Effectiveness of case management and post-acute services in older people after hospital discharge

Objective: To evaluate the benefits of coordinating community services through the Post-Acute Care (PAC) program in older patients after discharge from hospital. Design: Prospective multicentre, randomised controlled trial with six months of follow-up with blinded outcome measurement. Setting: Four university-affiliated metropolitan general hospitals in Victoria. Participants: All patients aged 65 years and over who were discharged between August 1998 and October 1999 and required community services after discharge. Interventions: Participants were randomly allocated to receive services of a Post-Acute Care (PAC) coordinator (intervention) versus usual discharge planning (control). Main outcome measures: Comparison of quality of life and carer stress at one-month post-discharge, mortality, hospital readmissions, use of community services and community and hospital costs over the six months post-discharge. Results: 654 patients were randomised, and 598 were included in the analysis (311 in the PAC group and 287 in the control group). There was no difference in mortality between the groups (both 6%), but significantly greater overall quality-of-life scores at one-month follow-up in the PAC group. There was no difference in unplanned readmissions, but PAC patients used significantly fewer hospital bed-days in the six months after discharge (mean, 3.0 days; 95% CI, 2.1-3.9) than control patients (5.2 days; 95% CI, 3.8-6.7). Total costs (including hospitalisation, community services and the intervention) were lower in the PAC than the control group (mean difference, $1545; 95% CI, $11-$3078). Conclusions: The PAC program is beneficial in the transition from hospital to the community in older patients.

Putting the group back into unions: A social psychological contribution to understanding union support

Industrial relations research that attempts to grapple with individuals' union-related sentiments and activities often draws on one of two traditions of psychological research—the individual-level factors tradition (for example, personality and attitude-behaviour relations) and the social context tradition (for example, frustration-aggression and relative deprivation). This paper provides an overview of research conducted from within these traditions to explain union-related phenomena and identifies some of the limitations that arise as a consequence of a shared tendency to treat people in an atomistic fashion. The paper argues for an understanding of the psychological processes that underpin group-based action. To this end, it elaborates a theoretical framework based on social identity theory and self-categorisation theory that would allow us to examine the dynamic interplay between the individual, their cognitions and their environment. The paper concludes with a brief discussion of a specific case of union mobilisation, to indicate how this theoretical framework might aid empirical analysis.

Purification of post-translationally modified proteins from bacteria: homologous expression and purification of histidine-tagged pilin from Neisseria meningitidis

Until recently, glycosylation of proteins in prokaryotes was regarded as uncommon and thought to be limited to special cases such as S-layer proteins and some archeal outer membrane proteins. Now, there are an increasing number of reports of bacterial proteins that are glycosylated. Pilin of pathogenic Neisseria is one of the best characterised post-translation ally modified bacterial proteins, with four different types of modifications reported, including a novel glycosylation. Pilin monomers assemble to form pilus fibres, which are long protein filaments that protrude from the surface of bacterial cells and are key virulence factors. To aid in the investigation of these modifications, pure pilin is required. A number of pilin purification methods have been published, but none are appropriate for the routine purification of pilin from many different isolates. This study describes a novel, rapid, and simple method of pilin purification from Neisseria meningitidis C311#3, which facilitates the production of consistent quantities of pure, native pilin. A 6 x histidine tag was fused to the C-terminus of the pilin subunit structural gene, pilE, via homologous recombination placing the 6 x histidine-tagged allele in the chromosome of N. meningitidis C311#3. Pilin was purified under non-denaturing conditions via a two-step process using immobilised metal affinity chromatography (IMAC), followed by dye affinity chromatography. Analysis of the purified pilin confirmed that it retained both of the post-translational modifications examined. This novel approach may prove to be a generally applicable method for purification and analysis of post-translationally modified proteins in bacteria. (C) 2003 Elsevier Science (USA). All rights reserved.

Caf?? com debate: os novos instrumentos da pol??tica industrial e tecnol??gica

A apresenta????o abordas os temas do desenvolvimento industrial e tecnol??gico brasileiro, bem como sua competitividade comercial no exterior

Colet??nea de pol??ticas p??blicas: volume 2: a pol??tica industrial no Brasil, 1985-1992: pol??ticos, burocratas e interesses organizados no processo de policy-making

O principal objetivo deste livro ?? constituir uma fonte de pesquisa para o estudo do processo de produ????o e implementa????o de pol??ticas p??blicas. Por meio de textos selecionados, analisa-se o pr??prio conceito de pol??ticas p??blicas, discute-se as defini????es utilizadas para distinguir suas diversas fases e apresenta-se algumas das principais correntes te??ricas de an??lise sobre o processo de pol??ticas p??blicas.

Ética calvinista, idealismo e revolução : Carlyle e a crítica da economia vitoriana

O artigo versa sobre a doutrina econômica e social de Thomas Carlyle, célebre autor escocês do século dezenove. Inicialmente, são revistos alguns aspectos essenciais da sociedade e do capitalismo industrial na Inglaterra durante o período. Resgatam-se, a seguir, as influências religiosas e filosóficas do pensamento social de Carlyle. Após, discutem-se sua concepção da história e a versão da Revolução Francesa por ele formulada para, na seqüência, introduzir sua crítica da economia vitoriana. Ao final, avaliam-se os avanços e contradições de sua teoria social.