Learning from people with long-term conditions: new insights for governance in primary health care

Internationally, system-wide changes to the structures and systems governing health care aim to improve outcomes for patients, quality of care and access to services. The introduction of top-down centrally driven solutions to governance of health care, at the same time as increasing policy emphasis on greater ‘bottom up’ patient and public involvement in all aspects of health care, has set up complex tensions for policy implementation and health care practice. This paper explores the interplay of these agendas in the context of changes in primary health care services provided by the National Health Service (NHS) in England. Specifically, it looks at an example of service user involvement in a study (the PEGI study) of professional response to changes in the governance and incentives in the care of people with long-term conditions. This qualitative study was conducted in three Primary Care Trust sites in England. Service users influenced and guided the study throughout. In-depth interviews with 56 health and social care professionals engaged in the development of local policies and the delivery of care for people with complex long-term illness drew on vignettes developed by 32 members from three Service User Reference Groups (SURG). Themes generated by the cross case analysis were validated through these SURG groups. The findings presented here focus on four themes about risk and comparison of professionals’/service users’ perspectives of the issues: managing risks/consistent support, the risks of letting go/feeling in control, professionalism/helping people to help themselves, and managing expectations/professionals losing out. Service user involvement added value by: validating understandings of governance, framing debates to focus on what matters at the point of care, and enabling perspective sharing and interaction. We suggest that more collaborative forms of governance in health care, that take account of service user perspectives and enable interaction with professional groups, could help to validate processes of quality assurance and provide motivation for continuous quality improvement. We offer a model for ‘opening up’ collaborative projects to evaluation and appraisal and a process for critical reflection of the interrelationships between the PEGI study context, researcher issues, methods/approach and outcomes/impact of service user involvement

Group-PCA for very large fMRI datasets

Increasingly-large datasets (for example, the resting-state fMRI data from the Human Connectome Project) are demanding analyses that are problematic because of the sheer scale of the aggregate data. We present two approaches for applying group-level PCA; both give a close approximation to the output of PCA applied to full concatenation of all individual datasets, while having very low memory requirements regardless of the number of datasets being combined. Across a range of realistic simulations, we find that in most situations, both methods are more accurate than current popular approaches for analysis of multi-subject resting-state fMRI studies. The group-PCA output can be used to feed into a range of further analyses that are then rendered practical, such as the estimation of group-averaged voxelwise connectivity, group-level parcellation, and group-ICA. (C) 2014 Elsevier Inc. All rights reserved.Peer reviewe

Further Development of Methodologies for Sustainability Assessment and Monitoring in Organic/Ecological Agriculture

