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This study examined relationships between urban productivity and affordable rental housing, focusing particularly on the location and availability of affordable rental housing relative to employment and labour markets in Australia’s capital cities and satellite cities.

Background Interdisciplinary plans of care (IPOCs) guide care standardization and satisfy accreditation requirements. Yet patient outcomes associated with IPOC usage through an electronic medical record (EMR) are not present in the literature. EMR systems facilitate the documentation of IPOC use and produce data to evaluate patient outcomes. Objectives This article aimed to evaluate whether IPOC-guided care as documented in an EMR is associated with inpatient mortality. Methods We contrasted whether IPOC-guided care was associated with a patient being discharged alive. We further tested whether the association differed across strata of acuity levels and overall frequency of IPOC usage within a hospital. Results Our sample included 165,334 adult medical/surgical discharges for a 12-month period for 17 hospitals. All hospitals had 1 full year of EMR use antedating the study period. IPOCs guided care in 85% (140,187/165,334) of discharges. When IPOCs guided care, 2.1% (3,009/140,187) of admissions ended with the patient dying while in the hospital. Without IPOC-guided care, 4.3% (1,087/25,147) of admissions ended with the patient dying in the hospital. The relative likelihood of dying while in the hospital was lower when IPOCs guided care (odds ratio: 0.45; 99% confidence interval: 0.41–0.50). Conclusion In this observational study within a quasi-experimental setting of 17 community hospitals and voluntary usage, IPOC-guided care is associated with a decreased likelihood of patients dying while in the hospital.

Background : Glucocorticoids (steroids) play a key role in the management of multiple medical conditions including haematological disorders. This study looked at the prevalence of steroid induced dysglycaemia in patients with haematological disorders receiving steroids as part of their treatment with the view of modifying its use and selection of patients where necessary. Methods : A retrospective review of haematology patients on treatment regimens including steroids. Information extracted included, demographic characteristics, clinical information such as age, gender, haematological disorder, type of steroid, daily and cumulative dose of steroid, duration of therapy, family history of diabetes and alcohol use. Results : The case records of 351 haematology patients were reviewed. However, eight patients with dysglycaemia before therapy were excluded. The median age of patients was 51.0 ± 26.0(IQR: Interquartile Range) years, with an age range of 13 to 87 years, and a female: male ratio of 1.2: 1 (p= 0.778). The prevalence of Steroid-Induced Dysglycaemia (SID) was 3.79% with a mean diagnosis interval of 8.8 + 2.1 months. Overall, 245 (71.4%) patients were on continuous steroids. Among the 13 patients who developed SID, 11 (84.6%) were on continuous steroids. In the majority of the patients (97.1%) there was no family history of diabetes in a first degree relative. Significant differences were found between patients with normoglycaemia and those with dysglycaemia with respect to age (p=0.049) and duration of steroid therapy (p=0.024). Conclusion : The prevalence of steroid-induced dysglycaemia is relatively low among Ghanaian patients with haematological disorders on steroid based chemotherapy. Keywords : steroids, haematological disorders, dysglycaemia, Ghana, risk factors. Funding : None declared

This research examined the housing aspirations of older Australians (i.e. aged 55 years and over), including home owners and renters in the private market and in social housing, to provide the evidence-base for policies needed to deliver their required housing and housing assistance.

This study examined the changing geography of homelessness. It outlines the extent to which homelessness has become more spatially concentrated over time; where it has risen and fallen; and the importance that housing affordability, poverty and labour market opportunities play in reshaping its distribution.

ObjectiveTwo apolipoprotein L1 (APOL1) risk variants (RV) are enriched in sub-Saharan African populations due to conferred resistance to Trypanosoma brucei. These variants associate with adverse renal outcomes by multiple causes including SLE. Despite emerging reports that SLE is common in Ghana, where APOL1 variant allelic frequencies are high, the regional contribution to SLE outcomes has not been described. Accordingly, this prospective longitudinal cohort study tested the associations between APOL1 high-risk genotypes and kidney outcomes, organ damage accrual and death in 100 Ghanaian patients with SLE.MethodsThis was a prospective cohort study of 100 SLE outpatients who sought care at Korle bu Teaching Hospital in Accra, Ghana. Adult patients who met 4 American College of Rheumatology criteria for SLE were genotyped for APOL1 and followed longitudinally for SLE activity as measured by the Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) hybrid and organ injury as measured by the Systemic Lupus International Collaborating Clinics Damage Index (SDI) at baseline and every 6 months for 1 year. Outcomes of interest were kidney function, SDI and case fatality.ResultsAssuming a recessive inheritance, the APOL1 high-risk genotype (2RV) associated with end-stage renal disease (ESRD) at an OR of 14 (p=0.008). These patients accrued more SDI points particularly in renal and neurological domains. The SDI was 81.3% higher in 2RV patients compared with 0RV or 1RV patients despite no difference in SLE activity (p=0.01). After a 12-month period of observation, 3/12 (25%) of the 2RV patients died compared with 2/88 (2.3%) of the 0RV or 1RV carriers (OR=13.6, p=0.01). Deaths were due to end-stage kidney disease and heart failure.ConclusionAPOL1 RVs were heritable risk factors for morbidity and mortality in this Ghanaian SLE cohort. Despite no appreciable differences in SLE activity, APOL1 high-risk patients exhibited progressive renal disease, organ damage accrual and a 13-fold higher case fatality.

