The impact of changing provider remuneration on clinical activity and quality of care: evaluation of a pilot NHS contract in Northern Ireland

Objectives A pilot NHS dental contract was introduced in Northern Ireland between 2015 and 2016, which involved changing the method for paying general dental practitioners working in the NHS from Fee-For-Service (FFS) to capitation-based payments, providing an opportunity for a robust evaluation. We investigated the impact of a change in payment methods on clinical activity and the quality of care provided. Design A difference-in-difference (DiD) evaluation was applied to clinical activity data from pilot NHS dental practices in Northern Ireland compared to matched control NHS practices, and applied to a questionnaire survey of patient-rated outcomes of health outcomes and care quality. We estimated the impact on access to care, treatment activity levels, practice finances and patient-rated outcomes of care of a change from FFS to a capitation-based system for one year, as well as the impact of a reversion back to FFS at the end of the pilot period. Results The monthly number of registered patients in the pilot practices increased more than the control practices during the capitation period, by 1.5 registrations per 1,000 registered patients. The monthly reductions in the volumes of all treatments in the pilot practices during the capitation period was much larger than the control practices, with 175 fewer treatment items. All measures rapidly returned to baseline levels following reversion from capitation back to FFS. NHS income per month increased in pilot practices, by £5,920 per month (calculated on FFS item cost basis) more than controls in the capitation period. The analysis of patient questionnaires suggest found that patients notices differences only in waiting times, skill-mix and number of radiographs, but not on other measures of healthcare process and quality. Conclusion General dental practitioners working in the NHS respond rapidly and consistently to changes in provider payment methods. A move from FFS to a capitation-based system had little impact on access to care, but did produce large reductions in clinical activity and patient charge income. Patients noticed little change in the service they received. This shows that changes in remuneration contracts have the potential to meet policy goals, such as meeting the expectations of patients within a predictable cost envelope. However, it is unlikely that all policy goals can be met simply by changing payment methods. Therefore, work is also needed to identify and evaluate interventions that can complement changes in remuneration to achieve desirable outcomes

Dense Ionized and Neutral Gas Surrounding Sgr A*

We present high resolution H41a hydrogen recombination line observations of the 1.2' (3 pc) region surrounding Sgr A* at 92 GHz using the OVRO Millimeter Array with an angular resolution of 7" x 3" and velocity resolution of 13 km/s. New observations of H31a, H35a, H41a, and H44a lines were obtained using the NRAO 12-m telescope, and their relative line strengths are interpreted in terms of various emission mechanisms. These are the most extensive and most sensitive observations of recombination line to date. Observations of HCO+ (1 - 0) transition at 89 GHz are also obtained simultaneously with a 40% improved angular resolution and 4-15 times improved sensitivity over previous observations, and the distribution and kinematics of the dense molecular gas in the circumnuclear disk (CND) are mapped and compared with those of the ionized gas. The line brightness ratios of the hydrogen recombination lines are consistent with purely spontaneous emission from 7000 K gas with n_e = 20,000 cm$^{-3}$ near LTE condition. A virial analysis suggests that the most prominent molecular gas clumps in the CND have mean densities of 10^7 cm^{-3}, sufficient to withstand the tidal shear in the Galactic Center region. Therefore, these clumps may survive over several dynamical times, and the CND may be a dynamically stable structure. We estimate a total gas mass of 3 x 10^5 solar mass for the CND. \Comment: 34 pages including 11 figures (4 jpgs), Latex, uses aastex. The full pdf format file including high resolution figures is available at http://www.astro.umass.edu/~myun/papers/SgrA.pdf . To appear in the 20 November 2004 (V616) issue of the Astrophysical Journa

Planetary Nebula Abundances and Morphology: Probing the Chemical Evolution of the Milky Way

This paper presents a homogeneous study of abundances in a sample of 79 northern galactic planetary nebulae whose morphological classes have been uniformly determined. Ionic abundances and plasma diagnostics were derived from selected optical line strengths in the literature, and elemental abundances were estimated with the Ionization Correction Factor developed by Kingsbourgh & Barlow (1994). We compare the elemental abundances to the final yields obtained from stellar evolution models of low-and intermediate-mass stars, and we confirm that most Bipolar planetary nebulae have high nitrogen and helium abundance, and are the likely progeny of stars with main-sequence mass larger than 3 solar masses. We derive =0.27, and discuss the implication of such a high ratio in connection with the solar neon abundance. We determine the galactic gradients of oxygen and neon, and found Delta log (O/H)/Delta R=-0.01 dex/kpc$ and Delta log (Ne/H)/Delta R=-0.01 dex/kpc. These flat PN gradients do not reconcile with galactic metallicity gradients flattening with time.Comment: The Astrophysical Journal, in pres

A persistent Norwegian Atlantic Current through the Pleistocene glacials

Changes in ocean‐circulation regimes in the northern North Atlantic and the Nordic Seas may affect not only the Arctic but potentially hemispheric or even global climate. Therefore, unraveling the long‐term evolution of the North Atlantic Current‐Norwegian Atlantic Current system through the Pleistocene glaciations could yield useful information and climatological context for understanding contemporary changes. In this work, ~50,000 km2 of 3‐D seismic reflection data are used to investigate the Pleistocene stratigraphy for evidence of paleo‐oceanographic regimes on the mid‐Norwegian margin since 2.58 Ma. Across 33 semicontinuous regional paleo‐seafloor surfaces ~17,500 iceberg scours have been mapped. This mapping greatly expands our spatiotemporal understanding of currents and iceberg presence in the eastern Nordic Seas. The scours display a dominant southwest‐northeast trend that complements previous sedimentological and numerical modeling studies that suggest northward‐flowing currents in the Norwegian Sea during the Pleistocene. This paleo‐oceanographic study suggests that through many of the Pleistocene glaciations, the location of surface ocean currents in the Norwegian Sea and, by extension, the eastern North Atlantic, were broadly similar to the present