In recent years there has been a great deal of interest in assessing the sustainability of agriculture in terms of its social, environmental and economic impact and a number of indicators and tools are used. Measurements take place at the farm or product level and indicators can be outcome related e.g. number of butterfly species present, or management related e.g. percentage of fields with margins growing wildflowers to attract butterflies. Given its underlying ethos, the organic/ecological agriculture sector should aim to be at the forefront of sustainability. The development of assessment approaches and recent discussions within the movement have identified continuous improvement towards best practice in sustainability to be one of the important features of the new direction. Positive effects in such areas as ‘environment’ are seen as one of the most important reasons for the financial support given to the organic sector, and as one of the reasons for consumers’ willingness to pay a premium for organic food. This project aimed to provide practical recommendations on the suitability of the available sustainability assessment frameworks, themes, tools and indicators for the organic sector and to help consider and further develop sustainability assessment approaches. A review of tools, indicators, themes and sustainability assessment methods was carried out. The opinions of organisations and individuals from within the organic sector were obtained through an international workshop and an online survey. Synergies and trade-offs between indicators were investigated using the database of FiBL’s SMART sustainability assessment tool to investigate the relationships between themes. Results from the project have illustrated that choosing the most promising indicators for the organic sector needs to be driven by the importance of the sustainability theme as well as using a suitable method. Choosing indicators solely on the basis of desirable goals may lead to a subjective and non-transparent indicator selection which cannot be externally verified. On the other hand, assessing the quality of indicators alone appears to be too much driven by method and the choice of tools will also need to be influenced by data availability and/or cost of data collection. The inclusion of indicators that assess areas within social sustainability and good governance (e.g. corporate social responsibility) should be encouraged within existing tools. This development should build on recent frameworks provided by, for instance the Food and Agriculture Organisation of the United Nations FAO and OECD (e.g. SAFA, guidelines on social LCA, DFID Sustainable Livelihoods Framework). Indicator development should also consider stakeholder views and perspectives (perhaps using, for example, the European Innovation Partnership Programme to contact stakeholders) and decide on threshold values that indicate poor, acceptable and good performance. The assessment of synergies and trade-offs has illustrated that farms with good performance with regards to governance are likely to have positive performance on most environmental, social and economic aspects. This highlights the importance of good corporate management at the farm level. Further work on synergies and trade-offs using samples of farms is urgently required. In addition, trade-offs between the economic dimension on the one hand and the environmental and social dimensions on the other hand, may need to be accepted at farm level. There is scope, however, for these to be addressed by policy makers, to help the farmers set the right priorities. Substantial trade-offs also exist within the environmental dimension (for example between greenhouse gas emissions and animal welfare) which might be more difficult to resolve. Priorities need to be set depending on the specific context of the farm. Areas of sustainability that are perceived by those within the organic sector as being potential strengths were identified. These could be harnessed in terms of communicating the benefits of organic production. These key strengths include biodiversity, ecosystem diversity, soil quality and greenhouse gas emissions. Although such key strengths may seem obvious to those working within the sector and for several there is some good scientific evidence available, it is likely that the benefits are not widely-known or publicised and that further development of the evidence base is required

Nobel and Novice: Author Prominence Affects Peer Review

Peer-review is a well-established cornerstone of the scientific process, yet it is not immune to status bias. Merton identified the problem as one in which prominent researchers get disproportionately great credit for their contribution while relatively unknown researchers get disproportionately little credit.1 We measure the extent of this effect in the peer-review process through a pre-registered field experiment. We invite more than 3,300 researchers to review a paper jointly written by a prominent author – a Nobel laureate – and by a relatively unknown author – an early-career research associate –, varying whether reviewers see the prominent author’s name, an anonymized version of the paper, or the less well-known author’s name. We find strong evidence for the status bias: while only 23 percent recommend “reject” when the prominent researcher is the only author shown, 48 percent do so when the paper is anonymized, and 65 percent do so when the little-known author is the only author shown. Our findings complement and extend earlier results on double-anonymized vs. singleanonymized review2,3,4,5,6,7 and strongly suggest that double-anonymization is a minimum requirement for an unbiased review process

First Observation of 15Be

The neutron-unbound nucleus 15Be was observed for the first time. It was populated using neutron transfer from a deuterated polyethylene target with a 59 MeV/u 14Be beam. Neutrons were measured in coincidence with outgoing 14Be particles and the reconstructed decay energy spectrum exhibits a resonance at 1.8(1) MeV. This corresponds to 15Be being unbound by 0.45 MeV more then 16Be thus significantly hindering the sequential two-neutron decay of 16Be to 14Be through this state

Comparative Analysis of Tandem Repeats from Hundreds of Species Reveals Unique Insights into Centromere Evolution

