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Integration, effectiveness and costs of different models of primary health care provision for people who are homeless: an evaluation study
Get PDFBackground
There is a high prevalence of health problems among single people who are homeless. Specialist primary health care services for this population have been developed in several locations across England; however, there have been very few evaluations of these services.
Objectives
This study evaluated the work of different models of primary health care provision in England to determine their effectiveness in engaging people who are homeless in health care and in providing continuity of care for long-term conditions. It concerned single people (not families or couples with dependent children) staying in hostels, other temporary accommodation or on the streets. The influence on outcomes of contextual factors and mechanisms (service delivery factors), including integration with other services, were examined. Data from medical records were collated on participants’ use of health care and social care services over 12 months, and costs were calculated.
Design and setting
The evaluation involved four existing Health Service Models: (1) health centres primarily for people who are homeless (Dedicated Centres), (2) Mobile Teams providing health care in hostels and day centres, (3) Specialist GPs providing some services exclusively for patients who are homeless and (4) Usual Care GPs providing no special services for people who are homeless (as a comparison). Two Case Study Sites were recruited for each of the specialist models, and four for the Usual Care GP model.
Participants
People who had been homeless during the previous 12 months were recruited as ‘case study participants’; they were interviewed at baseline and at 4 and 8 months, and information was collected about their circumstances and their health and service use in the preceding 4 months. Overall, 363 participants were recruited; medical records were obtained for 349 participants. Interviews were conducted with 65 Case Study Site staff and sessional workers, and 81 service providers and stakeholders.
Results
The primary outcome was the extent of health screening for body mass index, mental health, alcohol use, tuberculosis, smoking and hepatitis A among participants, and evidence of an intervention if a problem was identified. There were no overall differences in screening between the models apart from Mobile Teams, which scored considerably lower. Dedicated Centres and Specialist GPs were more successful in providing continuity of care for participants with depression and alcohol and drug problems. Service use and costs were significantly higher for Dedicated Centre participants and lower for Usual Care GP participants. Participants and staff welcomed flexible and tailored approaches to care, and related services being available in the same building. Across all models, dental needs were unaddressed and staff reported poor availability of mental health services.
Limitations
There were difficulties recruiting mainstream general practices for the Usual Care GP model. Medical records could not be accessed for 14 participants of this model.
Conclusions
Participant characteristics, contextual factors and mechanisms were influential in determining outcomes. Overall, outcomes for Dedicated Centres and for one of the Specialist GP sites were relatively favourable. They had dedicated staff for patients who were homeless, ‘drop-in’ services, on-site mental health and substance misuse services, and worked closely with hospitals and homelessness sector services
Live demonstration: real time imaging with electrical impedance tomography
No full textThis demo presents a high framerate (89 fps) electrical impedance tomography (EIT) system. It is a wearable, low-cost and non-invasive imaging system to continuously monitor regional lung ventilation for neonatal and SARS-CoV-2 patients. The system uses a 16-passive electrode belt around the chest to extract impedance changes as a result of lung ventilation
UN Global Compact: Communication on Engagement 2023
No full textThis report outlines some of the achievements of Middlesex University Dubai (MDX) from March 2021 until March 2023 in terms of implementing the Sustainable Development Goals (SDGs) within our community. This is the University’s third report for the UN Global Compact (UNGC). Middlesex University Dubai is committed to fostering and promoting a more sustainable, inclusive, and equitable environment for our students, staff, and the wider community.
This report highlights the initiatives that Middlesex University Dubai has in place to promote sustainability in terms of education, engagement with students and the building of relationships with the public and private sector
Corporate social responsibility, governance and financial constraints in Indian listed firms
No full textThe study examines the effect of corporate social responsibility (CSR) activities on financial constraints by using a balanced panel dataset of 1,496 firms listed on the National Stock Exchange (NSE) in India from 2014 to 2020. It employs a generalized method of moments (GMM) two-step estimator method to analyze the data. GMM analysis is efficient in dealing with the endogeneity issues among firm-level variables. The robustness checks are conducted by the three-step least square (3SLS) regression method to confirm the consistency of results. Whited and Wu index (2006) and the debt-to-asset ratio have been used to classify the firms into financially constrained and unconstrained firms. We find that financially constrained find it difficult to engage in CSR activities. However, CSR spending can help in reducing financial constraints for firms. CSR activities are associated with stakeholder engagement that reduces the likelihood of opportunistic behaviour of managers. Further, stakeholder engagements help firms to enhance their value through their relationship with customers, employees and other stakeholders. The study also finds that corporate governance alleviates financial constraints, implying that firms are becoming more accountable and transparent in disclosing CSR activities. Finally, it confirms that firms engaging in CSR activities face lower financial constraints. The study focuses on the Indian-listed firms only which can be extended to private firms in future research
Cataloguing the ‘oriental’ in MoDA’s Silver Studio Collection
Get PDFThis is a Culture & New Museum School Advanced Programme and University of Leicester’s School of Museum Studies project.
