Building the economic evidence case for social prescribing

Understanding the economic impact of social prescribing remains an urgent priority for the National Academy of Social Prescribing (NASP). As yet it is unclear how much data exists within the different systems to enable economic analyses of the impact of social prescribing schemes to be conducted. The complexity in understanding the economic impact of social prescribing—and indeed all non-clinical community-based approaches to health—is compounded by the multisector nature of social prescribing. Furthermore, a variety of approaches are being used to test similar but different understandings of both cost and value, including social value, cost, benefit and economic value. There are a growing range of reports and peer-reviewed publications that focus on the impact of social prescribing on health and social care demand, some of which have economic analyses and some which remain as potential data sets for economic analyses. At least one third of all outcomes (if not more) are directly related to the social determinants of health1,2 (SDH) which are not taken into account with economic analysis focused only on health service usage. This range of outcomes experienced by service users2-4 is driving many researchers to conduct economic analyses that attempt to assign value to outcomes beyond the health sector, for instance using social return on investment (SROI) and proxy values. Other researchers have discussed the evolution in economic analyses at length and suggest additional components to existing methodologies, e.g., multi criteria decision analysis (MCDA) to account for additional complexity of social prescribing5. Further developments are also being trialled such as the Wellbeing-adjusted Life Years (WELLBY) to understand the economic value attached to wellbeing6, as opposed to the Quality Adjusted Life Years (QALY), which reports the economic value of quality of life. We are entering an era of providing personalised support to people in integrated and multidisciplinary systems with different local population needs. As such, there is a need to evolve the approaches to determining cost and value of social prescribing, and to reach agreements on methodologies that all sectors are willing to accept as sound approaches. Furthermore, as discussed by McDaid and colleagues in 2019 7, there is a need to move beyond the immediate benefits of social prescribing and to explore the longer-term benefits of sustained engagement in non-clinical activities and provision of support to address issues linked to the SDH. This would enable more data to inform the preventative role and economic impact that social prescribing may have, which is currently an evidence gap. This rapid scoping review was commissioned by NASP and additional roundtables were supported by the National Centre for Creative Health and UKRI/AHRC’s ‘Mobilising Community Assets to Tackle Health Inequalities’ research programme (led by University College London). It aims to provide an update to the first economic evidence review from NASP and explore economic data and health and social care usage data in more detail. This rapid scoping review aims to ascertain: What the current literature indicates in terms of cost or value of social prescribing schemes or parts of the social prescribing scheme. If there are potential data sets that report the impact of social prescribing on health service usage that could have economic analysis applied to them. Stakeholder opinions on the methodological approaches for creating the current economic evaluation evidence base for social prescribing and potential future developments that are needed. How these findings can inform a larger programme of research that is needed to establish the economic impact and value of social prescribing across all relevant sectors in the community. As this report contains three separate elements to it, each element will be reported with methods and results, and then key themes will be brought together with recommendations

The Point of Origin of the Radio Radiation from the Unresolved Cores of Radio-Loud Quasars

Locating the exact point of origin of the core radiation in active galactic nuclei (AGN) would represent important progress in our understanding of physical processes in the central engine of these objects. However, due to our inability to resolve the region containing both the central compact object and the jet base, this has so far been difficult. Here, using an analysis in which the lack of resolution does not play a significant role, we demonstrate that it may be impossible even in most radio loud sources for more than a small percentage of the core radiation at radio wavelengths to come from the jet base. We find for 3C279 that $\sim85$ percent of the core flux at 15 GHz must come from a separate, reasonably stable, region that is not part of the jet base, and that then likely radiates at least quasi-isotropically and is centered on the black hole. The long-term stability of this component also suggests that it may originate in a region that extends over many Schwarzschild radii.Comment: 7 pages with 3 figures, accepted for publication in Astrophysics and Space Scienc

Magnetic fields in supernova remnants and pulsar-wind nebulae

We review the observations of supernova remnants (SNRs) and pulsar-wind nebulae (PWNe) that give information on the strength and orientation of magnetic fields. Radio polarimetry gives the degree of order of magnetic fields, and the orientation of the ordered component. Many young shell supernova remnants show evidence for synchrotron X-ray emission. The spatial analysis of this emission suggests that magnetic fields are amplified by one to two orders of magnitude in strong shocks. Detection of several remnants in TeV gamma rays implies a lower limit on the magnetic-field strength (or a measurement, if the emission process is inverse-Compton upscattering of cosmic microwave background photons). Upper limits to GeV emission similarly provide lower limits on magnetic-field strengths. In the historical shell remnants, lower limits on B range from 25 to 1000 microGauss. Two remnants show variability of synchrotron X-ray emission with a timescale of years. If this timescale is the electron-acceleration or radiative loss timescale, magnetic fields of order 1 mG are also implied. In pulsar-wind nebulae, equipartition arguments and dynamical modeling can be used to infer magnetic-field strengths anywhere from about 5 microGauss to 1 mG. Polarized fractions are considerably higher than in SNRs, ranging to 50 or 60% in some cases; magnetic-field geometries often suggest a toroidal structure around the pulsar, but this is not universal. Viewing-angle effects undoubtedly play a role. MHD models of radio emission in shell SNRs show that different orientations of upstream magnetic field, and different assumptions about electron acceleration, predict different radio morphology. In the remnant of SN 1006, such comparisons imply a magnetic-field orientation connecting the bright limbs, with a non-negligible gradient of its strength across the remnant.Comment: 20 pages, 24 figures; to be published in SpSciRev. Minor wording change in Abstrac