Centromeres are essential for chromosome segregation, yet their DNA sequences evolve rapidly. In most animals and plants that have been studied, centromeres contain megabase-scale arrays of tandem repeats. Despite their importance, very little is known about the degree to which centromere tandem repeats share common properties between different species across different phyla. We used bioinformatic methods to identify high-copy tandem repeats from 282 species using publicly available genomic sequence and our own data. The assumption that the most abundant tandem repeat is the centromere DNA was true for most species whose centromeres have been previously characterized, suggesting this is a general property of genomes. Our methods are compatible with all current sequencing technologies. Long Pacific Biosciences sequence reads allowed us to find tandem repeat monomers up to 1,419 bp. High-copy centromere tandem repeats were found in almost all animal and plant genomes, but repeat monomers were highly variable in sequence composition and in length. Furthermore, phylogenetic analysis of sequence homology showed little evidence of sequence conservation beyond ~50 million years of divergence. We find that despite an overall lack of sequence conservation, centromere tandem repeats from diverse species showed similar modes of evolution, including the appearance of higher order repeat structures in which several polymorphic monomers make up a larger repeating unit. While centromere position in most eukaryotes is epigenetically determined, our results indicate that tandem repeats are highly prevalent at centromeres of both animals and plants. This suggests a functional role for such repeats, perhaps in promoting concerted evolution of centromere DNA across chromosomes

Rapid range expansion in the Great Plains narrow-mouthed toad (Gastrophryne olivacea) and a revised taxonomy for North American microhylids

We investigated genetic variation within the Great Plains narrow-mouthed toad, Gastrophryne olivacea, across its geographic range in the United States and Mexico. An analysis of mitochondrial DNA (mtDNA) from 105 frogs revealed remarkably low levels of genetic diversity in individuals inhabiting the central United States and northern Mexico. We found that this widespread matrilineal lineage is divergent (ca. 2% in mtDNA) from haplotypes that originate from the western United States and western coast of Mexico. Using a dataset that included all five species of Gastrophryne and both species of the closely related genus Hypopachus, we investigated the phylogenetic placement of G. olivacea. This analysis recovered strong support that G. olivacea, the tropically distributed G. elegans, and the temperately distributed G. carolinensisconstitute a monophyletic assemblage. However, the placement of G. pictiventris and G. usta render Gastrophryne paraphyletic with respect to Hypopachus. To complement our mitochondrial analysis, we examined a small fragment of nuclear DNA and recovered consistent patterns. In light of our findings we recommend (1) the resurrection of the nomen G. mazatlanensis Taylor (1943) for the disjunct western clade of G. olivaceaand (2) the tentative placement of G. pictiventris and G. usta in Hypopachus. To explore possible scenarios leading to low levels of genetic diversity in G. olivacea, we used mismatch distributions and Bayesian Skyline plots to examine historic population expansion and demography. Collectively these analyses suggest that G. olivacea rapidly expanded in effective population size and geographic range during the late Pleistocene or early Holocene. This hypothesis is consistent with fossil data from northern localities and contemporary observations that suggest ongoing northern expansion. Given our findings, we suspect that the rapid range expansion of G. olivacea may have been facilitated by ecological associations with open habitats and seasonal water bodies

Can Protostellar Jets Drive Supersonic Turbulence in Molecular Clouds?

Jets and outflows from young stellar objects are proposed candidates to drive supersonic turbulence in molecular clouds. Here, we present the results from multi-dimensional jet simulations where we investigate in detail the energy and momentum deposition from jets into their surrounding environment and quantify the character of the excited turbulence with velocity probability density functions. Our study include jet--clump interaction, transient jets, and magnetised jets. We find that collimated supersonic jets do not excite supersonic motions far from the vicinity of the jet. Supersonic fluctuations are damped quickly and do not spread into the parent cloud. Instead subsonic, non-compressional modes occupy most of the excited volume. This is a generic feature which can not be fully circumvented by overdense jets or magnetic fields. Nevertheless, jets are able to leave strong imprints in their cloud structure and can disrupt dense clumps. Our results question the ability of collimated jets to sustain supersonic turbulence in molecular clouds.Comment: 33 pages, 18 figures, accepted by ApJ, version with high resolution figures at: http://www.ita.uni-heidelberg.de/~banerjee/publications/jet_paper.pd