48 research outputs found
Evaluation of the Social Services and Well-being (Wales) Act 2014: Literature Review
No full textThe author list for the literature review is provided below:
Evaluation of the Social Services and Well-being (Wales) Act 2014: Literature Review
Chapter authors:
Introduction and methods
Verity, F., Wallace, S., Llewellyn, M., Anderson, P. and Lyttleton-Smith, J.
Well-being
Anderson, P., Lyttleton-Smith, J., Kosnes, L., Read, S., Blackmore, H. and Williams, Z.
Prevention and early intervention
Verity, F., Read, S. and Richards, J.
Co-production
Andrews, N., Calder, G., Blanluet, N., Tetlow, S. and Wallace, S.
Multi-agency
Wallace, C., Orrell, A., Garthwaite, T., Tetlow, S. and Wallace, S.
Voice and control
Llewellyn, M., Saltus, R., Blackmore, H., Tetlow, S., Williams, Z. and Wallace, S.
Financial and economic
Phillips, C., Prowle, M., Tetlow, S. and Williams, Z.
Service user and carer experiences under the Act
Wallace, S.This report is a summary of the extensive review of the literature to inform the evaluation of the Social Services and Well-being (Wales) Act 2014. This document is a summary of the extensive review of the literature undertaken to inform the evaluation of the Social Services and Well-being (Wales) Act 2014 (hereafter referred to as ‘the Act’).1 The Welsh Government has commissioned a partnership between academics across four universities in Wales and expert advisers to deliver the evaluation. The Act sets out a government vision to produce ‘transformative changes’ in social service public policy, regulations, and delivery arrangements across Wales. It has 11 parts and is informed by five principles that set out a vision to produce transformative changes in public policy, regulations, and service delivery. Aligned to it are structures, processes, and codes of practice. The Evaluation of the Act – a study called IMPACT – is organised around each of the five principles together with a focus on the financial and economic aspects of the Act’s implementation. The approach to undertaking this evaluation research is to structure the evaluation by using the fundamental principles of the Act as the scaffolding. These principles are: • Well-being • Prevention • Co-Production • Multi-agency working • Voice and control There is also a focus on the financial and economic considerations of the implementation of the Act and this area constitutes the sixth evaluation study theme
Prehabilitation- Do we need metabolic flexibility
No full textMetabolic flexibility, the capacity to switch between energy sources in response to changing physiological demands, emerges as a critical determinant of perioperative resilience. In the context of surgery, where metabolic demands are high and energy homeostasis is disrupted, patients with metabolic inflexibility may experience worse outcomes due to impaired immune responses and heightened insulin resistance, resulting in prolonged recovery times. This article explores the implications of metabolic flexibility in the perioperative period and examines the potential for prehabilitation strategies, such as targeted exercise and nutritional interventions, to improve patient readiness for surgery. Cardio-pulmonary exercise testing (CPET) is discussed as a valuable assessment tool for metabolic flexibility, capable of providing insights into a patient’s fuel adaptability and overall metabolic health preoperatively. Evidence suggests that targeted exercise and nutritional strategies can enhance mitochondrial function, improve nutrient-sensing pathways, and increase substrate oxidation, which may reduce perioperative complications and support immune resilience. Future research should focus on refining methods to identify metabolically inflexible patients and tailoring prehabilitation interventions to optimise metabolic flexibility, particularly in populations vulnerable to metabolic dysfunction, such as those with obesity, diabetes, and cancer. This approach may establish new standards in perioperative care by aligning metabolic readiness with surgical recovery demands
Pension Provision and Retirement Saving: Lessons from the United Kingdom
No full textWe describe the trajectory of pension reform in the United Kingdom, which has focussed on keeping the cost of public pension programmes down during a period of steady population ageing whilst attempting to maintain an adequate minimum level of income security for low income households in retirement. Instruments for achieving these aims have been to target public benefits on low income households, permitting individuals to opt out of the second tier of the public programme into private retirement accounts, and the use of tax incentives to encourage additional private retirement saving. Frequent reforms to the pension programme raise the question of whether households can make reasonable private retirement saving provision in the light of growing complexity and potential shortcomings in individual decision-making. This paper sheds some light on these issues.pensions, social security, retirement saving
What is a Public Sector Pension Worth?
No full textWe measure accruals in defined benefit (DB) pension plans for public and private sector workers in Britain, using typical differences in scheme rules and sector-specific lifetime age-wage profiles by sex and educational group. We show not just that coverage by DB pension plans is greater in the public sector but that median pension accruals as a percentage of salary are more than 6% higher among DB-covered public sector workers than covered private sector workers. This is largely driven by earlier normal pension (retirement) ages but also by differences in earnings profiles across the sectors. Copyright � The Author(s). Journal compilation � Royal Economic Society 2009.
