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Informing evidence-based policy during the COVID-19 pandemic and recovery period: learning from a national evidence centre
Get PDFBackgroundThe COVID-19 pandemic demonstrated the vital need for research to inform policy decision-making and save lives. The Wales COVID-19 Evidence Centre (WCEC) was established in March 2021 and funded for two years, to make evidence about the impact of the pandemic and ongoing research priorities for Wales available and actionable to policy decision-makers, service leads and the public.ObjectivesWe describe the approaches we developed and our experiences, challenges and future vision.Program implementationThe centre operated with a core team, including a public partnership group, and six experienced research groups as collaborating partners. Our rapid evidence delivery process had five stages: 1. Stakeholder engagement (continued throughout all stages); 2. Research question prioritisation; 3. Bespoke rapid evidence review methodology in a phased approach; 4. Rapid primary research; and 5. Knowledge Mobilisation to ensure the evidence was available for decision-makers.Main achievementsBetween March 2021–23 we engaged with 44 stakeholder groups, completed 35 Rapid Evidence Reviews, six Rapid Evidence Maps and 10 Rapid Evidence Summaries. We completed four primary research studies, with three published in peer reviewed journals, and seven ongoing. Our evidence informed policy decision-making and was cited in 19 Welsh Government papers. These included pandemic infection control measures, the Action Plan to tackle gender inequalities, and Education Renew and Reform policy. We conducted 24 Welsh Government evidence briefings and three public facing symposia.Policy implicationsStrong engagement with stakeholder groups, a phased rapid evidence review approach, and primary research to address key gaps in current knowledge enabled high-quality efficient, evidence outputs to be delivered to help inform Welsh policy decision-making during the pandemic. We learn from these processes to continue to deliver evidence from March 2023 as the Health and Care Research Wales Evidence Centre, with a broader remit of health and social care, to help inform policy and practice decisions during the recovery phase and beyond.<br/
Supporting physical activity through co‑production in people with severe mental ill health (SPACES): protocol for a randomised controlled feasibility trial
Get PDFBACKGROUND: Severe mental ill health (SMI) includes schizophrenia, bipolar disorder and schizoaffective disorder and is associated with premature deaths when compared to people without SMI. Over 70% of those deaths are attributed to preventable health conditions, which have the potential to be positively affected by the adoption of healthy behaviours, such as physical activity. People with SMI are generally less active than those without and face unique barriers to being physically active. Physical activity interventions for those with SMI demonstrate promise, however, there are important questions remaining about the potential feasibility and acceptability of a physical activity intervention embedded within existing NHS pathways.METHOD: This is a two-arm multi-site randomised controlled feasibility trial, assessing the feasibility and acceptability of a co-produced physical activity intervention for a full-scale trial across geographically dispersed NHS mental health trusts in England. Participants will be randomly allocated via block, 1:1 randomisation, into either the intervention arm or the usual care arm. The usual care arm will continue to receive usual care throughout the trial, whilst the intervention arm will receive usual care plus the offer of a weekly, 18-week, physical activity intervention comprising walking and indoor activity sessions and community taster sessions. Another main component of the intervention includes one-to-one support. The primary outcome is to investigate the feasibility and acceptability of the intervention and to scale it up to a full-scale trial, using a short proforma provided to all intervention participants at follow-up, qualitative interviews with approximately 15 intervention participants and 5 interventions delivery staff, and data on intervention uptake, attendance, and attrition. Usual care data will also include recruitment and follow-up retention. Secondary outcome measures include physical activity and sedentary behaviours, body mass index, depression, anxiety, health-related quality of life, healthcare resource use, and adverse events. Outcome measures will be taken at baseline, three, and six-months post randomisation.DISCUSSION: This study will determine if the physical activity intervention is feasible and acceptable to both participants receiving the intervention and NHS staff who deliver it. Results will inform the design of a larger randomised controlled trial assessing the clinical and cost effectiveness of the intervention.TRIAL REGISTRATION: ISRCTN: ISRCTN83877229. Registered on 09.09.2022.</p
