Effects of a nurse-led, clinic and home-based intervention on recurrent hospital use in chronic heart failure

Background: Few studies have examined the potential benefits of specialist nurse-led programs of care involving home and clinic-based follow-up to optimise the post-discharge management of chronic heart failure (CHF). Objective: To determine the effectiveness of a hybrid program of clinic plus home-based intervention (C+HBI) in reducing recurrent hospitalisation in CHF patients. Methods: CHF patients with evidence of left ventricular systolic dysfunction admitted to two hospitals in Northern England were assigned to a C+HBI lasting 6 months post-discharge (n=58) or to usual, post-discharge care (UC: n=48) via a cluster randomization protocol. The co-primary endpoints were death or unplanned readmission (event-free survival) and rate of recurrent, all-cause readmission within 6 months of hospital discharge. Results: During study follow-up, more UC patients had an unplanned readmission for any cause (44% vs. 22%: P=0.0191 OR 1.95 95% CI 1.10-3.48) whilst 7 (15%) versus 5 (9%) UC and C+HBI patients, respectively, died (P=NS). Overall, 15 (26%) C+HBI versus 21 (44%) UC patients experienced a primary endpoint. C+HBI was associated with a non-significant, 45% reduction in the risk of death or readmission when adjusting for potential confounders (RR 0.55, 95% CI 0.28-1.08: P=0.08). Overall, C+HBI patients accumulated significantly fewer unplanned readmissions (15 vs. 45: P

Prolonged effects of a home-based intervention in patients with chronic illness

Background: Data on the long-term benefits of nonspecific disease management programs are limited. We performed a long-term follow-up of a previously published randomized trial. Methods: We compared all-cause mortality and recurrent hospitalization during median follow-up of 7.5 years in a heterogeneous cohort of patients with chronic illness initially exposed to a multidisciplinary, homebased intervention (HBI) (n = 260) or to usual postdischarge care (n = 268). Results: During follow-up, HBI had no impact on all-cause mortality (relative risk, 1.04; 95% confidence interval, 0.80-1.35) or event-free survival from death or unplanned hospitalization (relative risk, 1.03; 95% confidence interval, 0.86-1.24). Initial analysis suggested that HBI had only a marginal impact in reducing unplanned hospitalization, with 677 readmissions vs 824 for the usual care group (mean +/- SD rate, 0.72 +/- 0.96 vs 0.84 +/- 1.20 readmissions/patient per year; P = .08). When accounting for increased hospital activity in HBI patients with chronic obstructive pulmonary disease during follow-up for 2 years, post hoc analyses showed that HBI reduced readmissions by 14% within 2 years in patients without this condition (mean +/- SD rate, 0.54 +/- 0.72 vs 0.63 +/- 0.88 readmission/patient per year; P =. 04) and by 21% in all surviving patients within 3 to 8 years (mean +/- SD rate, 0.64 +/- 1.26 vs 0.81 +/- 1.61 readmissions/ patient per year; P =. 03). Overall, recurrent hospital costs were significantly lower ( 14%) in the HBI group (mean +/- SD, $ 823 +/- $ 1642 vs $ 960 +/- $ 1376 per patient per year; P =. 045). Conclusion: This unique study suggests that a nonspecific HBI provides long-term cost benefits in a range of chronic illnesses, except for chronic obstructive pulmonary disease.

Effects of government regulations, market orientation and ownership structure on corporate social responsibility in China:an empirical study

Previous research on corporate social responsibility mainly focuses on its nature and impact on business performance. This paper reports on a study that contributes to our understanding of the determinants of corporate social responsibility by focusing specifically on the role played by three strategically important variables, namely government regulation, ownership structure and market orientation. Results of a survey of 586 general managers of hotels in China suggest that the market orientation is the most significant predicator of corporate social responsibility followed by government regulation. In contrast, the ownership structure is found to have little effect. The implications of the findings for managers in China are discussed.

Measuring and assessing the effects and extent of international bond market integration

We review briefly the literature on international financial integration, especially as it pertains to bond market integration. This contextualizes the review we than provide of a number of papers contained in a special issue of this Journal. © 2005 Elsevier B.V. All rights reserved.