The ‘anger of Achilles’ begins the Iliad and the whole of the Western literary canon. Opera often portrays anger, whether in the stile concitato of Monteverdi or the revenge duets of Verdi. But many of the early operas that feature Achilles are based on Statius’ Latin Achilleid, dealing with the days before Troy, when Thetis hid her son in female disguise on Scyros. La finta pazza (Venice 1641) tells a version of this story as does John Gay’s burlesque Achilles and Handel’s Deidamia. From Berlioz’s Les Troyens to Offenbach’s La Belle Hélène and Michael Tippett’s searing King Priam, Achilles continues to figure as a major operatic subject. This chapter looks at the musical impact of these depictions of the hero to show how the ‘anger of Achilles’ is as influential in operatic performance as it is in literature.

INTRODUCTION:The Spanish National Network (REDETS) is a group of eight agencies, units and services, depending on National and Regional Governments that coordinate their work within a common methodological framework, guided by the principles of mutual recognition and cooperation. The necessity of considering a Quality Management System has been detected and, consequently, a common tool for all the members needs to be developed. We describe in this study the process to achieve that goal.METHODS:Based on both a review of previous literature and the proposal for a self-evaluating tool, a group of experts from each agency through consensus have developed a tool for self-evaluation in Health Technology Assessment (HTA) agencies. Through the structure described in the handbook of the Andalusian Agency for Healthcare Quality (ACSA), each standard should have a statement or proposal that needs to also include evidence or good practices, and the corresponding evaluation questions. In separate workgroups, the definition of these proposals, evidence and evaluation questions were developed. One face-to-face meeting and two meetings via teleconference were necessary to achieve a final document with all the quality standards.RESULTS:From a proposed structure of sixty-six standards, the titles, definitions, statements and evidence as well as good practices and evaluation questions were established in workgroups with consensus among all of the members (1 - 3). The final version of the self-assessment tool was composed of sixty-eight standards, grouped in twelve quality criteria structured in four dimensions: I Responsibility, II Clients and Stakeholders, III Production Process, and IV Resources.CONCLUSIONS:Quality management requires an evaluation tool and this version, based on a systematic review and consensus, is a useful and practical instrument for developing a handbook by each member of REDETS. An online version of the tool is in process of development.

In this article we investigate the associations between the payment and receipt of child support and housing circumstances of both resident and non-resident parents. We do so by analysing data from Wave 4 of the Household, Income and Labour Dynamics in Australia (HILDA) survey. The final analytic sample comprised 1,043 separated parents (637 resident parents, 406 non-resident parents). Our findings indicate that for resident parents the receipt of child support payments above $75 per week was significantly associated with better housing circumstances. By contrast, the payment of child support was not significantly related to housing outcomes for non-resident parents. Overall, our results suggest that resident parents in receipt of child support, particularly above the median amount, live with their children in better housing circumstances than resident parents receiving little or no child support. While this finding makes intuitive sense – money matters – the way in which child support appears to be differentially related to the housing circumstances of resident and non-resident parents warrants further investigation. Copyright © eContent Management Pty Ltd.