Seamlessly Converged Optical-Wireless Access Networks Using Free-Running Laser-enabled mmWave Signal Generation and RF Envelope Detection
Get PDFLow-cost component-based converged optical-wireless networks without DSP atintermediate RRHs are proposed and experimentally demonstrated, supporting 1.67 Gbit/s/ch dynamic and continuous BBU-UE data flows over 50 km SSMF and 3 m 38 GHz wireless link
The Effects of Stress Testing on US Banks’ Off-Balance Sheet Activities
Get PDFAbstractThis paper investigates the effects of the new post‐financial crisis regulatory regime – risk‐based capital ratios (RBC) and stress tests – on banks' off‐balance sheet activities (OBS). We use a panel of US bank holding companies over the period 2001–2018 to examine the relationship between banks' capital levels and OBS activities. Our major finding is that banks significantly reduced their OBS exposure following the introduction of the new capital regulatory framework requirements. In particular, we show that tighter regulatory RBC resulted in a reduction of OBS activities in well‐capitalised banks. Conversely, we find that under‐capitalised banks increased their OBS activities, which suggests the possibility of regulatory arbitrage
Marine redox dynamics and biotic response to the mid-Silurian Ireviken Extinction Event in a mid-shelf setting
Get PDFThe early Silurian Llandovery–Wenlock boundary interval is marked by significant marine perturbations and biotic turnover, culminating in the Ireviken Extinction Event and the Early Sheinwoodian Carbon Isotope Excursion. Here, we apply multiple independent redox proxies to the early Wenlock Buttington section, which was deposited in a mid-shelf location in the Welsh Basin, UK. To account for the regional geochemical variability in marine sediments due to factors such as sediment provenance, we first define oxic baseline values for the Welsh Basin, utilizing deeper water, well-oxygenated intervals of late Llandovery age. Our approach documents unstable, oscillating redox conditions on the mid-shelf at Buttington. We suggest that these dynamic redox fluctuations are likely to relate to changes in the position of the chemocline or a migrating oxygen minimum zone. Benthic biota, such as trilobites, brachiopods, bivalves and gastropods, appear to have been relatively unaffected by fluctuating oxic-ferruginous conditions, but were more severely impacted by the development of euxinia, highlighting the inhibiting role of toxic sulfides. By contrast, the redox perturbations appear to have placed extreme stress on graptolites, causing many extinction losses regardless of the specific development of euxinia. Supplementary material: The geochemical data for the Buttington section is available at https://doi.org/10.6084/m9.figshare.c.7165009 Thematic collection: This article is part of the Chemical Evolution of the Mid-Paleozoic Earth System and Biotic Response collection available at: https://www.lyellcollection.org/topic/collections/chemical-evolution-of-the-mid-paleozoic-earth-syste
The Commercial Determinants of Violence: Identifying Opportunities for Violence Prevention through a Public Health-Based Framework Analysis
Get PDFViolence has immediate and long-term repercussions for the health of individuals and communities. Recent increases in the understanding of public health approaches to violence prevention have focused on the policies and practices of government, health, and other public sector agencies. However, the roles of commercial bodies in fostering and preventing violence remain largelyunaddressed. The wealth and influence of some companies now exceeds that of many countries. Consequently, it is timely to explore the roles of commercial processes in violence. Using a conceptual framework for the commercial determinants of health, we examine seven practices: political; scientific; marketing; supply chain and waste; labor and employment; financial; and reputational management. We include areas directly linked with violence (e.g., firearms) and those that indirectly impact violence through the following: design and promotion of products; employment practices; and impacts on environment, poverty, and local resources. A range of avoidable commercial behaviorsare found to increase levels of violence including the following: lobbying practices; distortion of scientific processes; polluting manufacture and supply lines; poor employee protections; financial investment in organizations and regimes associated with violence; and misleading communications and marketing. We conclude commercial actors can take action to ensure their workers, clients,suppliers, and distributors help prevent, not promote, violence. New technologies such as artificial intelligence are transforming corporate processes and products and offer opportunities to implement violence prevention through commercial developments (e.g., monitoring online content). International regulation of commercial behaviors is needed to prevent interpersonal and interstate conflictand harms to health and trade
Detection of endometrial cancer in cervico-vaginal fluid and blood plasma: Leveraging proteomics and machine learning for biomarker discover
