In-reach nursing services improve older patient outcomes and access to emergency care

Aims: To identify the impact of in-reach services providing specialist nursing care on outcomes for older people presenting to the emergency department from residential aged care. Methods: Retrospective cohort study compared clinical outcomes of 2278 presentations from 2009 with 2051 presentations from 2011 before and after the implementation of in-reach services. Results: Median emergency department length of stay decreased by 24 minutes (7.0 vs 6.6 hours, P<0.001) and admission rates decreased by 23% (68 vs 45%, P<0.001). The proportion of people with repeat emergency department visits within six months decreased by 12% (27 vs 15%). The proportion of admitted patients who were discharged with an end of life palliative care plan increased by 13% (8 vs 21%, P=0.007). Conclusions: There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in-reach services.

Statistical approaches used to assess the equity of access to food outlets: a systematic review

Abstract: Background Inequalities in eating behaviours are often linked to the types of food retailers accessible in neighbourhood environments. Numerous studies have aimed to identify if access to healthy and unhealthy food retailers is socioeconomically patterned across neighbourhoods, and thus a potential risk factor for dietary inequalities. Existing reviews have examined differences between methodologies, particularly focussing on neighbourhood and food outlet access measure definitions. However, no review has informatively discussed the suitability of the statistical methodologies employed; a key issue determining the validity of study findings. Our aim was to examine the suitability of statistical approaches adopted in these analyses.
Methods: Searches were conducted for articles published from 2000–2014. Eligible studies included objective measures of the neighbourhood food environment and neighbourhood-level socio-economic status, with a statistical analysis of the association between food outlet access and socio-economic status.
Results Fifty four papers were included. Outlet accessibility was typically defined as the distance to the nearest outlet from the neighbourhood centroid, or as the numberof food outlets within a neighbourhood (or buffer). To assess if these measures were linked to neighbourhood disadvantage, common statistical methods included ANOVA, correlation, and Poisson or negative binomial regression. Although all studies involved spatial data, few considered spatial analysis techniques or spatial autocorrelation.
Conclusions: With advances in GIS software, sophisticated measures of neighbourhood outlet accessibility can be considered. However, approaches to statistical analysis often appear less sophisticated. Care should be taken to consider assumptions underlying the analysis and the possibility of spatially correlated residuals which could affect the results.

The National Perinatal Depression Initiative: An evaluation of access to general practitioners, psychologists and psychiatrists through the Medicare Benefits Schedule

OBJECTIVE: To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. METHOD: Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. RESULTS: The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. CONCLUSION: In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies.

November 2007: A New Approach to Information Literacy

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The development agenda for WIPO: another stillbirth?: A batttle between access to knowledge and enclousure

This paper has been produced as part of the examination in order to obtain a Master degree in Law (LLM), in Intellectual Property, at Queen Mary & Westfield College, University of London.