Ohio State University Law Class 1928
No full textFaculy: Hunter, Robert; Lattin, Norman; Laylin, Clarence; Mathews, Robert; Rose, William; Simes, Lewis M.; Tuttle, Alonzo H., Dean; Students: ; Allen, Joseph C.; Babbs, Charles F.; Bassichis, Jack; Beckwith, Theodore R.; Bingham, Charles D.; Blair, Byron D.; Cessna, Geneva C.; Cohen, Ruth F.; Danaher, James B.; Davis, William W.; De Bruin, Walter E.; Dowling, Ralph J.; Earhart, Daniel S.; Elder, William M.; Farr, Everett D.; Frater, George E.; Gay, Lowell E.; Giffen, Wm. M.; Githens, Philemon S.; Hamlin, Don F.; Harter, Joseph M.; Hartz, Lawrence F.; Hershey, Rice A.; Hill. W. W.; Jones, Carva C.; Kessler, Fritzie C.; Knapp, James L.; Labowitz, Leonard S.; Lape, Howard B.; Leibowitz, Gabriel; Littman, Harry S.; Luchs, Samuel D.; McCann, Richard L.; Maher, James M.; Miller, Rex K.; Moore, Wm. C.; Morierty, Edward A.; Nangle, J. C.; Nicholas, Carl A.; Nolan, James A.; Pfeiffer, John H.; Provenza, Joseph A.; Ralston, George K.; Sayles, Allen E.; Schmidt, Helene P.; Seikel, Mary P.; Sheehan, James; Shulman, Louis T.; Smith, Alex W.; Snyder, John J.; Stecher, Joseph D.; Stevens, F. E.; Tanner, Charles C.; Tetlow, Percy W.; Threlheld, Wayne H.; Warfield, Charles W.; Warwick, Paul B.; Watkins, Lloyd A.; Webber, Dan S., Jr.; White, Henry C.; Wise, Sylvan H.; Yantes, Edmond N.
Comparing Alternative Output-Gap Estimators: A Monte Carlo Approach
No full textThe author evaluates the ability of a variety of output-gap estimators to accurately measure the output gap in a model economy. A small estimated model of the Canadian economy is used to generate artificial data. Using output and inflation data generated by this model, the author uses each output-gap estimation methodology to construct an estimate of the true output gap. He then evaluates the methodologies by comparing their respective estimates of the output gap with the true gap. The estimators are evaluated on the basis of correlations between the actual and estimated output gap, as well as the root-mean-squared estimation error. The author also varies the properties of potential output and the output gap in the data-generating process to test the robustness of his results. His findings indicate that an estimator that combines the Hodrick-Prescott filter with a Blanchard-Quah structural vector autoregression (SVAR) yields an estimate that is accurate compared with competing methods at the end-of-sample. He also finds that the performance of the SVAR relative to that of other methodologies is quite robust to violations in the identifying assumptions of the SVAR.Business fluctuations and cycles; Econometric and statistical methods; Potential output
E03 Cardio-pulmonary exercise testing aids chronic obstructive pulmonary disease diagnosis in the perioperative evaluation of patients undergoing radical cystectomy
No full textChronic Obstructive Pulmonary Disease (COPD) is a chronic lung condition distinguished by structural changes and mucus build-up which causes dyspnoea. COPD is universally diagnosed by a spirometry test. A Forced Expiratory Volume in one second (FEV1)/Forced Vital Capacity (FVC) of <0.7, is often used to justify COPD diagnosis (Hopkinson et al., 2019, Brit Med J, 366, l4486). Reliance on spirometry tests alone may only highlight airway obstruction and not identify other consequences of COPD like impaired gas exchange which is implicated in the development of postoperative pulmonary complications. Cardio-pulmonary exercise testing (CPET) provides a more detailed look into the pathophysiology of COPD and is routinely used in perioperative settings to determine a patient’s fitness for surgery. The aims of this study were to 1) identify the number of bladder cancer patients with undiagnosed COPD, and 2) compare COPD-related CPET variables between bladder cancer patients medically diagnosed with COPD (COPDMED) who had the potential to be diagnosed at the time of CPET (COPDCPET) and those without COPD (non-COPD). All testing was performed per the American Thoracic Society/American College of Chest Physicians guidelines (2003, Am J Resp Crit Care Med, 167, 211-277). COPD-related CPET variables recorded included Minute Ventilation (V̇E; L·min-1), Peak Oxygen Consumption (V̇O2peak; mL·kg-1·min-1), the Anaerobic Threshold (AT; mL·kg-1·min-1), Ventilatory Equivalence for Carbon Dioxide (V̇E/V̇CO2), Breathing Reserve (BR; %). Eighty-two patients with bladder cancer (COPDMED [n=9], non-COPD [n=73]) underwent preoperative spirometry and CPET. In the non-COPD patients, 21 (29%) had an FEV1/FVC< 0.7, indicative of COPD and thus groups as COPDCPET. Within the COPDCPET group, 8 (40%) had an FEV1 between 50-70% of predicted which indicated moderate COPD. There was no difference found in all CPET variables measured between COPDMED and COPDCPET (P > 0.05). When COPDMED and COPDCPET were combined and compared against the non-COPD, there was a difference found in their median (95% CI) V̇Erest (13.3 [12.3-14.2] vs 11.75 [11.2-12.6] L·min-1, P = 0.02, g = 0.28). V̇O2peak (14.95 [13.64-18.12] vs 17.16 [16.35-19.11] mL·kg-1·min-1, P = 0.049, g = 0.29). V̇E/V̇CO2 at the AT (38 [36-40] vs 36 [34-37], P = 0.04, g = 0.49). There was also a difference in mean +/- SD BR (36 +/- 17 % vs 47 +/- 14 %, P = 0.004, g = 0.69). This study demonstrates the underdiagnosis of COPD in perioperative settings. Future research should assess the use of targeted COPD optimisation preoperatively
