349 research outputs found
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
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Simulating the impact on health of internalising the cost of carbon in food prices combined with a tax on sugar-sweetened beverages
Rising greenhouse gas emissions (GHGEs) have implications for health and up to 30 % of emissions globally are thought to arise from agriculture. Synergies exist between diets low in GHGEs and health however some foods have the opposite relationship, such as sugar production being a relatively low source of GHGEs. In order to address this and to further characterise a healthy sustainable diet, we model the effect on UK non-communicable disease mortality and GHGEs of internalising the social cost of carbon into the price of food alongside a 20 % tax on sugar sweetened beverages (SSBs).
Developing previously published work, we simulate four tax scenarios: (A) a GHGEs tax of £2.86/tonne of CO2 equivalents (tCO2e)/100 g product on all products with emissions greater than the mean across all food groups (0.36 kgCO2e/100 g); (B) scenario A but with subsidies on foods with emissions lower than 0.36 kgCO2e/100 g such that the effect is revenue neutral; (C) scenario A but with a 20 % sales tax on SSBs; (D) scenario B but with a 20 % sales tax on SSBs. An almost ideal demand system is used to estimate price elasticities and a comparative risk assessment model is used to estimate changes to non-communicable disease mortality.
We estimate that scenario A would lead to 300 deaths delayed or averted, 18,900 ktCO2e fewer GHGEs, and £3.0 billion tax revenue; scenario B, 90 deaths delayed or averted and 17,100 ktCO2e fewer GHGEs; scenario C, 1,200 deaths delayed or averted, 18,500 ktCO2e fewer GHGEs, and £3.4 billion revenue; and scenario D, 2,000 deaths delayed or averted and 16,500 ktCO2e fewer GHGEs. Deaths averted are mainly due to increased fibre and reduced fat consumption; a SSB tax reduces SSB and sugar consumption.
Incorporating the social cost of carbon into the price of food has the potential to improve health, reduce GHGEs, and raise revenue. The simple addition of a tax on SSBs can mitigate negative health consequences arising from sugar being low in GHGEs. Further conflicts remain, including increased consumption of unhealthy foods such as cakes and nutrients such as salt
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Overall and income specific effect on prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK: econometric and comparative risk assessment modelling study
Objective To model the overall and income specific effect of a 20% tax on sugar sweetened drinks on the prevalence of overweight and obesity in the UK.
Design Econometric and comparative risk assessment modelling study.
Setting United Kingdom.
Population Adults aged 16 and over.
Intervention A 20% tax on sugar sweetened drinks.
Main outcome measures The primary outcomes were the overall and income specific changes in the number and percentage of overweight (body mass index ≥25) and obese (≥30) adults in the UK following the implementation of the tax. Secondary outcomes were the effect by age group (16-29, 30-49, and ≥50 years) and by UK constituent country. The revenue generated from the tax and the income specific changes in weekly expenditure on drinks were also estimated.
Results A 20% tax on sugar sweetened drinks was estimated to reduce the number of obese adults in the UK by 1.3% (95% credible interval 0.8% to 1.7%) or 180 000 (110 000 to 247 000) people and the number who are overweight by 0.9% (0.6% to 1.1%) or 285 000 (201 000 to 364 000) people. The predicted reductions in prevalence of obesity for income thirds 1 (lowest income), 2, and 3 (highest income) were 1.3% (0.3% to 2.0%), 0.9% (0.1% to 1.6%), and 2.1% (1.3% to 2.9%). The effect on obesity declined with age. Predicted annual revenue was £276m (£272m to £279m), with estimated increases in total expenditure on drinks for income thirds 1, 2, and 3 of 2.1% (1.4% to 3.0%), 1.7% (1.2% to 2.2%), and 0.8% (0.4% to 1.2%).
Conclusions A 20% tax on sugar sweetened drinks would lead to a reduction in the prevalence of obesity in the UK of 1.3% (around 180 000 people). The greatest effects may occur in young people, with no significant differences between income groups. Both effects warrant further exploration. Taxation of sugar sweetened drinks is a promising population measure to target population obesity, particularly among younger adults
Who breaches the four-hour emergency department wait time target?:A retrospective analysis of 374,000 emergency department attendances between 2008 and 2013 at a type 1 emergency department in England
Background: The four-hour target is a key hospital emergency department performance indicator in
England and one that drives the physical and organisational design of the ED. Some studies have
identified time of presentation as a key factor affecting waiting times. Few studies have investigated
other determinants of breaching the four-hour target. Therefore, our objective was to describe patterns
of emergency department breaches of the four-hour wait time target and identify patients at highest
risk of breaching.