Market orientation of service networks:direct and indirect effects on sustained competitive advantage

Market orientation is an organization-wide concept that helps explain sustained competitive advantage (SCA). Since networks become ever more important, especially in the service sector, there is need to expand the concept of MO to a network setting. In line with Narver and Slater (1990), the concept of Market Orientation of Networks (MONW) is developed. This study indicates how MONW relates to the resource-based view (RBV) of the firm and the industrial organization (IO) view in explaining SCA. It is argued that MONW has direct and indirect effects on SCA. More precisely, the antecedent effect of MONW to resources and industry structure is considered.

The side effects of quantitative easing:evidence from the UK bond market

We examine the returns to UK government bonds before, during and between the phases of quantitative easing to identify the side effects for the market itself. We show that the onset of QE led to a sustained reduction in the costs of trading and removed some return regularities. However, controlling for a wide range of market activity, including issuance and QE announcements, we find evidence that investors could have earned excess returns after costs by trading in response to the purchase auction calendar. Drawing on economic theory, we explore the implications of these findings for both the efficiency of the market and the costs of government debt management in both the short and long run.

The effects of quantitative easing on the volatility of the gilt-edged market

We model the effects of quantitative easing on the volatility of returns to individual gilts, examining both the effects of QE overall and of the specific days of asset purchases. The action of QE successfully neutralized the six fold increase in volatility that had been experienced by gilts since the start of the financial crisis. The volatility of longer term bonds reduced more quickly than the volatility of short to medium term bonds. The reversion of the volatility of shorter term bonds to pre-crisis levels was found to be more sensitive to the specific operational actions of QE, particularly where they experienced relatively greater purchase activity.

An investigation of the effects of mothers' participation in adult literacy classes on interactive literacy activities (ILAs) at home

The National Center for Family Literacy (2003a) and the National Even Start Association (2005) have stated that the single most effective and influential factor in increasing student academic achievement is parental involvement. The purpose of this qualitative study was to determine how participation in adult literacy courses influences parent-child interaction in various educationally related activities known as Interactive Literacy Activities (ILAs). This study investigated ILAs from the mothers? perspective, and examines the changes that occur in parental involvement or ILAs when immigrant parents of a limited educational background participate in an adult education program. The principal method of data collection was key informant interviews (Gall, Borg, & Gall, 1996). Other methods of data collection included observations of parent-child interactions and field observations. Data analysis methods included Memo-ing (Miles & Huberman, 1994), within case analysis and cross-case analysis. ^ Findings demonstrate that changes occurred in the parent-child relationship when mothers of a limited educational background participated in an adult literacy course. When participating in ILAs or English literacy activities related to second language acquisition (including reading and speaking for comprehension and pronunciation), the children of these mothers took on the role of the adult. Participation in literacy activities was often initiated by the child and the children were frequently concerned with their mother's literacy acquisition. Mothers reported that their children were more confident, worked harder on school related activities and were more open to communication. ^ It can be concluded from this study that, in the case of these immigrant families, a mother's participation in adult literacy classes is influential in the relationship between mother and child. These children participated in ILAs for the benefit of their mothers and initiated literacy activities more frequently. The children responded better to their parents during literacy activities because there was a positive change in the relationship between mother and child. The relationship between mother and child appeared to be strengthened by greater trust, a sense of pride and more communication. ^

Children with special health care needs: Comparison of the effects of home care setting, prescribed pediatric extended care setting, and long-term care setting on child and family health outcomes and health care service use

Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL™ Generic Core Module for child health and functioning, PedsQL™ Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.

Effects of early childhood development interventions on parental behaviour: evidence from a home-visiting programme in Peru

Las visitas a domicilio tienen por objeto mejorar los resultados del niño, desplazando las habilidades de crianza de los cuidadores para que puedan ofrecer mejores oportunidades de estimulación a sus hijos. A pesar de este objetivo explícito, hay poca evidencia de países en desarrollo con respecto a los efectos del modelo de visitas a domicilio, en la provisión de la estimulación por los cuidadores. También hay una falta de pruebas de los programas de trabajo a gran escala y poca atención a los mecanismos mediante los cuales estas intervenciones afectan al comportamiento de los padres. Este análisis tiene por objeto contribuir a la literatura sobre las intervenciones de dos maneras. Primero, proporciona evidencia causal sobre los efectos de un programa de visitas a domicilio envergadura sobre el comportamiento del cuidador. En segundo lugar, se explora las restricciones que limitan este cambio de comportamiento y ofrece una forma de pensando en sus mecanismos que es consistente con la evidencia. Yo uso el aleatorio grupal diseño del componente de visitas al hogar del programa Cuna Más en Perú para recoger datos de 20 de control y de tratamiento de 20 distritos rurales sobre las prácticas de crianza y las creencias de los cuidadores en cuanto a la importancia de las interacciones entre padres e hijos para el desarrollo infantil.

