Integrated health and care systems in England : can they help prevent disease?

Objectives: Over the past 12 months, there has been increasing policy rhetoric regarding the role of the NHS in preventing disease and improving population health. In particular, the NHS Long Term Plan sees integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) as routes to improving disease prevention. Here, we place current NHS England integrated care plans in their historical context and review evidence on the relationship between integrated care and prevention. We ask how the NHS Long Term Plan may help prevent disease and explore the role of the 2019 ICS and STP plans in delivering this change. Methods: We reviewed the evidence underlying the relationship between integrated care and disease prevention, and analysed 2016 STP plans for content relating to disease prevention and population health. Results: The evidence of more integrated care leading to better disease prevention is weak. Although nearly all 2016 STP plans included a prevention or population health strategy, fewer than half specified how they will work with local government public health teams, and there was incomplete coverage across plans about how they would meet NHS England prevention priorities. Plans broadly focused on individual-level approaches to disease prevention, with few describing interventions addressing social determinants of health. Conclusions: For ICSs and STPs to meaningfully prevent disease and improve population health, they need to look beyond their 2016 plans and fill the gaps in the Long Term Plan on social determinants

Multimode switching induced by a transverse field planar magnetic nanowires

We report how transverse fields affect the axial field needed to "inject" domain walls from a large Permalloy (Ni80Fe20) pad into planar nanowires of width 184 nm, 303 nm, 321 nm, and 537 nm fabricated by electron beam lithography. For the narrowest wire, different switching fields are observed under the same transverse field conditions, indicating that more than one mode or state for the domain walls may exist. In contrast, in the widest wires a transverse field causes each reversal event to occur in two stages. The different response may be attributed to the magnetostatic energy differences of domain walls in wires of different widths

Incremental Material Flow Analysis with Bayesian Inference

Material Flow Analysis (MFA) is widely used to study the life-cycles of materials from production, through use, to reuse, recycling or disposal, in order to identify environmental impacts and opportunities to address them. However, development of this type of analysis is often constrained by limited data, which may be uncertain, contradictory, missing or over-aggregated. This article proposes a Bayesian approach, in which uncertain knowledge about material flows is described by probability distributions. If little data is initially available, the model predictions will be rather vague. As new data is acquired, it is systematically incorporated to reduce the level of uncertainty. After reviewing previous approaches to uncertainty in MFA, the Bayesian approach is introduced, and a general recipe for its application to Material Flow Analysis is developed. This is applied to map global production of steel, using Markov Chain Monte Carlo simulations. As well as aiding the analyst, who can get started in the face of incomplete data, this incremental approach to MFA also supports efforts to improve communication of results by transparently accounting for uncertainty throughout.ngineering and Physical Sciences Research Council. Grant Numbers: EP/K039326/1, EP/N02351x/

Observation of Magnetic Supercooling of the Transition to the Vortex State

We demonstrate that the transition from the high-field state to the vortex state in a nanomagnetic disk shows the magnetic equivalent of supercooling. This is evidence that this magnetic transition can be described in terms of a modified Landau first-order phase transition. To accomplish this we have measured the bulk magnetization of single magnetic disks using nanomechanical torsional resonator torque magnetometry. This allows observation of single vortex creation events without averaging over an array of disks or over multiple runs.Comment: 11 pages preprint, 4 figures, accepted to New Journal of Physic

Study of diffusion weighted MRI as a predictive biomarker of response during radiotherapy for high and intermediate risk squamous cell cancer of the oropharynx: The MeRInO study

Introduction and background: A significant proportion of patients with intermediate and high risk squamous cell cancer of the oropharynx (OPSCC) continue to relapse locally despite radical chemoradiotherapy (CRT). The toxicity of the current combination of intensified dose per fraction radiotherapy and platinum based chemotherapy limits further uniform intensification. If a predictive biomarker for outcomes from CRT can be identified during treatment then individualised and adaptive treatment strategies may be employed. Methods/design: The MeRInO study is a prospective observational imaging study of patients with intermediate and high risk, locally advanced OPSCC receiving radical RT or concurrent CRT Patients undergo diffusion weighted MRI prior to treatment (MRI_1) and during the third week of RT (MRI_2). Apparent diffusion coefficient (ADC) measurements will be made on each scan for previously specified target lesions (primary and lymph nodes) and change in ADC calculated. Patients will be followed up and disease status for each target lesion noted. The primary aim of the MeRInO study is to determine the threshold change in ADC from baseline to week 3 of RT that may identify the sub-group of non-responders during treatment. Discussion: The use of DW-MRI as a predictive biomarker during RT for SCC H&N is in its infancy but studies to date have found that response to treatment may indeed be predicted by comparison of DW-MRI carried out before and during treatment. However, previous studies have included all sub-sites and biological sub-types. Establishing ADC thresholds that predict for local failure is an essential step towards using DW-MRI to improve the therapeutic ratio in treating SCC H&N. This would be done most robustly in a specific H&N sub-site and in sub-types with similar biological behaviour. The MeRInO study will help establish these thresholds in OPSCC