Methods: This was a retrospective cohort study of a large type 1 Emergency department at an NHS
teaching hospital in Oxford, England. We analysed anonymised individual level patient data for
378,873 emergency department attendances, representing all attendances between April 2008 and
April 2013. We examined patient characteristics and emergency department presentation
circumstances associated with the highest likelihood of breaching the four-hour wait time target.
Results: We used 374,459 complete cases for analysis. In total, 8.3% of all patients breached the
four-hour wait time target. The main determinants of patients breaching the four-hour wait time target
were hour of arrival to the ED, day of the week, patient age, ED referral source, and the types of
investigations patients receive (p<0.01 for all associations). Patients most likely to breach the four-
hour target were older, presented at night, presented on Monday, received multiple types of
investigation in the emergency department, and were not self-referred (p<0.01 for all associations).
Patients attending from October to February had a higher odds of breaching compared to those
attending from March to September (OR 1.63, 95% CI 1.59 to 1.66).
Conclusions: There are a number of independent patient and circumstantial factors associated with
the probability of breaching the four-hour ED wait time target including patient age, ED referral
source, the types of investigations patients receive, as well as the hour, day, and month of arrival to
the ED. Efforts to reduce the number of breaches could explore late-evening/overnight staffing, access
to diagnostic tests, rapid discharge facilities, and early assessment and input on diagnostic and
management strategies from a senior practitioner
Translating evidence into practice : ACOs’ use of care plans for patients with complex health needs
Background
Care plans are an evidence-based strategy, encouraged by the Centers for Medicare and Medicaid Services, and are used to manage the care of patients with complex health needs that have been shown to lead to lower hospital costs and improved patient outcomes. Providers participating in payment reform, such as accountable care organizations, may be more likely to adopt care plans to manage complex patients.
Objective
To understand how Medicare accountable care organizations (ACOs) use care plans to manage patients with complex clinical needs.
Design
A qualitative study using semi-structured interviews with Medicare ACOs.
Participants
Thirty-nine interviews were conducted across 18 Medicare ACOs with executive-level leaders and associated clinical and managerial staff.
Approach
Development, structure, use, and management of care plans for complex patients at Medicare ACOs.
Key Results
Most (11) of the interviewed ACOs reported using care plans to manage care of complex patients. All care plans include information about patient history, current medical needs, and future care plans. Beyond the core elements, care plans included elements based on the ACO’s planned use and level of staff and patient engagement with care planning. Most care plans were developed and maintained by care management (not clinical) staff.
Conclusions
ACOs are using care plans for patients with complex needs, but their use of care plans does not always meet the best practices. In many cases, ACO usage of care plans does not align with prescribed best practices: ACOs are adapting use of care plans to better fit the needs of patients and providers
Hydatellaceae identified as a new branch near the base of the angiosperm phylogenetic tree
Although the relationship of angiosperms to other seed plants remains controversial, great progress has been made in identifying the earliest extant splits in flowering-plant phylogeny, with the discovery that the New Caledonian shrub Amborella trichopoda, the water lilies (Nymphaeales), and the woody Austrobaileyales constitute a basal grade of lines that diverged before the main radiation in the clade. By focusing attention on these ancient lines, this finding has re-written our understanding of angiosperm structural and reproductive biology, physiology, ecology and taxonomy. The discovery of a new basal lineage would lead to further re-evaluation of the initial angiosperm radiation, but would also be unexpected, as nearly all of the ∼460 flowering-plant families have been surveyed in molecular studies. Here we show that Hydatellaceae, a small family of dwarf aquatics that were formerly interpreted as monocots, are instead a highly modified and previously unrecognized ancient lineage of angiosperms. Molecular phylogenetic analyses of multiple plastid genes and associated noncoding regions from the two genera of Hydatellaceae identify this overlooked family as the sister group of Nymphaeales. This surprising result is further corroborated by evidence from the nuclear gene phytochrome C (PHYC), and by numerous morphological characters. This indicates that water lilies are part of a larger lineage that evolved more extreme and diverse modifications for life in an aquatic habitat than previously recognized. ©2007 Nature Publishing Group
The 3rd Fermi GBM Gamma-Ray Burst Catalog: The First Six Years
Since its launch in 2008, the Fermi Gamma-ray Burst Monitor (GBM) has
triggered and located on average approximately two gamma-ray bursts (GRB) every
three days. Here we present the third of a series of catalogs of GRBs detected
by GBM, extending the second catalog by two more years, through the middle of
July 2014. The resulting list includes 1405 triggers identified as GRBs. The
intention of the GBM GRB catalog is to provide information to the community on
the most important observables of the GBM detected GRBs. For each GRB the
location and main characteristics of the prompt emission, the duration, peak
flux and fluence are derived. The latter two quantities are calculated for the
50-300~keV energy band, where the maximum energy release of GRBs in the
instrument reference system is observed, and also for a broader energy band
from 10-1000 keV, exploiting the full energy range of GBM's low-energy NaI(Tl)
detectors. Using statistical methods to assess clustering, we find that the
hardness and duration of GRBs are better fitted by a two-component model with
short-hard and long-soft bursts, than by a model with three components.