Bank dividends and signaling to information-sensitive depositors

Esta tese investiga se a composição do endividamento dos bancos afeta sua política de dividendos. Identificou-se que investidores sensíveis a informações (investidores institucionais) são alvos de sinalização através de dividendos por parte dos bancos. Utilizando uma base de dados exclusiva de bancos brasileiros, foi possível identificar vários tipos de credores, especificamente, investidores institucionais, empresas não financeiras e pessoas físicas, que são alvos potenciais de sinalização por dividendos. Adicionalmente, a existência de vários bancos de capital fechado, controlados e geridos por um pequeno grupo de acionistas, em que a sinalização direcionada a acionistas é implausível, permite inferir que bancos que utilizam mais fundos de investidores sensíveis a informações (institucionais) pagam mais dividendos, controlando por diversas características. Durante a crise financeira, este comportamento foi ainda mais pronunciado. Esta relação reforça o papel dos dividendos como uma forma custosa e crível de comunicar sobre a qualidade dos ativos dos bancos. A hipótese de que os dividendos podem ser utilizados como uma forma de expropriação dos depositantes por parte dos acionistas é refutada, uma vez que, se fosse esse o caso, observar-se-ia esse maiores dividendos em bancos com depositantes menos sensíveis a informação. Além disso, foi verificada uma relação negativa entre o pagamento de dividendos e o custo de captação (juros pagos em certificados de depósito bancário) e uma relação positiva de dividendos com o tamanho e com os lucros passados, e que os bancos de capital fechado pagam mais dividendos do que os de capital aberto, uma descoberta que também se alinha com a ideia de que os depositantes seriam os alvos da sinalização por dividendos. Finalmente, encontrou-se também uma relação negativa entre dividendos e adequação de capital do bancos, o que indica que pressões regulatórias podem induzir os bancos a pagar menos dividendos e que o pagamento de dividendos é negativamente relacionado com o crescimento da carteira de crédito, o que é consistente com a ideia de que os bancos com maiores oportunidades de investimento retêm seus lucros para aumentar seu patrimônio líquido e sua capacidade de conceder crédito.

What kind of judiciary do we want?: the access to justice in Brazil

The goal of this paper is to discuss a key issue in the Democratic Rule of Law State: what are the role and main functions of the Judiciary in Brazil? Is the Judiciary mainly a public service provider, adjudicating disputes and guaranteeing individual rights? Or also as a state power, it should mainly control and guide the moral values of the society, changing the status quo and reducing social conflicts? In this sense, what are the conflicts that must be examined by the Judiciary? We will seek to answer these questions based on a discussion subsidized by courts official statistics and the results of surveys conducted with the Brazilian general population. The surveys measured how do citizens feel about their judicial system and what are the circumstances and the facts that determine the judicialization of conflicts. We work with the perceptions and attitudes of citizens relating to the Judiciary as it is today and discuss the Judiciary they want. Then, we compare how attitudes and perceptions relate to actual behavior and use of courts.

The access to demand

In this paper I argue that, in developing countries, sufficient aggregate demand is not enough to motivate investment and achieve full employment. Besides, according to the Keynesian developmental macroeconomics under construction, competent business enterprises must have access to that demand –access which is denied to most of them because developing countries face the tendency to the cyclical and chronic overvaluation of the exchange rate

June Journeys in Brazil: from the networks to the streets

This article seeks to analyse the mass protests that ecloded in the main cities in Brazil in June 2013 - the so-called June Journeys -, event which represented an inflection moment in the country's recent political history and inaugurated a new social mobilization cycle in the country. This analysis will begin with the presupposition that the strong digital inclusion that has been going on over recent years was a main element, but not the only one, responsible for the occurrence of protests. Still, although digital inclusion has been a central tool that allowed these demonstrations to happen in the first place, it was not the only responsible for leading over 1 million people to the streets. Factors such as frustrated expectations over the continuity of the social inclusion process that had been ongoing over the last decade, the rising educational level and a political representation crisis contributed to social mobilization, and were amplified due to widening internet access - and, therefore, access to information - across the population

The Approach To The Administrative Mapping In Knowledge Management For Portugal Libraries

In the study of theoretical trends in Administration, the management of information follows the development of theories of Administration; constant-adaptations are suffered. Information Science as Museums, Archives and Libraries, understands and concerns itself with the changes wrought in these endeavour of the knowledge society as new forms of communication and integration. They interact in ways such as to maximize access to information and facilitate improvement on their structural environment. The research aims at identifies the requirements and specifications of an information system for knowledge management in the public's library enviromnent and proposes to achieve a pre-defined structure for the implementation of administration management. The research is conducted with public's library of the metropolian region of the North's Portugal. In the improvement of systems theoretical administrative trends become management decisions and result in the ultimate success of the organization.

