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Gallstone‐related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated gallstone‐disease is by laparoscopic cholecystectomy, which can be safely and cost‐effectively performed during a short hospital stay or as day‐case. This paper aims to evaluate the referral pattern of patients with gallstones, which treatment is given and whether patients admitted as emergency could have benefited from earlier elective referral. The management of these patients is examined in the context of payment by results to determine cost and potential savings.

The approach takens was prospective clinical audit and patient questionnaire in a district general hospital. Cost comparisons were made using secondary care income (NHS tariff) and estimated cost of hospitalisation, investigations and treatment.

Between May and July 2007, 114 patients were admitted with symptomatic gallstones, 62 (54.4 per cent) were emergencies. Cholecystectomy was performed in all 52 elective patients and performed or planned for 59/62 (95.2 per cent) emergencies. A total 17/62 emergencies (27.4 per cent) presented with complications of gallstones. 38/62 (61.3 per cent) had similar symptoms before, with 21/38 (55.3 per cent) diagnosed in primary care or by another hospital department. 11 (52.4 per cent) of these had not been referred for a surgical opinion; taking account of age, co‐morbidity and data acquired for elective admissions, the cost of their treatment could have been reduced by at least £16,194.

A large proportion of patients admitted with symptomatic biliary disease could have been referred earlier and electively. Such referral practice could improve the quality of care and reduce cost for the NHS both in primary and secondary care.

In the literature of librarianship, the education of a reference librarian has, on the whole, meant two things. First, it has referred to the theoretical and/or practical training in reference services that a student receives in library school. Second, it has meant the training, or lack of it, the new librarian receives in making the transition from library school to the reference desk. What reference education has not meant, to judge by the literature, is the ongoing training or professional development a working reference librarian might receive on the job.

While working in a rural district library system, the question of planning library/information services to meet the needs of the population was always of foremost importance. Community profiles of the region had been conducted continuously for ten years, and during the eleventh year it was decided to survey the entire area in a methodical way to search for the information needs of the population. The purpose of the study was to identify information needs in a specific rural area in Israel in order to design a plan for library/information provision to meet those needs. The study consisted of a literature search of relevant material on information needs in rural areas and less developed countries and a multi‐level field survey in one specific rural area of Israel.

The equation of unified knowledge says that S = f (A,P) which means that the practical solution to a given problem is a function of the existing, empirical, actual realities and the future, potential, best possible conditions of general stable equilibrium which both pure and practical reason, exhaustive in the Kantian sense, show as being within the realm of potential realities beyond any doubt. The first classical revolution in economic thinking, included in factor “P” of the equation, conceived the economic and financial problems in terms of a model of ideal conditions of stable equilibrium but neglected the full consideration of the existing, actual conditions. That is the main reason why, in the end, it failed. The second modern revolution, included in factor “A” of the equation, conceived the economic and financial problems in terms of the existing, actual conditions, usually in disequilibrium or unstable equilibrium (in case of stagnation) and neglected the sense of right direction expressed in factor “P” or the realization of general, stable equilibrium. That is the main reason why the modern revolution failed in the past and is failing in front of our eyes in the present. The equation of unified knowledge, perceived as a sui generis synthesis between classical and modern thinking has been applied rigorously and systematically in writing the enclosed American‐British economic, monetary, financial and social stabilization plans. In the final analysis, a new economic philosophy, based on a synthesis between classical and modern thinking, called here the new economics of unified knowledge, is applied to solve the malaise of the twentieth century which resulted from a confusion between thinking in terms of stable equilibrium on the one hand and disequilibrium or unstable equilibrium on the other.

This paper aims to examine the marketing strategies designed by three innovative early 1900s food companies. It traces the coordination of these businesses’ research funding, advertising, direct mail and promotional tactics to show how they intersected and impacted consumers and health professionals in the period when scientists were first able to quantify the relationship between good health and food. The paper analyzes internal company documents, advertisements and marketing materials from Knox Gelatine, Borden and Sunkist.

Research for this paper benefited from the author’s unlimited access to the private documents of the Knox Gelatine Company and its executives. These documents were analyzed chronologically and thematically. They chronicled the company’s attempts to influence the medical world and the ways it cultivated home economists. The paper also used publicly available digitized documents from Sunkist and Borden. The paper would benefit from further detailed analysis of these documents to parse Knox’s targeting by race and ethnicity.

In the 1920s, Knox, Borden and Sunkist developed a marketing strategy which leveraged a new class of experts – the hundreds of thousands of medical professionals, home economists, teachers and government agents who advised American women. By distributing specific laboratory research on the nutritional benefits of their products to this emerging class of health professionals and the consumers who trusted them, these companies developed relationships with opinion leaders designed specifically to influence product sales.