Get PDFBACKGROUND: The anatomical continuity between the uterine cavity and the lower genital tract allows for the exploitation of uterine-derived biomaterial in cervico-vaginal fluid for endometrial cancer detection based on non-invasive sampling methodologies. Plasma is an attractive biofluid for cancer detection due to its simplicity and ease of collection. In this biomarker discovery study, we aimed to identify proteomic signatures that accurately discriminate endometrial cancer from controls in cervico-vaginal fluid and blood plasma.METHODS: Blood plasma and Delphi Screener-collected cervico-vaginal fluid samples were acquired from symptomatic post-menopausal women with (n = 53) and without (n = 65) endometrial cancer. Digitised proteomic maps were derived for each sample using sequential window acquisition of all theoretical mass spectra (SWATH-MS). Machine learning was employed to identify the most discriminatory proteins. The best diagnostic model was determined based on accuracy and model parsimony.FINDINGS: A protein signature derived from cervico-vaginal fluid more accurately discriminated cancer from control samples than one derived from plasma. A 5-biomarker panel of cervico-vaginal fluid derived proteins (HPT, LG3BP, FGA, LY6D and IGHM) predicted endometrial cancer with an AUC of 0.95 (0.91-0.98), sensitivity of 91% (83%-98%), and specificity of 86% (78%-95%). By contrast, a 3-marker panel of plasma proteins (APOD, PSMA7 and HPT) predicted endometrial cancer with an AUC of 0.87 (0.81-0.93), sensitivity of 75% (64%-86%), and specificity of 84% (75%-93%). The parsimonious model AUC values for detection of stage I endometrial cancer in cervico-vaginal fluid and blood plasma were 0.92 (0.87-0.97) and 0.88 (0.82-0.95) respectively.INTERPRETATION: Here, we leveraged the natural shed of endometrial tumours to potentially develop an innovative approach to endometrial cancer detection. We show proof of principle that endometrial cancers secrete unique protein signatures that can enable cancer detection via cervico-vaginal fluid assays. Confirmation in a larger independent cohort is warranted.FUNDING: Cancer Research UK, Blood Cancer UK, National Institute for Health Research.</p
Funding and access to hospice care in Wales
Get PDFExecutive SummaryPalliative and end of life care in WalesThe growing number of elderly people resident in Wales, coupled with challenges within social care regarding recruitment and retainment of staff are placing increased supply and demand pressures on palliative care resources (Skills for Care, 2019; Welsh Government, 2017). Palliative care referrals increased significantly due to co-morbidities associated with COVID-19, and there have been calls for further investment by Welsh Government to address palliative care workforce issues (Bryer et al., 2022; Fenton et al., 2022; Rawlinson et al., 2021). There are various models of palliative care used in Wales, including hospice at home, hospice in-patient care and a combination of approaches (Luta et al., 2021; Mann et al., 2019). In Wales, the End of Life Implementation Board (Welsh Government, 2017, 2021) has been set up to provide a national, one Wales approach to end of life care, providing leadership and peer support. The End of Life Implementation Board acts as a forum to drive forward change and oversee the efforts of Health Boards to deliver the Welsh Government vision of improving end of life care in Wales (Welsh Government, 2017). Purpose of this reportThis report provides a high-level analysis of reported income of hospices in Wales, together with illustrative case studies of providing hospice care for eight patients in North Wales. This report highlights the important role hospices have in providing care and reducing pressures on hospital resources in Wales.Access to end of life care funding across WalesHospices in Wales have historically received public funding from a range of sources. Some hospices have clear commissioning arrangements or Service-Level Agreements with Health Boards that contribute to core services such as inpatient beds or hospice at home services, while others do not. Since 2008, there has been a level of funding provided to hospices across Wales through Welsh Government following the Sugar review (Sugar et al., 2008). This meant that some hospices were then in receipt of funding from both Local Health Boards and the Welsh Government, which made up their total funding. In 2016, The Welsh Government transferred responsibility for all funding to Health Boards under a ring-fenced arrangement. Our objectives1) To review the level of statutory funding for each adult hospice in Wales for the year 2019 (pre-COVID-19 pandemic), using publicly available accounts data from Companies House. 2) To calculate and forecast the number of hospice beds required in Wales in accordance with the Specialist Palliative Care Funding Formula for Wales (Finlay, 2009). 