H2-SCR). The results showed that 1%Pd-0.5%Au/TiO2 catalyst exhibited the highest NOx conversion and N2 selectivity, as well as a wide activity temperature window. Moreover, the 1%Pd-0.5%Au/TiO2 catalyst offered remarkable resistance to high gas hourly space velocity (GHSV). XRD, XPS and TEM results illustrated that the excellent H2-SCR performance of 1%Pd-0.5%Au/TiO2 catalyst was closely related to the formed PdAu alloy and the higher dispersion of active sites compared with 1%Pd/TiO2. In-situ DRIFTS results revealed that more and new adsorbed nitrogen oxides species, as well as more adsorbed NH3 and NH4+ active species generated over 1%Pd-0.5%Au/TiO2 catalyst, thus accelerating the ability to active H2 atom and the subsequent reaction with adsorbed nitrogen oxides species
Not every public sector is a field: evidence from the recent overhaul of the English NHS
No full textA structural interpretation of institutionalism has become dominant in public management research. Yet, studies tend to assume an institutional-level phenomenon without specifying how an organizational field was identified or whether structural characteristics can indeed be found in the organizational population studied. This lacuna is illustrated by exploring the structural interpretation of the field construct in the case of the recent overhaul of English primary care. Findings demonstrate the need for a more robust application of institutionalism in empirical research. Possible research problems for public management and a future research agenda based on a more relational approach to fields are discussed
Framing the neoliberal canon: resisting the market myth via literary enquiry
No full textThere is widespread recognition that neoliberal rhetoric about ‘free markets’ stands in considerable tension with ‘really existing’ neoliberalizing processes. However, the oft-utilized analytical distinction between ‘pure’ economic and political theory and ‘messy’ empirical developments takes for granted that neoliberalism, at its core, valorizes free markets. In contrast, the paper explores whether neoliberal intellectuals ever made such an argument. Using Friedrich Hayek and Milton Friedman as exemplars, our reading of canonical neoliberal texts focuses on author framing gestures, particular understandings of the term ‘science’, techniques of characterization, and constructions of epistemological legitimacy. This enables us to avoid the trap of assuming that these texts are about free markets and instead enquires into their constitution as literary artefacts. As such, we argue that the remaking of states and households rather than the promotion of free markets is at the core of neoliberalism. Our analysis has significant implications. For example, it means that authoritarian neoliberalism is not a departure from but actually more in line with the ‘pure’ neoliberal canon than in the past. Therefore, neoliberalism ought to be critiqued not for its rhetorical promotion of free markets but instead for seeking to reorganize societies in coercive, non-democratic and unequal ways. This also enables us to acknowledge that households are central to resistance to neoliberalism as well as to the neoliberal worldview itself
Authoritarian neoliberalism: trajectories of knowledge production and praxis
No full textThis introduction to the special issue takes as its point of departure threecentres of gravity that have shaped the study of neoliberalism but have alsoestablished barriers to further progress in these debates. By promoting anintersectional materialist research agenda which challenges extant ideational,modernist and empiricist tendencies in scholarship on neoliberalism, theessay contextualizes the special issue articles by outlining and clarifying keyaspects of our understanding of authoritarian neoliberalism. In particular, wereflect on themes related to conceptualization and periodization, which areof importance for both this special issue but also for broader questions ofknowledge production and praxis. Through doing so, we argue that there aretwo distinct yet connected trajectories within the research agenda onauthoritarian neoliberalism: one which focuses on the intertwinement ofauthoritarian statisms and neoliberal reforms; and another which tracesvarious lineages of transformation of key societal sites in capitalism (e.g.states, households, workplaces, urban spaces). Recognition of this spectrum ofauthoritarian neoliberal practices is important as it helps us uncover howinequalities of power are produced and reproduced in capitalist societies,and pushes us to consider more fully how other worlds can be madepossible. Nevertheless, it is affirmed that we must remain open to what anemancipatory society might look like, and what struggles would be mostappropriate, in and across various socio-spatial contexts
Organ donation: Reducing the risk of health care associated infection
No full textHealth care-associated infection is a real and relative risk within the realm of organ donation. Despite detailed guidance from the Advisory Committee on the Safety of Blood, Tissues and Organs on the microbiological safety of human organs, tissues and cells used in transplantation, the topic has received limited exposure in the literature. This paper will give a context to the Safety of Blood, Tissues and Organs guidance, outline the key recommendations for mandatory/recommended screening and provide a summary of infections that may be present at the time of donation that require careful risk assessment. This does not detract from national guidelines and cannot replace expert advice but will raise awareness and complement safe and effective care delivery.</p
'It's now or never' - nulliparous women's experiences of pregnancy at advanced maternal age: A grounded theory study.