Furthermore, information is provided on the settings and modifications of the
triggering criteria and exceptional operational conditions during years five
and six in the mission. This third catalog is an official product of the Fermi
GBM science team, and the data files containing the complete results are
available from the High-Energy Astrophysics Science Archive Research Center
(HEASARC).Comment: 225 pages, 13 figures and 8 tables. Accepted for publication in
Astrophysical Journal Supplement 201
The Fermi GBM Gamma-Ray Burst Spectral Catalog: Four Years Of Data
In this catalog we present the updated set of spectral analyses of GRBs
detected by the Fermi Gamma-Ray Burst Monitor (GBM) during its first four years
of operation. It contains two types of spectra, time-integrated spectral fits
and spectral fits at the brightest time bin, from 943 triggered GRBs. Four
different spectral models were fitted to the data, resulting in a compendium of
more than 7500 spectra. The analysis was performed similarly, but not
identically to Goldstein et al. 2012. All 487 GRBs from the first two years
have been re-fitted using the same methodology as that of the 456 GRBs in years
three and four. We describe, in detail, our procedure and criteria for the
analysis, and present the results in the form of parameter distributions both
for the observer-frame and rest-frame quantities. The data files containing the
complete results are available from the High-Energy Astrophysics Science
Archive Research Center (HEASARC).Comment: Accepted for publication in ApJ
What is the best way to evaluate social prescribing? A qualitative feasibility assessment for a national impact evaluation study in England
Objectives
Despite significant investment in social prescribing in England over the last decade, we still do not know if it works, or how models of social prescribing fit within wider health and care policy and practice. This study explores current service delivery structures and assesses the feasibility of a national evaluation of the link worker model.
Methods
Semi-structured interviews were conducted between May and September 2020, with 25 key informants from across social prescribing services in England. Participants included link workers, voluntary, community and social enterprise staff, and those involved in policy and decision-making for social prescribing services. Interview and workshop transcripts were analysed thematically, adopting a framework approach.
Results
We found differences in how services are provided, including by individual link workers, and between organisations and regions. Standards, referral pathways, reporting, and monitoring structures differ or are lacking in voluntary services as compared to clinical services. People can self-refer to a link worker or be referred by a third party, but the lack of standardised processes generated confusion in both public and professional perceptions of the link worker model. We identified challenges in determining the appropriate outcomes and outcome measures needed to assess the impact of the link worker model.
Conclusions
The current varied service delivery structures in England poses major challenges for a national impact evaluation. Any future rigorous evaluation needs to be underpinned with national standardised outcomes and process measures which promote uniform data collection
Dimensionality of Carbon Nanomaterials Determines the Binding and Dynamics of Amyloidogenic Peptides: Multiscale Theoretical Simulations
Experimental studies have demonstrated that nanoparticles can affect the rate of protein self-assembly, possibly interfering with the development of protein misfolding diseases such as Alzheimer's, Parkinson's and prion disease caused by aggregation and fibril formation of amyloid-prone proteins. We employ classical molecular dynamics simulations and large-scale density functional theory calculations to investigate the effects of nanomaterials on the structure, dynamics and binding of an amyloidogenic peptide apoC-II(60-70). We show that the binding affinity of this peptide to carbonaceous nanomaterials such as C60, nanotubes and graphene decreases with increasing nanoparticle curvature. Strong binding is facilitated by the large contact area available for π-stacking between the aromatic residues of the peptide and the extended surfaces of graphene and the nanotube. The highly curved fullerene surface exhibits reduced efficiency for π-stacking but promotes increased peptide dynamics. We postulate that the increase in conformational dynamics of the amyloid peptide can be unfavorable for the formation of fibril competent structures. In contrast, extended fibril forming peptide conformations are promoted by the nanotube and graphene surfaces which can provide a template for fibril-growth
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