This research benefited from access to the private documents of Knox Gelatine Company which divulge the company’s attempts to influence the medical world and cultivate home economists. The paper would benefit from further analysis of these documents to parse the company’s targeting by race and ethnicity as well as a deeper comparison to companies that tried to work with health professionals unsuccessfully and companies that adopted this tactic in the household products or tobacco area. Opportunities also exist to do a fuller analysis of variations in food marketing by rural versus urban as well as race.

By reconstructing the sequencing and content of these three companies’ 1920s marketing strategies, this research uncovers a form of early 20th century food marketing directed at health and science professionals which has been neglected in advertising histories.

The Certificate of Need (CON) process was created primarily as a cost containment mechanism to prevent duplication of health care facilities and equipment. The intent of CON programs was to deter new health services programs while protecting existing programs and, to some extent, counterbalance market-place principles. Obtaining a Certificate of Need is expensive and time-consuming, and thus remains a relevant issue today. Maintaining a regulated environment may have some spill over benefits in terms of stability and quality. To examine this topic, in the summer of 2000, a small-scale survey was designed and administered to ascertain the views of hospital administrators on the CON process in Maryland. Despite some limitations of the survey specific to the size of the representative sample and mix in respondents, several conclusions can be drawn.

This paper examines the overlap between two groups of children, those with speech, language and communication needs (SLCN) and those with social, emotional and behavioural difficulties (SEBD). The case is made that these are common and overlap, with serious consequences for the children and families concerned. The difficulties experienced by the children and their families have implications for health inequalities and should influence the way in which both child and adolescent mental health and public health services are conceptualised and delivered.

This article examines the concept of employability as applied to older workers. It argues that much of the lack of success experienced by older job seekers in securing employment may be based on the mismatch between what older job seekers believe employers want and what employers are seeking. It reports data from a small sample of older South Australians who were interviewed concerning their perceived employment choices, now and in the past, their self assessed skill currency, their judgements as to their employability, and their explanation for success or failure in seeking employment. Overwhelmingly interviewees believed themselves employable and their skills current, yet these optimistic beliefs are seldom confirmed by labour market success. Those who were successful seemed distinguished in two ways – either they had been able to tap into opportunities through personal networks or they had developed a new skill where the competition was less intense and this enabled them to command an income. Taking charge of their lives, analysing their situation in a strategic way, initiating actions where the likelihood of a successful outcome was higher, creating demand for what they could offer were all strategies that led to employment. However, such behaviours may not be typical of this age group. Interview data clearly showed that it was the more resilient individuals who coped more effectively and that these individuals were more successful in securing reemployment.

Despite the fact that recent anthropological interest in infrastructure has done much to illuminate the infrastructure asset as an assemblage of actors, technologies and ideas, an interdisciplinary approach is required to unpack how the infrastructure project comes together as an assemblage and to define the role that financial technologies and discourses play in shaping it. Here, an interdisciplinary approach is applied to a novel infrastructure asset, London's Thames Tideway Tunnel, in order to show how multiple actors and visions of the world are brought together to make the infrastructure asset come to fruition. The paper concludes that this interdisciplinary approach to infrastructure can allow us to keep multiple sides of the infrastructure project in sight simultaneously. This includes both the creation of a rhetorical vision and spectacle around the asset, and the underlying financial arrangements that bind it together. If we do so, we can understand how new infrastructural forms utilise particular financial technologies and ideas to change the relationship between the public and the private, and between consumers and providers, and act towards the creation of a new ‘public good’ that normalises private provision.

Employee well-being in a casino work environment is crucial for the quality of work-life and employees' performance. This study examines the dimensions of well-being at a casino in Malaysia to gain deeper insights into employee challenges and motivational factors to arrive at practical mitigation efforts.

The study adopted a qualitative approach involving 14 semi-structured interviews with casino employees in Malaysia. Interviews lasted 30 min to 2 h at a time when Covid-19 was raging in 2021. Responses were analysed via a data-driven approach and coded using NVivo software to delineate the contents into analytical categories of well-being dimensions.

The findings suggest that employees at the casino face challenges in achieving work-life balance. Employee's well-being suffers from insufficient break time, irregular working hours affecting family time, managing customer temper tantrums and lack of emotional support systems and remunerations altered by the pandemic. Women employees were particularly vulnerable.

The findings suggest a need to create better working conditions and address well-being with counselling support for stress management, a balanced approach by employers to the “customer is always right” mantra, creating promising career pathways and supervisors to have better oversight of workaholics. The research focused only on one casino and there was limited access to management departments for an organizational perspective.

This study adds to the body of knowledge on employee well-being in the context of a casino. It suggests hospitality and tourism organizations review their human resource practices that would ease the stresses at the workplace and create support systems to promote employee well-being. Crucially, in a pandemic crisis, well-being dimensions must be accommodating and integrative to employee sentiments, sensitivity and self-actualization.