High continuity of care is prized by users of mental health services and lauded in health policy. It is especially important in long-term conditions like schizophrenia. However, it is not routinely ...measured, and therefore not often evaluated when service reorganisations take place. In addition, the impact of continuity of care on clinical outcomes is unclear.AimsWe set out to examine continuity of care in people with schizophrenia, and to relate this to demographic variables and clinical outcomes.
Pseudoanonymised community data from 5552 individuals with schizophrenia presenting over 11 years were examined for changes in continuity of care using the numbers of community teams caring for them and the Modified Modified Continuity Index (MMCI). These and demographic variables were related to clinical outcomes measured with the Health of the Nation Outcome Scales (HoNOS). Data were analysed using generalised estimating equations and multivariate marginal models.
There was a significant decline in MMCI and significant worsening of HoNOS total scores over 11 years. Higher (worse) HoNOS scores were significantly and independently related to older age, later years and both lower MMCI and more teams caring for the individual in each year. Most HoNOS scales contributed to the higher total scores.
There is evidence of declining continuity of care in this 11-year study of people with schizophrenia, and of an independent effect of this on worse clinical outcomes. We suggest that this is related to reorganisation of services.Declaration of interestNone.
The process of company reorganisation by merger or division operations, which is the object of recent accounting regulations, are of a real interest for the accounting specialists, taking into ...consideration the elements of newness and the complexity of financial-accounting operations. In this article, we aim to present the particularities of the specific accounting methods of the operations performed for the reorganisation of companies.
The financial accounting aspects concerning the reorganisation of companies by merger operations are of special interest, both for the specialists in the theory field and for those in the accounting ...practice taking into account the permanent changes and adaptions of the Romanian regulations to the European and international accounting framework. This article aims to approach the aspects concerning the accounting treatment of the value differences created as a result of the evaluation of the companies involved in merger operations.
Trauma places a burden on healthcare services accounting for a large proportion of Emergency Department presentations. COVID-19 spread rapidly affecting over 30 million worldwide. To manage trauma ...presentations the Department of Trauma & Orthopaedic Surgery reorganised service delivery.
To assess the impact of service reorganisation and Virtual Clinics on patients in a Regional Unit in Ireland.
A retrospective review of trauma activity following introduction of Virtual Fracture Clinics and Theatre COVID Pathways for a 10 week period in comparison with the same 2019 period. All patients underwent both nasopharyngeal and oropharyngeal swabs PCR testing prior to operations. Theatre and outpatient activity were evaluated. Clinic data were accumulated using the Integrated Patient Management System.
Theatre Activity: 242 patients underwent surgery in our trauma unit (mean 2.98 per list) during the COVID- 19 period. 29 cases were performed in repurposed elective hospital giving a total of 271 during the 2020 study period. 371 cases were performed in the same 2019 period (mean 4.58 per list). Outpatient Activity: We noted a 25.86% fracture clinic referral reduction during the COVID 19 period compared to 2019. There was a 150.77% increase in patients managed through Trauma Assessment Clinic. 639 patients were managed through the Virtual Fracture Clinic Pathway during COVID 19 period.
Over one in four fracture clinic patients can be managed virtually. A new dedicated Acute Fracture Unit within our institution permitted streamlining of care and social distancing. The “Non-COVID” pathway for ambulatory trauma was essential in managing the growing presentations of these injuries.
•COVID precautions resulted in a reduction in the number of trauma theatres cases•Numbers of clinic referrals also dropped significantly•There is a growing role for virtual fracture clinics in the current pandemic•Over 1 in 4 traditional fracture clinics can be dealt with virtually•Pragmatic approaches are necessary to deal with trauma in the face of new normal
The tax base and the related value added tax is fully determined on the delivery of goods and/or the performance of services. The present article discusses a series of theoretical and practical ...aspects regarding the cases where the tax basis for the VAT can be reduced in accordance with the provisions of Article 287 from the Fiscal Code and the related Methodological appliance pronouncements.
