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Objectives: Frailty is a clinical syndrome characterized by decreased physiologic reserve that diminishes the ability to respond to stressors such as acute illness. Veterans Health Administration (VA) emergency departments (ED) are the primary venue of care for Veterans with acute illness and represent key sites for frailty recognition. As questionnaire‐based frailty instruments can be cumbersome to implement in the ED, we examined two administratively derived frailty scores for use among VA ED patients. Methods: This national retrospective cohort study included all VA ED visits (2017–2020). We evaluated two administratively derived scores: the Care Assessment Needs (CAN) score and the VA Frailty Index (VA‐FI). We categorized all ED visits across four frailty groups and examined associations with outcomes of 30‐day and 90‐day hospitalization and 30‐day, 90‐day, and 1‐year mortality. We used logistic regression to assess the model performance of the CAN score and the VA‐FI. Results: The cohort included 9,213,571 ED visits. With the CAN score, 28.7% of the cohort were classified as severely frail; by VA‐FI, 13.2% were severely frail. All outcome rates increased with progressive frailty (p‐values for all comparisons < 0.001). For example, for 1‐year mortality based on the CAN score frailty was determined as: robust, 1.4%; prefrail, 3.4%; moderately frail, 7.0%; and severely frail, 20.2%. Similarly, for 90‐day hospitalization based on VA‐FI, frailty was determined as prefrail, 8.3%; mildly frail, 15.3%; moderately frail, 29.5%; and severely frail, 55.4%. The c‐statistics for CAN score models were higher than for VA‐FI models across all outcomes (e.g., 1‐year mortality, 0.721 vs. 0.659). Conclusions: Frailty was common among VA ED patients. Increased frailty, whether measured by CAN score or VA‐FI, was strongly associated with hospitalization and mortality and both can be used in the ED to identify Veterans at high risk for adverse outcomes. Having an effective automatic score in VA EDs to identify frail Veterans may allow for better targeting of scarce resources. [ABSTRACT FROM AUTHOR]

Examines the industrialization and unemployment in the West Midlands in England. Employment rate in the region between the period 1945 and 1975; Disparity in employment and unemployment; Long-term background to unemployment.

On 26 June 1978, Sir Geoffrey Howe proposed a new and radical policy to reverse the decline of Britain's inner city areas: the creation of ‘Enterprise Zones’ (EZs). Within these zones, state intervention was to be minimized in the hope that the removal of the dead hand of bureaucracy and stifling taxation would encourage entrepreneurs to create or expand businesses and in the process provide the jobs and environmental improvements which the inner cities so badly needed. When Sir Geoffrey became Chancellor in May 1979, he began to implement this policy and the result, some two years later, is that eleven EZS have been designated. The present article outlines the background to the EZ policy, discusses how the Chancellor's original ideas were modified in the course of implementation, and notes some of the arguments relating to prospects for the scheme's success. [ABSTRACT FROM AUTHOR]