3) To compare and contrast the costs of end of life care for hospice service users through illustrative case studies obtained from work with Hosbis Dewi Sant and hospital end of life care costs in Wales. FindingsThere is variation in statutory funding between hospices across Wales. Statutory funding as a proportion of hospice care expenditure across Wales in 2019 ranged from 10% to 71%. Statutory funding as a proportion of hospice care expenditure in North Wales ranged from 15% to 19%, while in South Wales and Powys, the proportions ranged from 10% to 71%. The average statutory funding proportion across Wales was 30%. This highlighted a strong dependence on charitable donations to supplement the statutory income in those hospices not directly managed and financed by the NHS. Hospices in Wales can reduce pressures on public expenditure through their integrated financing models, as opposed to hospital-based end of life care fully funded by public funds through Local Health Boards.Using the Specialist Palliative Care Funding Formula for Wales in conjunction with the latest Welsh population estimates, we calculated a current shortfall of 114 hospice beds in Wales (Finlay, 2009; Welsh Government, 2022b). Applying the formula indicates a current need for a total of 211 hospice beds in Wales. As of 2018, there were only 97 inpatient adult hospice beds in Wales (Hospice UK, 2018). This number does not account for children and young person hospice beds. The cost of end of life care delivered by hospices and hospitals in Wales are presented through illustrative case studies for eight patients who received care in Hosbis Dewi Sant. The cost for a hospice patient staying for fourteen days ranged from £5,131 to £6,332, with a mean cost of £5,708 per patient. The cheapest hospital-based option in Betsi Cadwaladr University Health Board (BCUHB) for the same period was £6,860. Significant public expenditure savings can be achieved through increased utilisation of hospice-based care when considering the average statutory contribution to hospices is just 30%. With hospices contributing the other 70% of the cost of care through raising their own funds, ultimately reducing public expenditure through the co-funding model. Recommendations • Hospice funding should be reviewed in Wales, to better align funding allocations across Health Boards to reflect population density, urban and rural settings and any other services available.• Based on efficiency and equity arguments, increase funding to provide the best support for complex case individuals with Palliative care needs. • To explore patterns in patient preferences for end of life care and to configure services accordingly. • End of life care needs to be well represented at Health Board level across all Health Boards in Wales. This would reflect better connectedness between acute care, social care and the third sector in Wales.• Hospice staff are well placed to contribute to teaching future medical and nursing staff and students to support a better environment in hospitals at the end of life.Future research• Future research should investigate the quality of tailored end of life care in hospice services throughout the whole of Wales with an emphasis on cost-benefit to the wider society, including opportunity cost factors such as the impact on productivity of family carers in the wider economy. • Collection of detailed costs for hospice and hospital-based end of life care would allow future economic analyses, including demand forecasting and the modelling of service provision. <br/
The chamical interactions between phenolic resin and wood studied by liquid-state NMR spectroscopy
Get PDFWood modification with thermosetting resins is an increasingly popular method aiming to expand the number of applications for readily available plantation timber (Hill 2006). Phenol urea formaldehyde (PUF) resin is impregnated into the timber, which is dried, and subsequently heat cured (Kupfernagel et al. 2021, 2022). This treatment renders the raw material dimensionally stable and imparts the ability to withstand wood destroying fungi and insects. The mode of action in doing so is typically considered a passive modification, but covalent bonds between the PUF resin and wood might form at low abundance. Since these covalent bonds are rare and structurally similar to linkages that occur in wood itself, a high-resolution method is required to accurately observe the formation of new bonds. In the current study we used liquid-state 1 H-13C-heteronuclear single quantum coherence (HSQC) NMR experiments to identify chemical bonds in modified and unmodified wood with high accuracy. This method has been used in the past to detect even rare covalent bonds in modified wood. During the sample preparation, a ball-milled wood powder is dissolved in DMSO-d6, which yields a viscous gel that can be handled like a liquid in solution-state NMR experiments (Yelle et al. 2008, Kim & Ralph 2010). Lime and poplar samples, that were previously compared in anti-swelling efficiency tests, have been used for the NMR analysis (Kupfernagel et al. 2023). While the same kind of covalent bonds are formed in different timbers, their abundance was shown to be significantly different, which could be due differences in the chemical composition of the two wood species