Manipulating ultracold atoms with a reconfigurable nanomagnetic system of domain walls

The divide between the realms of atomic-scale quantum particles and lithographically-defined nanostructures is rapidly being bridged. Hybrid quantum systems comprising ultracold gas-phase atoms and substrate-bound devices already offer exciting prospects for quantum sensors, quantum information and quantum control. Ideally, such devices should be scalable, versatile and support quantum interactions with long coherence times. Fulfilling these criteria is extremely challenging as it demands a stable and tractable interface between two disparate regimes. Here we demonstrate an architecture for atomic control based on domain walls (DWs) in planar magnetic nanowires that provides a tunable atomic interaction, manifested experimentally as the reflection of ultracold atoms from a nanowire array. We exploit the magnetic reconfigurability of the nanowires to quickly and remotely tune the interaction with high reliability. This proof-of-principle study shows the practicability of more elaborate atom chips based on magnetic nanowires being used to perform atom optics on the nanometre scale.Comment: 4 pages, 4 figure

Material Stock Demographics: Cars in Great Britain.

Recent literature on material flow analysis has been focused on quantitative characterization of past material flows. Fewer analyses exist on past and prospective quantification of stocks of materials in-use. Some of these analyses explore the composition of products' stocks, but a focus on the characterization of material stocks and its relation with service delivery is often neglected. We propose the use of the methods of human demography to characterize material stocks, defined herein as stock demographics, exploring the insights that this approach could provide for the sustainable management of materials. We exemplify an application of stock demographics by characterizing the composition and service delivery of iron, steel, and aluminum stocks of cars in Great Britain, 2002-2012. The results show that in this period the stock has become heavier, it is traveling less, and it is idle for more time. The visualization of material stocks' dynamics demonstrates the pace of product replacement as a function of its usefulness and enables the formulation of policy interventions and the exploration of future trends.This work was supported by EPSRC, grant reference EP/N02351X/1.This is the final version of the article. It first appeared from the American Chemical Society via https://doi.org/10.1021/acs.est.5b0501

Strategies for Intracellular Survival of Burkholderia pseudomallei

Burkholderia pseudomallei is the causative agent of melioidosis, a disease with high mortality that is prevalent in tropical regions of the world. A key component of the pathogenesis of melioidosis is the ability of B. pseudomallei to enter, survive, and replicate within mammalian host cells. For non-phagocytic cells, bacterial adhesins have been identified both on the bacterial surface and associated with Type 4 pili. Cell invasion involves components of one or more of the three Type 3 Secretion System clusters, which also mediate, at least in part, the escape of bacteria from the endosome into the cytoplasm, where bacteria move by actin-based motility. The mechanism of actin-based motility is not clearly understood, but appears to differ from characterized mechanisms in other bacterial species. A small proportion of intracellular bacteria is targeted by host cell autophagy, involving direct recruitment of LC3 to endosomes rather than through uptake by canonical autophagosomes. However, the majority of bacterial cells are able to circumvent autophagy and other intracellular defense mechanisms such as the induction of inducible nitric oxide synthase, and then replicate in the cytoplasm and spread to adjacent cells via membrane fusion, resulting in the formation of multi-nucleated giant cells. A potential role for host cell ubiquitin in the autophagic response to bacterial infection has recently been proposed

Temperature dependence of electrical properties of electrodeposited Ni-based nanowires

The influence of annealing on the microstructure and the electrical properties of cylindrical nickel-based nanowires has been investigated. Nanowires of nickel of nominally 200 nm diameter and of permalloy (Py) of nominally 70 nm were fabricated by electrochemical deposition into nanoporous templates of polycarbonate and anodic alumina, respectively. Characterization was carried out on as-grown nanowires and nanowires heat treated at 650°C. Transmission electron microscopy and diffraction imaging of as-grown and annealed nanowires showed temperature-correlated grain growth of an initially nano-crystalline structure with ≤8 nm (Ni) and ≤20 nm (Py) grains towards coarser poly-crystallinity with grain sizes up to about 160 nm (Ni) and 70 nm (Py), latter being limited by the nanowire width. The electrical conductivity of individual as-grown and annealed Ni nanowires was measured in situ within a scanning electron microscope environment. At low current densities, the conductivity of annealed nanowires was estimated to have risen by a factor of about two over as-grown nanowires. We attribute this increase, at least in part, to the observed grain growth. The annealed nanowire was subsequently subjected to increasing current densities. Above 120 kA mm -2 the nanowire resistance started to rise. At 450 kA mm -2 the nanowire melted and current flow ceased

Quantum Dynamics of Spin Wave Propagation Through Domain Walls

Through numerical solution of the time-dependent Schrodinger equation, we demonstrate that magnetic chains with uniaxial anisotropy support stable structures, separating ferromagnetic domains of opposite magnetization. These structures, domain walls in a quantum system, are shown to remain stable if they interact with a spin wave. We find that a domain wall transmits the longitudinal component of the spin excitations only. Our results suggests that continuous, classical spin models described by LLG equation cannot be used to describe spin wave-domain wall interaction in microscopic magnetic systems