Market work and household production in Brazil

This thesis is composed of three papers in which the research questions are related to the double burden that accrues to Brazilian women. The first and second papers address this issue by looking at expenditure decisions about home production. The first paper examines whether the expenditure decisions about production goods, such as white appliances, relative to entertainment goods, such as TVs, are the outcome of a bargaining process between husbands and wives. The second paper looks at the demand for maid services and for production durable goods, examining the extent to which other household members substitute for maid services and durable goods in home production. The third paper addresses the effects of Brazilian women's double burden on their labor market participation by examining whether the occupational choice of Brazilian women is affected by their gender roles and whether entry into other occupations that are not identified as female occupations has become easier since the introduction of anti-discrimination laws in the labor market. The first paper combines two Brazilian data sets: a Brazilian household expenditure survey, Pesquisa de Orçamento Familiares (POF), and a Brazilian household survey, Pesquisa Nacional Por Amostra de Domicílios (PNAD). The results of the first paper indicate that the decision about durable goods ownership is the outcome of a bargaining process between husband and wife. The test on the coefficients of the marriage market variable and the indicators of households in which only the wife and households in which only the husband makes expenditure decisions corroborate the expectations about wives' preferences for production goods. The same data sets as the first paper are used in the second paper. The finding of the second paper indicates that if the marriage market is favorable to women, that is if the ratio of women to men goes from 1.07 to 0.96, the increment in the household probability of owning at least one maid's substitute durable goods is equivalent to 24% the impact of moving a household up one income quintile. Moreover, the results indicate that daughters' time substitutes for wives' time and maid services in home production. Parents may want daughters trained in home production to be able to perform their future role as wives. However, this training comes at a cost to daughters' investment in formal education, narrowing their future career options. The data used in the third paper come from a Brazilian household survey, Pesquisa Nacional Por Amostra de Domicílios (PNAD). Gender roles are responsible for women to choose female-dominated occupations, married women are 1.14 times more likely to work in female-dominated occupations and having a child six years and older increases on average by 12% the probability that women work in female-dominated occupations instead of genderintegrated occupations in 2001. However, it becomes easier for all types of women to enter into male-dominated and gender-integrated occupations in 2001 compared to 1981.

Effects of Information and Time of Use Pricing on Irish Electricity Demand and Supply

In this dissertation I quantify residential behavior response to interventions designed to reduce electricity demand at different periods of the day. In the first chapter, I examine the effect of information provision coupled with bimonthly billing, monthly billing, and in-home displays, as well as a time-of-use (TOU) pricing scheme to measure consumption over each month of the Irish Consumer Behavior Trial. I find that time-of-use pricing with real time usage information reduces electricity usage up to 8.7 percent during peak times at the start of the trial but the effect decays over the first three months and after three months the in-home display group is indistinguishable from the monthly treatment group. Monthly and bi-monthly billing treatments are not found to be statistically different from another. These findings suggest that increasing billing reports to the monthly level may be more cost effective for electricity generators who wish to decrease expenses and consumption, rather than providing in-home displays. In the following chapter, I examine the response of residential households after exposure to time of use tariffs at different hours of the day. I find that these treatments reduce electricity consumption during peak hours by almost four percent, significantly lowering demand. Within the model, I find evidence of overall conservation in electricity used. In addition, weekday peak reductions appear to carry over to the weekend when peak pricing is not present, suggesting changes in consumer habit. The final chapter of my dissertation imposes a system wide time of use plan to analyze the potential reduction in carbon emissions from load shifting based on the Ireland and Northern Single Electricity Market. I find that CO2 emissions savings are highest during the winter months when load demand is highest and dirtier power plants are scheduled to meet peak demand. TOU pricing allows for shifting in usage from peak usage to off peak usage and this shift in load can be met with cleaner and cheaper generated electricity from imports, high efficiency gas units, and hydro units.