JURNAL AGROTEKNOLOGI
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Will policy to constrain GP referrals damage health? Evidence using practice level NHS emergency admissions administrative data
No full textAttempts to control hospital expenditure by managing down General Practitioner (GP) referrals are reoccurring features of UK health policy. However, despite the best efforts of GPs to benchmark referral criteria, patient health may be damaged and other costs created by constraining referrals to targets. This paper adopts an indirect method to indicate whether rationing practice referrals may damage population health by distorting the use of health resources away from patients' interests. We utilise a comprehensive database at practice level that allows us to explore the relationship between referrals and emergency admissions, using a panel fixed effects model of admissions that allows for the endogeneity of referrals. We find that practice referrals are positively and partially correlated with emergency admissions, which is consistent with time-varying practice-level sickness shocks driving the relationship between referrals and emergency care, rather than shocks to the practice willingness to refer, or to system reforms. In this environment, government policy to constrain referrals may make the elective care less responsive to practice-level variations in illness, and thereby lower health
Try again, fail again: Samuel Beckett and the sequel play
No full textSamuel Beckett’s Waiting for Godot has spawned several unauthorized sequel plays, which see Godot arrive on stage in 1960s Yugoslavia, 1980s Ireland, 1990s America, and early 2000s Japan. The sequel play is a largely ignored phenomenon in literary scholarship, with the sequel form itself routinely dismissed as a derivative and inevitably disappointing text. Yet the sequel text also resituates and re-evaluates the original text, and its reiterative nature aptly parallels the paradox of non-ending in Beckett’s original Waiting for Godot. Focusing on four unauthorized stage sequels to Beckett’s play – Miodrag Bulatović’s Godot Has Arrived (Godo je došao, 1966), Alan Titley’s Godot Arrives (Tagann Godot, 1987), Daniel Curzon’s Godot Arrives (1999), and Minoru Betsuyaku’s Godot Has Come (Yattekita Godot, 2007) – this essay examines how these sequels rework the cultural logic of Godot’s arrival to their own critical and political ends. These playwrights draw on the very recursive, even frustrating nature of the sequel form itself as an exegetic framework, reproducing the trope of non-ending that characterizes Beckett’s own work
Reducing health inequalities through general practice: protocol for a realist review (EQUALISE)
No full textIntroduction Healthcare organisations recognise the moral imperative to address inequalities in health outcomes but often lack an understanding of which types of interventions are likely to reduce them. This realist review will examine the existing evidence on the types of interventions or aspects of routine care in general practice that are likely to decrease or increase health inequalities (ie, inequality-generating interventions) across cardiovascular disease, cancer, diabetes and chronic obstructive pulmonary disease.
Methods and analysis Our realist review will follow Pawson’s five iterative stages. We will start by developing an initial programme theory based on existing theories and discussions with stakeholders. To navigate the large volume of literature, we will access the primary studies through the identification of published systematic reviews of interventions delivered in general practice across the four key conditions. We will examine the primary studies included within each systematic review to identify those reporting on inequalities across PROGRESS-Plus categories. We will collect data on a range of clinical outcomes including prevention, diagnosis, follow-up and treatment. The data will be synthesised using a realist logic of analysis. The findings will be a description and explanation of the general practice interventions which are likely to increase or decrease inequalities across the major conditions.
Ethics and dissemination Ethics approval is not required because this study does not include any primary research. The findings will be integrated into a series of guiding principles and a toolkit for healthcare organisations to reduce health inequalities. Findings will be disseminated through peer-reviewed publications, conference presentations and user-friendly summaries.
PROSPERO registration number CRD42020217871
Rapid evidence review to inform safe return to campus in the context of coronavirus disease 2019 (COVID-19)
No full textBackground: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted predominantly through the air in crowded and unventilated indoor spaces, especially among unvaccinated people. Universities and colleges are potential settings for its spread.
Methods: An interdisciplinary team from public health, virology, and biology used narrative methods to summarise and synthesise evidence on key control measures, taking account of mode of transmission.
Results: Evidence from a wide range of primary studies supports six measures. Vaccinate (aim for > 90% coverage and make it easy to get a jab). Require masks indoors, especially in crowded settings. If everyone wears well-fitting cloth masks, source control will be high, but for maximum self-protection, respirator masks should be worn. Masks should not be removed for speaking or singing. Space people out by physical distancing (but there is no “safe” distance because transmission risk varies with factors such as ventilation, activity levels and crowding), reducing class size (including offering blended learning), and cohorting (students remain in small groups with no cross-mixing). Clean indoor air using engineering controls—ventilation (while monitoring CO2 levels), inbuilt filtration systems, or portable air cleaners fitted with high efficiency particulate air [HEPA] filters). Test asymptomatic staff and students using lateral flow tests, with tracing and isolating infectious cases when incidence of coronavirus disease 2019 (COVID-19) is high. Support clinically vulnerable people to work remotely. There is no direct evidence to support hand sanitising, fomite controls or temperature-taking. There was no evidence that freestanding plastic screens, face visors and electronic air-cleaning systems are effective.