Physiologic and productive responses of Holstein dairy cows with access to the constant or limited shade

The work: was carried out to evaluate the physiologic and productive responses of 16 Holstein breed cows, in different lactating stages and production levels, maintained in two free stall corral types, with or without plastic sheet covering, in the southeast-northwest of the covered area edges. The animals were confined in free stall system, during the months of the summer, with access to the constant or Limited shade. A complete randomized experimental design was: used. The physiological variables measured were respiratory frequency (morning an afternoon) and rectal temperature (morning and afternoon). The productive variables were milk production (morning, afternoon and daily), dry matter (DM) intake (% live weight) and efficiency of milk production (kg of milk/kg DM intake). The animals with access to the constant shade presented respiratory frequency (74.1 vs 81.0 breath/min.) and rectal temperature (39.5 vs 39.7 degrees C) lower and mirk production (22.6 vs 20.9 kg/day) and efficiency of milk production (1.3 vs 1.2 kg of milk/kg DM ingested) higher than the animals with access to the limited shade. There was no effect on the dry matter intake.

Quality of life (QoL) in relation to disease severity in Brazilian Parkinson's patients as measured using the WHOQOL-BREF

This study aimed at evaluating and describing the QoL and its association with the severity of disease among Brazilian Parkinson's disease (PD) patients. In this cross-sectional study 68 PD patients were interviewed using the World Health Organization Quality of Life instrument Short Form (WHOQOL-BREF) and the Hoehn-Yahr (HY) scale. Analysis of variance, chi(2), Kruskal-Wallis and Mann-Whitney U-tests, Spearman and Cronbach reliability coefficients were used to analyze the data. The results indicate: (1) physical capacity was the domain that showed the most deterioration; (2) severity of PD is associated with QoL measured by WHOQOL-BREF; (3) overall QoL, working capacity, activities of daily living (ADL) and self-esteem are affected in both transitional periods in the progression of PD (mild to moderate and moderate to advanced). Satisfaction with general health, pain, energy, positive feelings, personal relationship and satisfaction with home are affected in the first period of transition while mobility, body image, sexual activity and access to information are affected in the second. This study mainly shows specific facets that are affected depending on the specific periods of PD progression, which can help to understand the impact of the disease, the effectiveness of care, and the demand for health care resources. (C) 2007 Elsevier B.V. All rights reserved.

Inequalities in access to education and healthcare

The burden of disease is borne by those who suffer as patients but also by society at large, including health service providers. That burden is felt most severely in parts of the world where there is no infrastructure, or foreseeable prospects of any, to change the status quo without external support. Poverty, disease and inequality pervade all the activities of daily living in low-income regions and are inextricably linked. External interventions may not be the most appropriate way to impact on this positively in all circumstances, but targeted programmes to build social capital, within and by countries, are more likely to be sustainable. By these means, basic oral healthcare, underpinned by the primary healthcare approach, can be delivered to more equitably address needs and demands. Education is fundamental to building knowledge-based economies but is often lacking in such regions even at primary and secondary level. Provision of private education at tertiary level may also introduce its own inequities. Access to distance learning and community-based practice opens opportunities and is more likely to encourage graduates to work in similar areas. Recruitment of faculty from minority groups provides role models for students from similar backgrounds but all faculty staff must be involved in supporting and mentoring students from marginalized groups to ensure their retention. The developed world has to act responsibly in two crucial areas: first, not to exacerbate the shortage of skilled educators and healthcare workers in emerging economies by recruiting their staff; second, they must offer educational opportunities at an economic rate. Governments need to lead on developing initiatives to attract, support and retain a competent workforce.

Debt financing rollercoaster: Latin American and Caribbean access to international bond markets since the debt crisis, 1982-2012

Includes bibliography

Architecture for publication and universal access to smart transducers

This paper proposes a simple and powerful architecture for publication and universal access to smart transducers, through existing and established open standards. Smart transducers are put to work on standards and styles already included in the Web, exploring resources in Cloud Computing and simplifying access to data. © 2012 IEEE.