PURPOSE To create a multivariable predictive model for glaucoma in an exclusively African American population and to compare the performance of the model with individual structural parameters derived from SD-OCT. PATIENTS AND METHODS A total of 103 healthy eyes and 118 glaucomatous eyes of African American patients underwent SD-OCT optic disc and macular scanning. Twenty-seven optic nerve head, retinal nerve fiber layer (RNFL), and ganglion cell parameters were collected. A multivariable model was derived using a backward elimination variable selection procedure. Areas under the curve were used to measure the diagnostic performance of the individual parameters and the multivariable model. RESULTS The best performing parameters for glaucoma patients included inferior quadrant thickness (AUC=0.9239), average RNFL thickness (AUC=0.9209), sup2 RNFL thickness (AUC=0.9157), superior quadrant thickness (AUC=0.8906), and vertical CDR (AUC=0.8640). The best performing parameters for early glaucoma patients were sup2 RNFL thickness (AUC=0.8680), inferior quadrant thickness (AUC=0.8571), average RNFL thickness (AUC=0.8550), superior quadrant thickness (AUC=0.8420), and inf2 RNFL thickness (AUC=0.8420). The AUC of the multivariable model was 0.8918 for early glaucoma and 0.9744 for moderate/advanced glaucoma. There was some variability in the performance of the model based on disc size. CONCLUSIONS These findings confirm that several individual RNFL, ONH, and GCA parameters have excellent diagnostic performance in differentiating glaucomatous patients from healthy patients in African American population. A multivariable model was developed and validated with high diagnostic accuracy.

(1999). Speaking un‐likeness: The double text in Christina Rossetti's ‘After Death’ and ‘Remember’. Textual Practice: Vol. 13, No. 1, pp. 25-41.

This lecture discusses children out of place, and talks about how children in general, from the eighteenth century until contemporary times, came to be seen as always out of place. Foundlings, lostlings, and changelings are studied in this lecture, and three key dates — 1739, 1872, and 1926 — are examined. The lecture also tries to show how ideas on children formed poetry, and how poetry formed ideas about children.

Summary Background Admission cardiotocography is widely used to identify pregnancies that might benefit from continuous electronic fetal monitoring in labour. We aimed to compare the effect on neonatal outcome of admission cardiotocography versus intermittent auscultation of the fetal heart rate. Methods 8580 women admitted to the delivery ward of a Dublin teaching hospital who were at low risk of fetal distress in labour were randomly assigned admission cardiotocography (20 min) or the unit's usual care (intermittent auscultation only, with continuous cardiotocography only if clinically indicated). The primary outcome was moderate to severe neonatal morbidity, or perinatal mortality in the absence of a major congenital malformation. Analyses were by intention to treat. Findings 44 (1·0%) women assigned admission cardiotocography did not undergo the procedure; 15 (0·4%) assigned usual care had admission cardiotocography. The primary endpoint occurred in 56 (1·3%) of 4298 women assigned admission cardiotocography and 55 (1·3%) of 4282 in the usual-care group (relative risk 1·01; 95% CI 0·70–1·47). Other indices of neonatal morbidity also showed no differences. Despite an increase in use of continuous cardiotocography (1·39; 1·33–1·45) and fetal blood sampling (1·30; 1·14–1·47) with admission cardiotocography, there were no significant differences in the rates of caesarean delivery (1·13; 0·92–1·40), instrumental delivery (1·03; 0·92–1·16), or episiotomy (1·06; 0·99–1·13). Interpretation Routine use of cardiotocography for 20 min on admission to the delivery ward does not improve neonatal outcome. No significant increase in operative delivery was apparent, probably because of liberal use of fetal blood sampling.

Evidence suggests that both infection and fever during labor are closely associated with the later development of cerebral palsy. This seems to be the case for term as well as preterm infants. This prospective cohort study of 4915 low-risk women who entered labor at 36 to 41 weeks' gestation attempted to clarify the association between maternal fever and neonatal encephalopathy and to show whether it is independent of other intrapartum risk factors. The participants were assigned, just after amniotomy, to have or not have cardiotocographic monitoring for 20 minutes. All women in the study were thought to be at low risk of intrapartum fetal distress. Oral temperature was monitored at hourly intervals during labor, and fever was diagnosed if it exceeded 37.5°C. Intrapartum fever developed in 336 women, 6.8% of the total. Sixteen newborn infants developed encephalopathy, and seven of their mothers (44%) had maternal fever. On multiple logistic regression analysis, controlling for nulliparity, gestation, induction of labor, total length of labor, and instrumental delivery, maternal fever was significantly associated with neonatal encephalopathy; the adjusted odds ratio (OR) was 4.7. The adjusted OR for a high base deficit in the presence of maternal fever was 2.2, and for admission to the neonatal unit, 1.78. An association with cord blood acidemia, noted on univariate analysis, was no longer significant. Only 1 of the 16 neonates with encephalopathy had a positive blood culture, and only this infant and one other had an elevated C-reactive protein level. These findings indicate that maternal fever during labor is closely and independently associated with neonatal encephalopathy. Fever is, in fact, a more reliable indicator that a given fetus is at risk of encephalopathy than an abnormal cardiotocographic record. In general, these results support a role for inflammatory mechanisms in the cause of neurological morbidity in newborn infants.