Conclusions: The above evidence-based measures should be combined into a multi-faceted strategy to maximise both student safety and the continuation of in-person and online education provision. Those seeking to provide a safe working and learning environment should collect data (e.g. CO2 levels, room occupancy) to inform their efforts
MS Pococke 379 : Taqwīm al-buldān by Abū l-Fidāʾ
No full textSelections photographed by Dr. Julia Bray for the project "Arabic Books and Astronomy in 17th C Oxford
Assessing the healthiness of UK food companies' product portfolios using food sales and nutrient composition data
No full textBackground
The provision and over-consumption of foods high in energy, saturated fat, free sugars or salt are important risk factors for poor diet and ill-health. In the UK, policies seek to drive improvement through voluntary reformulation of single nutrients in key food groups. There has been little consideration of the overall progress by individual companies. This study assesses recent changes in the nutrient profile of brands and products sold by the top 10 food and beverage companies in the UK.
Methods
The FSA/Ofcom nutrient profile model was applied to the nutrient composition data for all products manufactured by the top 10 food and beverage companies and weighted by volume sales. The mean nutrient profiling score, on a scale of 1–100 with thresholds for healthy products being 62 for foods and 68 for drinks, was used to rank companies and food categories between 2015 and 2018, and to calculate the proportion of individual products and sales that are considered by the UK Government to be healthy.
Results
Between 2015 and 2018 there was little change in the sales-weighted nutrient profiling score of the top 10 companies (49 to 51; p = 0.28) or the proportion of products classified as healthy (46% to 48%; p = 0.23). Of the top five brands sold by each of the ten companies, only six brands among ten companies improved their nutrient profiling score by 20% or more. The proportion of total volume sales classified as healthy increased from 44% to 51% (p = 0.07) driven by an increase in the volume sales of bottled water, low/no calorie carbonates and juices, but after removing soft drinks, the proportion of foods classified as healthy decreased from 7% to 6% (p = 33).
Conclusions
The UK voluntary reformulation policies, setting targets for reductions in calories, sugar and salt, do not appear to have led to significant changes in the nutritional quality of foods, though there has been progress in soft drinks where the soft drink industry levy also applies. Further policy action is needed to incentivise companies to make more substantive changes in product composition to support consumers to achieve a healthier diet
The Simons Observatory: Bandpass and polarization-angle calibration requirements for B-mode searches
No full textWe quantify the calibration requirements for systematic uncertainties for next-generation ground-based observatories targeting the large-angle B-mode polarization of the Cosmic Microwave Background, with a focus on the Simons Observatory (SO). We explore uncertainties on gain calibration, bandpass center frequencies, and polarization angles, including the frequency variation of the latter across the bandpass. We find that gain calibration and bandpass center frequencies must be known to percent levels or less to avoid biases on the tensor-to-scalar ratio r on the order of Δ r~10-3, in line with previous findings. Polarization angles must be calibrated to the level of a few tenths of a degree, while their frequency variation between the edges of the band must be known to O(10) degrees. Given the tightness of these calibration requirements, we explore the level to which residual uncertainties on these systematics would affect the final constraints on r if included in the data model and marginalized over. We find that the additional parameter freedom does not degrade the final constraints on r significantly, broadening the error bar by O(10%) at most. We validate these results by reanalyzing the latest publicly available data from the collaboration within an extended parameter space covering both cosmological, foreground and systematic parameters. Finally, our results are discussed in light of the instrument design and calibration studies carried out within SO
The impact of premature extrauterine exposure on infants’ stimulus-evoked brain activity across multiple sensory systems
No full textPrematurity can result in widespread neurodevelopmental impairment, with the impact of premature extrauterine exposure on brain function detectable in infancy. A range of neurodynamic and haemodynamic functional brain measures have previously been employed to study the neurodevelopmental impact of prematurity, with methodological and analytical heterogeneity across studies obscuring how multiple sensory systems are affected. Here, we outline a standardised template analysis approach to measure evoked response magnitudes for visual, tactile, and noxious stimulation in individual infants (n = 15) using EEG. By applying these templates longitudinally to an independent cohort of very preterm infants (n = 10), we observe that the evoked response template magnitudes are significantly associated with age-related maturation. Finally, in a cross-sectional study we show that the visual and tactile response template magnitudes differ between a cohort of infants who are age-matched at the time of study but who differ according to whether they are born during the very preterm or late preterm period (n = 10 and 8 respectively). These findings demonstrate the significant impact of premature extrauterine exposure on brain function and suggest that prematurity can accelerate maturation of the visual and tactile sensory system in infants born very prematurely. This study highlights the value of using a standardised multi-modal evoked-activity analysis approach to assess premature neurodevelopment, and will likely complement resting-state EEG and behavioural assessments in the study of the functional impact of developmental care interventions
Reamed intramedullary nailing versus circular frame external fixation for segmental tibial fractures (STIFF-F): a mixed methods feasibility study
No full textBackground
Segmental tibial fractures are fractures in two or more areas of the tibial diaphysis resulting in a separate intercalary segment of the bone. Surgical fixation is recommended for patients with segmental tibial fractures as non-operative treatment outcomes are poor. The most common surgical interventions are intramedullary nailing (IMN) and circular frame external fixation (CFEF), but evidence about which is better is of poor quality. An adequately powered randomised controlled trial (RCT) to determine optimum treatment is required. STIFF-F aimed to assess the feasibility of a multicentre RCT comparing IMN with CFEF for segmental tibial fracture.