Physical Conditions in the Narrow-Line Region of M51

We have investigated the physical conditions in the narrow-line region (NLR) of M51 using long-slit spectra obtained with the Space Telescope Imaging Spectrograph (STIS) aboard the Hubble Space Telescope (HST) and 3.6 cm radio continuum observations obtained with the Very Large Array (VLA). Emission-line diagnostics were employed for nine NLR clouds, which extend 2.5" (102 pc) from the nucleus, to examine the electron density, temperature, and ionization state of the NLR gas. The emission-line ratios are consistent with those typically found in Seyfert nuclei and indicate that within the inner near-nuclear region (r ~< 1") the ionization decreases with increasing radius. Upper-limits to the [O III] electron temperature (T ~< 11,000 K) for the inner NLR clouds indicate that photoionization is the dominant ionization mechanism close to the nucleus. The emission-line fluxes for most of the NLR clouds can be reproduced reasonably well by simple photoionization models using a central power-law continuum source and supersolar nitrogen abundances. Shock+precursor models, however, provide a better fit to the observed fluxes of an NLR cloud ~2.5" south of the nucleus that is identified with the extra-nuclear cloud (XNC). The large [O III] electron temperature of this cloud (T = 24,000 K) further suggests the presence of shocks. This cloud is straddled by two radio knots and lies near the location where a weak radio jet, ~2.5" (102pc) in extent, connects the near-nuclear radio emission with a diffuse lobe structure spanning \~4" (163 pc). It is plausible that this cloud represents the location where the radio jet impinges on the disk ISM.Comment: 25 pages, 26 figures (9 color), 7 tables. Accepted for publication in the Astrophysical Journa

The state of play: securities of childhood - insecurities of children

This article is broadly concerned with the positioning of children, both within and outside the subject area of International Relations. It considers the costs of an adult- 5 centric standpoint in security studies and contrasts this with investments made seemingly on behalf of children and their security. It begins by looking at how children and childhoods are constructed and contained - yet also defy categorization - at some cost to their protection. The many competing children and childhoods that are invoked in security discourses and partially sustain their victimcy are then illustrated. It is 10 argued that at their entry point into academia they are essentialized and sentimentalized. Power relations which subvert, yet also rely on children and childhoods can only be disrupted through a reconfiguration of politics and agency which includes an engagement with political literacy on a societal level and acknowledgement of the ubiquitous presence of war in all our live

Lyman Alpha Emitters at Redshift 5.7 in the COSMOS Field

We present results from a narrow-band optical survey of a contiguous area of 1.95 deg^2, covered by the Cosmic Evolution Survey (COSMOS). Both optical narrow-band (lambda_c = 8150 AA and Delta_lambda = 120 AA) and broad-band (B, V, g', r', i', and z') imaging observations were performed with the Subaru prime-focus camera, Suprime-Cam on the Subaru Telescope. We provide the largest contiguous narrow-band survey, targetting Ly alpha emitters (LAEs) at z~5.7. We find a total of 119 LAE candidates at z~5.7. Over the wide-area covered by this survey, we find no strong evidence for large scale clustering of LAEs. We estimate a star formation rate (SFR) density of ~7*10^-4 M_sun yr^-1 Mpc^-3 for LAEs at z~5.7, and compare it with previous measurements.Comment: 26 pages, 19 figures. to appear in the ApJ Supplement COSMOS Special Issu

Co‐production of health and social science research with vulnerable children and young people: A rapid review

Background The term ‘care-experienced’ refers to anyone who is currently in care or has been in care at any stage in their life. A complex interplay of factors leads to care-experienced children and young people (CECYP) experiencing poorer oral health and access to dental care than their peers. A rapid review of the co-production of health and social care research with vulnerable children and young people (CYP) was carried out to inform the development of a co-produced research project exploring the oral health behaviours and access to dental services of CECYP. Here, ‘co-production’ refers to the involvement of CYP in the planning or conduct of research with explicit roles in which they generate ideas, evidence and research outputs. Aim To learn how to meaningfully involve vulnerable CYP in the co-production of health and social science research. Objectives To identify: Different approaches to facilitating the engagement of vulnerable CYP in co-production of health and social science research; different activities carried out in such approaches, challenges to engaging vulnerable CYP in co-production of health and social science research and ways to overcome them and areas of best practice in relation to research co-production with vulnerable CYP. Search Strategy A rapid review of peer-reviewed articles was conducted in six databases (MEDLINE, Embase, SocINDEX, CINAHL, PsycINFO and Web of Science) and grey literature to identify studies that engaged vulnerable CYP in co-approaches to health and social research. Main Results Of 1394 documents identified in the search, 40 were included and analysed. A number of different approaches to co-production were used in the studies. The CYP was involved in a range of activities, chiefly the development of data collection tools, data collection and dissemination. Individual challenges for CYP and researchers, practical and institutional factors and ethical considerations impacted the success of co-production. Discussion and Conclusion Co-production of health and social science with vulnerable CYP presents challenges to researchers and CYP calling for all to demonstrate reflexivity and awareness of biases, strengths and limitations. Used appropriately and well, co-production offers benefits to researchers and CYP and can contribute to research that reflects the needs of vulnerable CYP. Adherence to the key principles of inclusion, safeguarding, respect and well-being facilitates this approach. Patient and Public Contribution Members of our patient and public involvement and stakeholder groups contributed to the interpretation of the review findings. This manuscript was written together with a young care leaver, Skye Boswell, who is one of the authors. She contributed to the preparation of the manuscript, reviewing the findings and their interpretation