A profound understanding of the properties of unmodified and saturated fatty acid-modified calcite surfaces is essential for elucidating their resistance and stability in the presence of water ...droplets. Additional insights can be obtained by also studying the effects of carboxylic acid-saturated aqueous solutions. We elucidate surface wettability, structure, and nanomechanical properties beneath and at the edge of a deposited droplet after its evaporation. When calcite was coated by a highly packed monolayer of stearic acid, a hydrophilic region was found at the three-phase contact line. In atomic force microscopy mapping, this region is characterized by low adhesion and a topographical hillock. The surface that previously was covered by the droplet demonstrated a patchy structure of about 6 nm height, implying stearic acid reorganization into a patchy bilayer-like structure. Our data suggest that during droplet reverse dispensing and droplet evaporation, pinning of the three-phase contact line leads to the transport of dissolved fatty carboxylic acid and possibly calcium bicarbonate Ca(HCO3)2 molecules to the contact line boundary. Compared to the surface of intrinsically hydrophobic materials, such as polystyrene, the changes in contact angle and base diameter during droplet evaporation on stearic acid-modified calcite are strikingly different. This difference is due to stearic acid reorganization on the surface and transport to the water–air interface of the droplet. An effect of the evaporating droplet is also observed on unmodified calcite due to dissolution and recrystallization of the calcite surface in the presence of water. In the case where a water droplet saturated with octanoic acid is used instead of water, the stearic acid-coated calcite remains considerably more stable. Our findings are discussed in terms of the coffee-ring effect.
Excited state dynamics of two new-type thermally activated delayed fluorescence emitters (DABNA-1 and DABNA-2) synthesised based on multiple resonance effect is studied based on first-principles ...calculation, and their light-emitting mechanism is explored. The excited state dynamics combing with the adiabatic energy structure of several low-lying excited states indicates that three lowest triplet states are involved in the light-emitting process. The analysis of reorganisation energy indicates different performances for two molecules in solvent and in film. Our theoretical work provides rational explanation for experimental results, and also gives clear picture for light-emitting mechanism of these new-type molecules.
In this study, we theoretically investigate the interactions of hydrogen bonding in excited states and the mechanism of intramolecular proton transfer (ESIPT) for the novel compound ...3-benzothiazol-2-yl-2-hydroxy-5-methyl-benzaldehyde-oxime (HBT-phos) theoretically. Herein, the effects of atomic electronegativity of chalcogen (O, S and Se) are also focused. Firstly, employing quantum theory of atoms-in-molecules (QTAIM) method, we confirm intrinsic quality of O-H···N within HBT-phos derivatives (HBT-phos-O, HBT-phos-S and HBT-phos-Se). By astutely examining changes in geometries and infrared (IR) spectra, we elegantly demonstrate O-H···N is remarkably strengthened in S
1
state, indicating a pronounced tendency towards ESIPT. Computational hydrogen bonding energies further magnificently support this conclusion. Probing into photo-induced excitation, we discover heightened electronic densities surrounding N atom that play pivotal roles in attracting protons, thereby facilitating ESIPT. Ultimately, upon comparing potential energy curves in excited states, we deduce ESIPT process is expected to be exceptionally rapid with low atomic electronegativity (O → S → Se), which elucidates why detecting fluorescence peak of HBT-phos-S itself proves challenging in experiment. This study not only fills the void in understanding ESIPT mechanism within HBT-phos derivatives and authentically reveals its unambiguous mechanism, but also presents atomic-electronegativity-dependent ESIPT behaviour and the explanation for fluorescence quenching observed in prior experiment.
Enterprise resource planning (ERP) systems are highly complex information systems. The implementation of these systems is a difficult and high cost proposition that places tremendous demands on ...corporate time and resources. Many ERP implementations have been classified as failures because they did not achieve predetermined corporate goals. This article identifies success factors, software selection steps, and implementation procedures critical to a successful implementation. A case study of a largely successful ERP implementation is presented and discussed in terms of these key factors.
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