A precision determination of the mass of the η\eta meson

Several processes of meson production in proton-deuteron collisions have been measured simultaneously using a calibrated magnetic spectrograph. Among these processes, the $\eta$ meson is seen clearly as a sharp missing--mass peak on a slowly varying background in the $p+d\to ^3\textrm{He} +X$ reaction. Knowing the kinematics of the other reactions with well determined masses, it is possible to deduce a precise mass for the $\eta$ meson. The final result, $m(\eta)=547.311\pm 0.028 \textrm{(stat)} \pm 0.032 \textrm{(syst) MeV/c}^2$, is significantly lower than that found by the recent NA48 measurement, though it is consistent with values obtained in earlier counter experiments.Comment: 10 pages, 6 figures, Fig. 3 change

Search for a W' boson decaying to a bottom quark and a top quark in pp collisions at sqrt(s) = 7 TeV

Results are presented from a search for a W' boson using a dataset corresponding to 5.0 inverse femtobarns of integrated luminosity collected during 2011 by the CMS experiment at the LHC in pp collisions at sqrt(s)=7 TeV. The W' boson is modeled as a heavy W boson, but different scenarios for the couplings to fermions are considered, involving both left-handed and right-handed chiral projections of the fermions, as well as an arbitrary mixture of the two. The search is performed in the decay channel W' to t b, leading to a final state signature with a single lepton (e, mu), missing transverse energy, and jets, at least one of which is tagged as a b-jet. A W' boson that couples to fermions with the same coupling constant as the W, but to the right-handed rather than left-handed chiral projections, is excluded for masses below 1.85 TeV at the 95% confidence level. For the first time using LHC data, constraints on the W' gauge coupling for a set of left- and right-handed coupling combinations have been placed. These results represent a significant improvement over previously published limits.Comment: Submitted to Physics Letters B. Replaced with version publishe

Search for the standard model Higgs boson decaying into two photons in pp collisions at sqrt(s)=7 TeV

A search for a Higgs boson decaying into two photons is described. The analysis is performed using a dataset recorded by the CMS experiment at the LHC from pp collisions at a centre-of-mass energy of 7 TeV, which corresponds to an integrated luminosity of 4.8 inverse femtobarns. Limits are set on the cross section of the standard model Higgs boson decaying to two photons. The expected exclusion limit at 95% confidence level is between 1.4 and 2.4 times the standard model cross section in the mass range between 110 and 150 GeV. The analysis of the data excludes, at 95% confidence level, the standard model Higgs boson decaying into two photons in the mass range 128 to 132 GeV. The largest excess of events above the expected standard model background is observed for a Higgs boson mass hypothesis of 124 GeV with a local significance of 3.1 sigma. The global significance of observing an excess with a local significance greater than 3.1 sigma anywhere in the search range 110-150 GeV is estimated to be 1.8 sigma. More data are required to ascertain the origin of this excess.Comment: Submitted to Physics Letters

Measurement of the Lambda(b) cross section and the anti-Lambda(b) to Lambda(b) ratio with Lambda(b) to J/Psi Lambda decays in pp collisions at sqrt(s) = 7 TeV

The Lambda(b) differential production cross section and the cross section ratio anti-Lambda(b)/Lambda(b) are measured as functions of transverse momentum pt(Lambda(b)) and rapidity abs(y(Lambda(b))) in pp collisions at sqrt(s) = 7 TeV using data collected by the CMS experiment at the LHC. The measurements are based on Lambda(b) decays reconstructed in the exclusive final state J/Psi Lambda, with the subsequent decays J/Psi to an opposite-sign muon pair and Lambda to proton pion, using a data sample corresponding to an integrated luminosity of 1.9 inverse femtobarns. The product of the cross section times the branching ratio for Lambda(b) to J/Psi Lambda versus pt(Lambda(b)) falls faster than that of b mesons. The measured value of the cross section times the branching ratio for pt(Lambda(b)) > 10 GeV and abs(y(Lambda(b))) < 2.0 is 1.06 +/- 0.06 +/- 0.12 nb, and the integrated cross section ratio for anti-Lambda(b)/Lambda(b) is 1.02 +/- 0.07 +/- 0.09, where the uncertainties are statistical and systematic, respectively.Comment: Submitted to Physics Letters

Measurement of isolated photon production in pp and PbPb collisions at sqrt(sNN) = 2.76 TeV

Isolated photon production is measured in proton-proton and lead-lead collisions at nucleon-nucleon centre-of-mass energies of 2.76 TeV in the pseudorapidity range |eta|<1.44 and transverse energies ET between 20 and 80 GeV with the CMS detector at the LHC. The measured ET spectra are found to be in good agreement with next-to-leading-order perturbative QCD predictions. The ratio of PbPb to pp isolated photon ET-differential yields, scaled by the number of incoherent nucleon-nucleon collisions, is consistent with unity for all PbPb reaction centralities.Comment: Submitted to Physics Letters