Components of a safe cystectomy service during coronavirus disease 2019 in a high-volume centre
No full textObjective: Delivery of a safe cystectomy service is a multidisciplinary exercise. In this article, we detail the measures implemented at our institution to deliver a cystectomy service for bladder cancer patients during coronavirus disease 2019 (COVID-19). /
Methods: A ‘one-stop’ enhanced recovery clinic had been established at our hospital, consisting of an anaesthetist, an exercise testing service, urinary diversion nurses, clinical nurse specialists and surgeons. During COVID-19, we modified these processes in order to continue to provide urgent cystectomy safely for bladder cancer. We collected patients’ outcomes prospectively measuring demographic characteristics, oncological and perioperative outcomes, the presence of COVID-19 symptoms and confirmed COVID-19 test results. /
Results: From March to May 2020, 25 patients underwent radical cystectomy for bladder cancer. Twenty-four procedures were performed with robotic assistance and one open as part of a research trial. We instituted modifications at various multidisciplinary steps, including patient selection, preoperative optimisation, enhanced recovery protocols, patient counselling and perioperative protocols. Thirty-day mortality was 0%. The 30-day rate of Clavien ⩾3 complications was 8%. Postoperatively, none of the patients developed COVID-19 based on World Health Organization criteria and testing. /
Conclusion: We safely delivered a complex cystectomy service during the peak of the COVID-19 pandemic without any COVID-19-related morbidity or mortality. /
Level of evidence: Level 2b
Pension Provision and Retirement Saving: Lessons from the United Kingdom
No full textWe describe the trajectory of pension reform in the United Kingdom, which has focussed on keeping the cost of public pension programmes down during a period of steady population ageing whilst attempting to maintain an adequate minimum level of income security for low income households in retirement. Instruments for achieving these aims have been to target public benefits on low income households, permitting individuals to opt out of the second tier of the public programme into private retirement accounts, and the use of tax incentives to encourage additional private retirement saving. Frequent reforms to the pension programme raise the question of whether households can make reasonable private retirement saving provision in the light of growing complexity and potential shortcomings in individual decision-making. This paper sheds some light on these issues.
Paediatric Anti‐Müllerian Hormone measurement: Male and female reference intervals established using the automated Beckman Coulter Access AMH assay
No full textObjectiveAnti-Müllerian Hormone (AMH) concentration is high at birth in males, demonstrating the presence of functional testicular tissue in the prepubertal period, and acting as a useful marker in the investigation of paediatric reproductive disorders. AMH also provides a tool in the investigation of female virilization, premature ovarian failure and polycystic ovarian syndrome in childhood. Robust, assay-specific paediatric AMH reference intervals are therefore required for clinical interpretation of results. The aim of this study was to derive age-specific AMH reference intervals for males and females aged 0-18 years.Design and PatientsPlasma samples were obtained from patients at Royal Manchester Children's Hospital and analysed for AMH using the automated Beckman Coulter Access AMH Assay. Patients under investigation for paediatric reproductive or endocrine disorders were excluded from the study.MeasurementsSeven hundred and 2 patient plasma samples (465 male, 237 female) were subject to AMH measurement, and results were analysed in order to derive continuous and discrete reference intervals for the paediatric age range.ResultsClear discrimination between male and female AMH results was evident in the prepubertal age range, with some overlap between the genders following pubertal onset.ConclusionsWe have derived age-related reference intervals for plasma AMH in the paediatric age range (0-18 years) using the automated Beckman Coulter Access AMH assay which will aid in the investigation of paediatric endocrine disorders such as disorders of sexual development
