Discrete Conditional Phase-type models utilising classification trees: Application to modelling health service capacities

Discrete Conditional Phase-type (DC-Ph) models consist of a process component (survival distribution) preceded by a set of related conditional discrete variables. This paper introduces a DC-Ph model where the conditional component is a classification tree. The approach is utilised for modelling health service capacities by better predicting service times, as captured by Coxian Phase-type distributions, interfaced with results from a classification tree algorithm. To illustrate the approach, a case-study within the healthcare delivery domain is given, namely that of maternity services. The classification analysis is shown to give good predictors for complications during childbirth. Based on the classification tree predictions, the duration of childbirth on the labour ward is then modelled as either a two or three-phase Coxian distribution. The resulting DC-Ph model is used to calculate the number of patients and associated bed occupancies, patient turnover, and to model the consequences of changes to risk status.

Dose-dependent effects of folic acid on blood concentrations of homocysteine: a meta-analysis of the randomized trials

Background: Dietary supplementation with B vitamins that lower blood homocysteine concentrations is expected to reduce cardiovascular disease risk, but there has been uncertainty about the optimum regimen to use for this purpose.

AGEs, RAGE, and Diabetic Retinopathy

Diabetic retinopathy is a major diabetic complication with a highly complex etiology. Although there are many pathways involved, it has become established that chronic exposure of the retina to hyperglycemia gives rise to accumulation of advanced glycation end products (AGEs) that play an important role in retinopathy. In addition, the receptor for AGEs (RAGE) is ubiquitously expressed in various retinal cells and is upregulated in the retinas of diabetic patients, resulting in activation of pro-oxidant and proinflammatory signaling pathways. This AGE-RAGE axis appears to play a central role in the sustained inflammation, neurodegeneration, and retinal microvascular dysfunction occurring during diabetic retinopathy. The nature of AGE formation and RAGE signaling bring forward possibilities for therapeutic intervention. The multiple components of the AGE-RAGE axis, including signal transduction, formation of ligands, and the end-point effectors, may be promising targets for strategies to treat diabetic retinopathy.

An interprofessional approach to improving paediatric medication safety.

BACKGROUND: Safe drug prescribing and administration are essential elements within undergraduate healthcare curricula, but medication errors, especially in paediatric practice, continue to compromise patient safety. In this area of clinical care, collective responsibility, team working and communication between health professionals have been identified as key elements in safe clinical practice. To date, there is limited research evidence as to how best to deliver teaching and learning of these competencies to practitioners of the future.

METHODS: An interprofessional workshop to facilitate learning of knowledge, core competencies, communication and team working skills in paediatric drug prescribing and administration at undergraduate level was developed and evaluated. The practical, ward-based workshop was delivered to 4th year medical and 3rd year nursing students and evaluated using a pre and post workshop questionnaire with open-ended response questions.

RESULTS: Following the workshop, students reported an increase in their knowledge and awareness of paediatric medication safety and the causes of medication errors (p < 0.001), with the greatest increase noted among medical students. Highly significant changes in students' attitudes to shared learning were observed, indicating that safe medication practice is learnt more effectively with students from other healthcare disciplines. Qualitative data revealed that students' participation in the workshop improved communication and teamworking skills, and led to greater awareness of the role of other healthcare professionals.

CONCLUSION: This study has helped bridge the knowledge-skills gap, demonstrating how an interprofessional approach to drug prescribing and administration has the potential to improve quality and safety within healthcare.

Credit Unions in Great Britain: Recent Trends and Current Prospects

Against the current backdrop of deteriorating economic and financial conditions we consider recent trends and current prospects for credit unions in Great Britain. We note that although credit unions have experienced solid membership and asset growth there are clouds on the horizon. Bad debts and loan arrears are on the rise and may be linked to recent legislative amendments and the increasing use by Government of credit unions as a mechanism to achieve its financial inclusion goals. Whatever the reason, the deterioration in the loan book needs to be quickly addressed, or it will ultimately result in either more government bailouts or a stream of failing credit unions.

An Examination of Volunteer Motivation in Credit Unions: Informing Volunteer Resource Management

Volunteer recruitment and retention is a problem that most credit unions experience. Research suggests that knowledge of volunteer motivation can inform volunteer management strategies. This paper uses a survey approach to determine whether current volunteers in credit unions in Northern Ireland are more motivated by the actual act of volunteering, by the output from the volunteering activity (including altruism) or because the volunteering activity increases their human capital value. Altruistic reasons are found to be the most influential, with the act of volunteering also scoring highly. This knowledge should inform volunteer recruitment programmes and internal appraisal processes as management can reinforce messages that provide positive feedback to volunteers on the social benefits being achieved by the credit union. This will further motivate current volunteers, ensuring retention. When motivation was analyzed by volunteer characteristics we found that older volunteers, retired volunteers and volunteers who are less educated are more motivated in their role. There was little evidence that individuals volunteer to improve their human capital worth.

Profiling: a Strategy for Successful Volunteer Recruitment in Credit Unions

Credit unions are non-profit financial organisations that provide financial services to their members. They are located in 97 countries across the world. All credit unions are governed by a volunteer board and many are reliant on volunteers for all their labour requirements. However, recruiting volunteers is a problem. The literature on recruitment issues in volunteering in general, suggests that the not-for-profit sector looks to the private sector for guidance on recruitment policies and approaches. One such approach which is considered in this paper is ‘market segmentation’ wherein the potential volunteer body is profiled to determine if an individual is likely to volunteer and if they are, to identify the type of role they are most likely to be attracted to. Prior literature on volunteering in non-profit organisations suggests that certain types of individual (dominant individuals) are more likely to volunteer. This paper investigates whether this dominant status profile is evident amongst volunteers in credit unions in Northern Ireland (NI). The study finds that people with dominant characteristics are more likely to be attracted to volunteering to the board of directors and individuals who have less dominant traits overall should be offered more social/participative type roles. This information can be used by credit union governing boards for volunteer recruitment, retention and management purposes.