Methods
STIFF-F was a mixed-methods feasibility study comprising a pilot RCT conducted at six UK Major Trauma Centres, qualitative interviews drawing on Phenomenology and an online survey of rehabilitation. The primary outcome was recruitment rate. Patients, 16 years and over, with a segmental tibial fracture (open or closed) deemed suitable for IMN or CFEF were eligible to participate. Randomisation was stratified by site using random permuted blocks of varying sizes. Participant or assessor blinding was not possible. Interviews were undertaken with patients about their experience of injury, treatment, recovery and participation. Staff were interviewed to identify contextual factors affecting trial processes, their experience of recruitment and the treatment pathway. An online survey was developed to understand the rehabilitation context of the treatments.
Results
Eleven patients were screened and three recruited to the pilot RCT. Nineteen staff and four patients participated in interviews, and 11 physiotherapists responded to the survey. This study found the following: (i) segmental tibial fractures were rarer than anticipated, (ii) the complexity of the injury, study setup times and surgeon treatment preferences impeded recruitment, (iii) recovery from a segmental tibial fracture is challenging, and rehabilitation protocols are inconsistent and (iv) despite the difficulty recruiting, staff valued this research question and strived to find a way forward.
Conclusion
The proposed multicentre RCT comparing IMN with CFEF is not feasible. This study highlighted the difficulty of recruiting patients to an RCT of a complex rare injury over a short time period.
Trial registration
The study was registered with the International Standard Randomised Controlled Trials Number Registry: ISRCTN1122966
ON-bipolar cell gene expression during retinal degeneration: implications for optogenetic visual restoration
No full textPurpose
Retinal bipolar cells survive even in the later stages of inherited retinal degenerations (IRDs) and so are attractive targets for optogenetic approaches to vision restoration. However, it is not known to what extent the remodelling that these cells undergo during degeneration affects their function. Specifically, it is unclear if they are free from metabolic stress, receptive to adeno-associated viral vectors, suitable for opsin-based optogenetic tools and able to propagate signals by releasing neurotransmitter.
Methods
Fluorescence activated cell sorting (FACS) was performed to isolate labelled bipolar cells from dissociated retinae of litter-mates with or without the IRD mutation Pde6brd1/rd1 selectively expressing an enhanced yellow fluorescent protein (EYFP) as a marker in ON-bipolar cells. Subsequent mRNA extraction allowed Illumina® microarray comparison of gene expression in bipolar cells from degenerate to those of wildtype retinae. Changes in four candidate genes were further investigated at the protein level using retinal immunohistochemistry over the course of degeneration.
Results
A total of sixty differentially expressed transcripts reached statistical significance: these did not include any genes directly associated with native primary bipolar cell signalling, nor changes consistent with metabolic stress. Four significantly altered genes (Srm2, Slf2, Anxa7 & Cntn1), implicated in synaptic remodelling, neurotransmitter release and viral vector entry had immunohistochemical staining colocalising with ON-bipolar cell markers and varying over the course of degeneration.
Conclusion
Our findings suggest relatively few gene expression changes in the context of degeneration: that despite remodelling, bipolar cells are likely to remain viable targets for optogenetic vision restoration. In addition, several genes where changes were seen could provide a basis for investigations to enhance the efficacy of optogenetic therapies