No full textBackground: Delayed pregnancy is increasingly common in many countries including the UK. There has been international interest in providing maternity care which aims to improve outcomes for mothers and babies when pregnancy occurs after the age of 35. Despite this, there is a lack of understanding of the experience of pregnancy at advanced maternal age from the woman’s perspective. Objectives: To explore the experience of uncomplicated pregnancy for nulliparous women aged 35 and over and determine key processes involved in their pregnancy journey.Design: A two phase constructivist grounded theory study. Setting: x of England, United Kingdom. Participants: 15 nulliparous women aged 35 and over, in their third trimester of pregnancy. Methods: Data were collected through semi-structured, in depth interviews which were transcribed and analysed using coding, constant comparison and memo-writing. Results: The core category ‘It’s now or never’ reflects how women may experience their pregnancy. This appears to influence feelings of readiness to become a mother, anxieties about the pregnancy and their care choices. This was felt more acutely as maternal age advances towards 40 years and beyond.Conclusions: Women’s understanding that their future chances to have a baby may be limited can impact upon the way pregnancy is experienced. Despite having an uncomplicated pregnancy, older pregnant women may experience considerable worry throughout their pregnancy. Further research is required on how health care providers can better support women in early pregnancy and in making decisions regarding childbirth choices which are related to age.<br/
The impact of obesity and bariatric surgery on circulating and tissue biomarkers of endometrial cancer risk
No full textObesity is the strongest risk factor for endometrial cancer (EC). To inform targeted screening and prevention strategies, we assessed the impact of obesity and subsequent bariatric surgery-induced weight loss on endometrial morphology and molecular pathways implicated in endometrial carcinogenesis. Blood and endometrial tissue were obtained from women with class III-IV obesity (body mass index ≥40kg/m2 and ≥50kg/m2, respectively) immediately prior to gastric bypass or sleeve gastrectomy, and at two and 12 months’ follow up. The endometrium underwent pathological examination and immunohistochemistry was used to quantify proliferation (Ki-67), oncogenic signaling (PTEN, pAKT, pERK) and hormone receptor (ER, PR) expression status. Circulating biomarkers of insulin resistance, reproductive function and inflammation were also measured at each time point. Seventy-two women underwent bariatric surgery. At 12 months, the mean change in total and excess body weight was -32.7% and -62.8%, respectively. Baseline endometrial biopsies revealed neoplastic change in ten women (14%): four had EC, six had atypical hyperplasia (AH). Following bariatric surgery, most cases of AH resolved (5/6) without intervention (3/6) or with intrauterine progestin (2/6). Biomarkers of endometrial proliferation (Ki-67), oncogenic signaling (pAKT) and hormone receptor status (ER, PR) were significantly reduced, with restoration of glandular PTEN expression, at 2 and 12 months. There were reductions in circulating biomarkers of insulin resistance (HbA1c, HOMA-IR) and inflammation (hsCRP, IL-6), and increases in reproductive biomarkers (LH, FSH, SHBG). We found an unexpectedly high prevalence of occult neoplastic changes in the endometrium of women undergoing bariatric surgery. Their spontaneous reversal and accompanying down-regulation of PI3K-AKT-mTOR signaling with weight loss may have implications for screening, prevention and treatment of this disease