Public acceptability of financial incentives for smoking cessation in pregnancy and breastfeeding

Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design. Design Cross-sectional survey. Setting and participants British general public. Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers. These were shopping vouchers for: (1) validated smoking cessation in pregnancy and (2) after birth; (3) for a smoke-free home; (4) for proven breast feeding; (5) a free breast pump; (6) payments to health services for reaching smoking cessation in pregnancy targets and (7) breastfeeding targets. Ipsos MORI used area quota sampling and home-administered computer-assisted questionnaires, with randomised question order to assess agreement with different incentives (measured on a five-point scale). Demographic data and target behaviour experience were recorded. Analysis used multivariable ordered logit models. Results Agreement with incentives was mixed (ranging from 34% to 46%) among a representative sample of 1144 British adults. Mean agreement score was highest for a free breast pump, and lowest for incentives for smoking abstinence after birth. More women disagreed with shopping vouchers than men. Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump. Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over, particularly provider targets for smoking cessation. Non-white ethnic groups agreed particularly with breastfeeding incentives. Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours. Up to £40/month vouchers for behaviour change were acceptable (>85%). Conclusions Women and the less educated were more likely to disagree, but men and women of childbearing age to agree, with incentives designed for their benefit. Trials evaluating reach, impact on health inequalities and ethnic groups are required prior to implementing incentive interventions

‘Off With Their Heads’: British Prime Ministers and the Power to Dismiss

The British prime minister’s power to appoint and dismiss ministers is probably his most important single power. This article explores how prime ministers from Macmillan to Blair have used that power. The article considers the criteria that prime ministers use when choosing to appoint or dismiss individuals from office before examining the calculations and miscalculations that prime ministers have made in practice. Finally, the article analyses the way that prime ministers have exercised, in particular, their power to dismiss and finds that Thatcher was far more likely than others to sack cabinet colleagues on ideological or policy grounds. The article emphasizes that prime ministers’ relationships with especially powerful ministers – ‘big beasts of the jungle’ – are crucial to an understanding of British government at the top.</jats:p

Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study

Objective: To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study. Design: Cross-sectional survey and qualitative interviews. Setting: Scotland and North West England. Participants: Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees. Methods: Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data. Results: Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; p<0.001). Net agreement for provider incentives for breastfeeding targets was 44.1% (219/497) and net disagreement was 38.6% (192/497). Agreement was more likely for women (compared with men): OR 1.81 (1.09 to 3.00; p=0.023) and health visitors/maternity staff (compared with doctors): OR 2.54 (95% CI 1.65 to 3.91; p<0.001). Key emergent themes were 'moral tensions around acceptability', 'need for incentives', 'goals', 'collective or divisive action' and 'monitoring and proof'. While provider incentives can focus action and resources, tensions around the impact on relationships raised concerns. Pressure, burden of proof, gaming, box-ticking bureaucracies and health inequalities were counterbalances to potential benefits. Conclusions: Provider incentives are favoured by non-medical staff. Solutions which increase trust and collaboration towards shared goals, without negatively impacting on relationships or increasing bureaucracy are required

Design of the low-speed NLF(1)-0414F and the high-speed HSNLF(1)-0213 airfoils with high-lift systems

The design and testing of Natural Laminar Flow (NLF) airfoils is examined. The NLF airfoil was designed for low speed, having a low profile drag at high chord Reynolds numbers. The success of the low speed NLF airfoil sparked interest in a high speed NLF airfoil applied to a single engine business jet with an unswept wing. Work was also conducted on the two dimensional flap design. The airfoil was decambered by removing the aft loading, however, high design Mach numbers are possible by increasing the aft loading and reducing the camber overall on the airfoil. This approach would also allow for flatter acceleration regions which are more stabilizing for cross flow disturbances. Sweep could then be used to increase the design Mach number to a higher value also. There would be some degradation of high lift by decambering the airfoil overall, and this aspect would have to be considered in a final design

Cohesin cleavage by separase is enhanced by a substrate motif distinct from the cleavage site.

Chromosome segregation begins when the cysteine protease, separase, cleaves the Scc1 subunit of cohesin at the metaphase-to-anaphase transition. Separase is inhibited prior to metaphase by the tightly bound securin protein, which contains a pseudosubstrate motif that blocks the separase active site. To investigate separase substrate specificity and regulation, here we develop a system for producing recombinant, securin-free human separase. Using this enzyme, we identify an LPE motif on the Scc1 substrate that is distinct from the cleavage site and is required for rapid and specific substrate cleavage. Securin also contains a conserved LPE motif, and we provide evidence that this sequence blocks separase engagement of the Scc1 LPE motif. Our results suggest that rapid cohesin cleavage by separase requires a substrate docking interaction outside the active site. This interaction is blocked by securin, providing a second mechanism by which securin inhibits cohesin cleavage

Flea‘in Around: A Look at the Identification, Preservation, Clearing, and Mounting of Siphonaptera