New Museum School Advanced Programme aims to open up who makes and enjoys arts and heritage by allowing professionals to continue full-time employment while attending distance learning. The course has a flexible and modular structure leading to post-graduate qualifications from PGDip to MA level. The accessible recruitment process for applicants with a wide-range of experiences and budget aims to diversify the Arts and Heritage workforce.
In this project, Kirsty Kerr looked at the use of the word ‘oriental’ as a descriptive term in the Museum of Domestic Design & Architecture (MoDA)’s Silver Studio Collection. It was used by studio designers to describe a loosely-defined set of visual characteristics that gestured vaguely towards ‘Eastern’ motifs, either in their own work or in visual reference material. Subsequent cataloguers of these items have continued to use the term ‘oriental’ uncritically. The project was not simply about reporting the terms used by the Silver Studio, but how MoDA describe the collection now - primarily in their internal catalogue, but also considering its impact on wider practice. It aimed to build on work going on elsewhere in the sector, which draws attention to the need to tackle in-built assumptions inherent within museum databases. Reflecting on current discourse, the report explores how MoDA might unpack the word today to add more specific or suitable terms to the catalogue, in order to be both more appropriate and more useful to all users in finding relevant items.
The project spanned eight weeks, with one dedicated work day per week. The first three were onsite and to familiarise with MoDA’s collection stores and database, and the items therein. The remaining weeks took place remotely and involved collating research, grounding it within relevant theory and critically reflecting on museum practice
Unicorn Rising
No full text'Unicorn Rising' is a fantasy poem by A J Dalton published in the Winter 2023 issue of Illustrated Worlds magazine. The poem falls into the broader category of 'speculative poetry'. 'Unicorn Rising' has eco-critical themes. 'I, Medusa' was a fantasy poem by A J Dalton published in a previous issue
Five poems by A J Dalton: Loki's Lament, Viking Winter, The Misery and Mirth of Mjolnir, Odin Wayfarer, A Girl's Vision
No full text'Loki's Lament', 'Viking Winter', 'The Misery and Mirth of Mjolnir', 'Odin Wayfarer' and 'A Girl's Vision' represent a small collection of speculative poems (fantasy) by A J Dalton based on Norse mythology. The poems were published as a set in the Lothlorien Poetry Journal in Dec 2023. Other Norse poems by A J Dalton include 'The Final Saga' and 'Valkyrie Love'
A life in fragments: the ecology, behavior, and conservation of the recently described Parecis Plateau titi monkey (Plecturocebus parecis)
Get PDFWhile some South American primates are well-studied, many are poorly known to science. This makes reports of their ecology very valuable, especially when the region inhabited is threatened by human activities. We combined data from three independent field studies to provide a better understanding of the behavior, ecology, chemical composition of plant items consumed, and conservation of the Parecis Plateau titi monkey (Plecturocebus parecis), a recently described species from the southern Amazonian Arc of Deforestation. Specifically, we collected behavioral data for eight groups over 8 months and quantified the monkeys’ activity budget. To analyze the chemical compounds in the plants eaten, we used vanillin to determine condensed tannin and alkaline precipitation to quantify total alkaloid content. We also determined the extent of forest loss and fragmentation from 2000 to 2019 within the known range of the Parecis Plateau titi monkey using satellite imagery. We found that group size ranged 2–6 individuals, and the monkeys spent 31% of the day foraging, 22% resting, 19% feeding, 14% moving, and 14% in other activities. The monkeys ate 50 plant species from 24 families and appeared to be unusually tolerant of dietary tannins but avoided alkaloids. Habitat modification within the species’ range has been extensive: forest cover declined by 16.1% in 2000–2019; the largest areas of continuous forest were reduced by 37.5%; mean fragment size decreased 67.5% (from 421.0–136.9 ha). Forest loss and fragmentation were most significant in the northern half of the species’ range and its southern border. Given the Parecis Plateau titi monkey’s tolerance for toxic dietary species, the intense modification of its geographic range, and its capacity to live in fragmented habitats, we recommend that future studies investigate these topics across all 37 species of titi monkeys. In addition, recordings of vocal repertoires will improve field surveys and help with population estimates, especially for titi monkey species living in geographic regions that have been heavily modified by humans
Authentic by design: developing students for the talent economy
No full textMiddlesex University provides intellectually demanding degrees focusing on professional practice for which 'authenticity' is a key principle underpinning LTA strategy. Viewed positively by student as demonstrated in NSS 2023 (Assessment and Feedback +4.54 above sector) this strategy embraces a range of technologically enhanced methods to enable the development of highly sought after graduate competencies: creativity, critical thinking, problem-solving, communication, empathy and collaboration.
We will discuss:
• How programmes develop graduates that are future focussed and employment ready;
• Embedding industry awards in curricula;
• Collaborative practice- and project-based approaches;
• Inclusive authentic assessment through coursework to explore students’ understanding of topics