Fleas are remarkable and highly specialized insects, with no part of their external anatomy being easily mistaken for that of any other insect. Due to their small size, the subtle differences among the distinguishing morphological characteristics of each species, and complexities of preparing specimens, identifying, and working with fleas is challenging. Various documents and taxonomic keys are available that discuss mounting procedures and the identification of medically important fleas for large regions of the world including the United States; however, many of these have become antiquated over time. Some of the distinguishing specialized characteristics exhibited among flea species, as presented in older keys, come in the form of line drawings, which are accurate but can be difficult to use when comparing it to structures on a whole specimen when viewed through a microscope. This paper presents a guide which describes in detail previously developed, but obscure techniques covering the preservation, preparation, clearing, and mounting of Siphonaptera specimens. In addition, we are also presenting an easy-to-use photographic key of twelve flea species collected from back yard wildlife, as well as pet cats and dogs in Orange County, CA. This key, which is freely available online at the Orange County Mosquito and Vector Control District’s website, is an effective tool for the identification of common flea species found in southern California. Using the key in conjunction with the mounting guide will provide users with a full-circle guide to preserving, identifying, and mounting flea specimens. Keyed flea genera include Cediopsylla, Ctenocephalides, Diamanus, Echidinophaga, Hoplopsyllus, Leptopsylla, Nosopsyllus, Orchopoeas, Pulex, and Xenopsylla. Examined hosts include cats, coyotes, dogs, mice, opossums, rabbits, raccoons, rats, skunks, squirrels, and woodrats

Physical ACtivity facilitation for Elders (PACE):Study protocol for a randomised controlled trial

BACKGROUND: As people live longer, their risk of disability increases. Disability affects quality of life and increases health and social care costs. Preventing or delaying disability is therefore an important objective, and identifying an effective intervention could improve the lives of many older people. Observational and interventional evidence suggests that physical activity may reduce the risk of age-related disability, as assessed by physical performance measures. However it is unclear what approach is the most cost-effective intervention in changing long-term physical activity behaviour in older adults. A new theory-driven behavioural intervention has been developed, with the aim of increasing physical activity in the everyday lives of older adults at risk of disability. This pilot study tests the feasibility and acceptability of delivering this intervention to older adults. METHODS/DESIGN: A randomised controlled trial (RCT) design will be used in the pilot study. Sixty patients aged 65 years and older will be recruited from primary care practices. Patients will be eligible to participate if they are inactive, not disabled at baseline, are at risk of developing disability in the future (Short Physical Performance Battery score <10/12), and have no contraindications to physical activity. Following baseline measures, participants will be randomised in a 2:1 ratio to the intervention or to a control arm and all participants will be followed-up after 6 months. Those randomised to the intervention arm will receive sessions with a trained Physical Activity Facilitator, delivering an intervention based on self-determination theory. Control participants receive a booklet on healthy ageing. The main outcomes of interest are recruitment, adherence, retention and acceptability. Data will also be collected on: self-report and accelerometer-recorded physical activity; physical performance; depression; wellbeing; cognitive function; social support; quality of life, healthcare use, and attitudes to physical activity. A mixed-methods process evaluation will run alongside the RCT. DISCUSSION: The intervention, if effective, has the potential to reduce disability and improve quality of life in older adults. Before proceeding to a full-scale trial a pilot trial is necessary to ensure intervention feasibility and acceptability, and that the intervention shows evidence of promise. TRIAL REGISTRATION: Current Controlled Trials ISRCTN80470273. Registered 25 October 2013

Effects of maternal separation on brain stress systems: Modulation by voluntary exercise in male rats

Early life stress (ELS) has been shown to predispose animals to anxiety- and depression-like behaviour in adulthood. Recent evidence suggests that repeated stress in adulthood dysregulates the hypothalamic orexin/hypocretin system. The current study examined the effects of maternal separation (MS), a well validated rodent model of ELS, on the expression of anxiety-like behaviour following the re-exposure to stress in adulthood. The pattern of Fos-expression in hypothalamic orexin neurons and stress sensitive brain regions was also characterised. Finally, this study examined whether the effects of this double-hit of stress could be reversed using a voluntary exercise intervention during early adulthood. Male rat pups (n=25) were removed from dams for 3hrs on postnatal days (PND) 2-14 (MS). Controls (C; n=25) remained undisturbed during this period except for weekly weighing. On PND 75, animals were randomly allocated to either a ‘stress’ (30min restraint stress) or ‘no stress’ condition (S or NS). A subset of MS animals (n=6) was allowed access to exercise wheels for 1hr/day from PND 40-70. Following this, all animals were behaviourally tested in the open field apparatus for 10mins. Two hours after initiation of restraint, animals were perfused and brains were processed for Fos-protein immunohistochemistry and co-labelled for orexin or tyrosine-hydroxylase (TH). Counts of Fos-positive neurons were made in the hypothalamus, paraventricular nucleus (PVN), paraventricular thalamus (PVT) and ventral tegmental area (VTA). MS-NS rats exhibited behaviour that was indistinguishable from C-NS rats. However, male MS-S rats exhibited decreased exploratory behaviour in the open field task compared to C-S rats. This was associated with a decrease in the percentage of Fos-positive orexin cells in the hypothalamus and reduced Fos-protein in the PVN, PVT and TH-positive VTA cells compared to C-S rats. Interestingly, the exercise intervention reversed the behavioural effects of MS following stress and normalized orexin cell and VTA-TH cell Fos-expression. In conclusion, MS resulted in altered open field behaviour and hypoactivation of the orexin system in response to adult stress. The current study indicates that changes in orexin system function may involve altered activity in stress-sensitive brain regions such as the VTA, PVN and PVT. Importantly, the behavioural and neural changes observed were reversed by voluntary exercise in early adulthood. These findings highlight the importance of non-pharmacological interventions in the treatment of stress-related disorders