PHOENIX: Public Health and Obesity in England – the New Infrastructure eXamined First interim report: the scoping review

The PHOENIX project aims to examine the impact of structural changes to the health and care system in England on the functioning of the public health system, and on the approaches taken to improving the public’s health. The scoping review has now been completed. During this phase we analysed: Department of Health policy documents (2010-2013), as well as responses to those documents from a range of stakeholders; data from 22 semi-structured interviews with key informants; and the oral and written evidence presented at the House of Commons Communities and Local Government Committee on the role of local authorities in health issues. We also gathered data from local authority (LA) and Health and Wellbeing Board (HWB) websites and other sources to start to develop a picture of how the new structures are developing, and to collate demographic and other data on local authorities. A number of important themes were identified and explored during this phase. In summary, some key points related to three themes - governance, relationships and new ways of working - were: The reforms have had a profound effect on leadership within the public health system. Whilst LAs are now the local leaders for public health, in a more fragmented system, leadership for public health appears to be more dispersed amongst a range of organisations and a range of people within the LA. At national level, the leadership role is complex and not yet developed (from a local perspective). Accountability mechanisms have changed dramatically within public health, and many people still seem to be unclear about them. Some performance management mechanisms have disappeared, and much accountability now appears to rely on transparency and the democratic accountability that this would (theoretically) enable. The extent to which ‘system leaders’ within PHE are able to influence local decisions and performance will depend on the strength of relationships principally between the LA and the local Public Health England centre. These relationships will take time to develop. Many people have faced new ways of working, in new settings, and with new relationships to build. Public health teams in LAs have faced the most profound of these changes, having gone from a position of ‘expert voice’ to a position where they must defend their opinions and activities in the context of competing demands and severely restricted resources. Public health staff may require new skills, and may need to seek new ‘allies’ to thrive in the new environment. HWBs could be crucial in bringing together a fragmented system and dispersed leadership. The next phase of data collection will begin in March with the initiation of case study work. National surveys will be conducted in June/July this year (2014), and at the same time the following year. In this work, we will further explore the following themes: relationships, governance, decision making, new ways of working, and opportunities and difficulties

Measuring the neutron star equation of state using X-ray timing

One of the primary science goals of the next generation of hard X-ray timing instruments is to determine the equation of state of the matter at supranuclear densities inside neutron stars, by measuring the radius of neutron stars with different masses to accuracies of a few percent. Three main techniques can be used to achieve this goal. The first involves waveform modelling. The flux we observe from a hotspot on the neutron star surface offset from the rotational pole will be modulated by the star's rotation, giving rise to a pulsation. Information about mass and radius is encoded into the pulse profile via relativistic effects, and tight constraints on mass and radius can be obtained. The second technique involves characterising the spin distribution of accreting neutron stars. The most rapidly rotating stars provide a very clean constraint, since the mass-shedding limit is a function of mass and radius. However the overall spin distribution also provides a guide to the torque mechanisms in operation and the moment of inertia, both of which can depend sensitively on dense matter physics. The third technique is to search for quasi-periodic oscillations in X-ray flux associated with global seismic vibrations of magnetars (the most highly magnetized neutron stars), triggered by magnetic explosions. The vibrational frequencies depend on stellar parameters including the dense matter equation of state. We illustrate how these complementary X-ray timing techniques can be used to constrain the dense matter equation of state, and discuss the results that might be expected from a 10m$^2$ instrument. We also discuss how the results from such a facility would compare to other astronomical investigations of neutron star properties. [Modified for arXiv]Comment: To appear in Reviews of Modern Physics as a Colloquium, 23 pages, 9 figure

Associated patterns of insecticide resistance in field populations of malaria vectors across Africa.

The development of insecticide resistance in African malaria vectors threatens the continued efficacy of important vector control methods that rely on a limited set of insecticides. To understand the operational significance of resistance we require quantitative information about levels of resistance in field populations to the suite of vector control insecticides. Estimation of resistance is complicated by the sparsity of observations in field populations, variation in resistance over time and space at local and regional scales, and cross-resistance between different insecticide types. Using observations of the prevalence of resistance in mosquito species from the complex sampled from 1,183 locations throughout Africa, we applied Bayesian geostatistical models to quantify patterns of covariation in resistance phenotypes across different insecticides. For resistance to the three pyrethroids tested, deltamethrin, permethrin, and λ-cyhalothrin, we found consistent forms of covariation across sub-Saharan Africa and covariation between resistance to these pyrethroids and resistance to DDT. We found no evidence of resistance interactions between carbamate and organophosphate insecticides or between these insecticides and those from other classes. For pyrethroids and DDT we found significant associations between predicted mean resistance and the observed frequency of mutations in the gene in field mosquito samples, with DDT showing the strongest association. These results improve our capacity to understand and predict resistance patterns throughout Africa and can guide the development of monitoring strategies

General dimensions of human brain morphometry inferred from genome-wide association data

Understanding the neurodegenerative mechanisms underlying cognitive decline in the general population may facilitate early detection of adverse health outcomes in late life. This study investigates genetic links between brain morphometry, ageing and cognitive ability. We develop Genomic Principal Components Analysis (Genomic PCA) to model general dimensions of brain-wide morphometry at the level of their underlying genetic architecture. Genomic PCA is applied to genome-wide association data for 83 brain-wide volumes (36,778 UK Biobank participants) and we extract genomic principal components (PCs) to capture global dimensions of genetic covariance across brain regions (unlike ancestral PCs that index genetic similarity between participants). Using linkage disequilibrium score regression, we estimate genetic overlap between those general brain dimensions and cognitive ageing. The first genetic PCs underlying the morphometric organisation of 83 brain-wide regions accounted for substantial genetic variance (R2  = 40%) with the pattern of component loadings corresponding closely to those obtained from phenotypic analyses. Genetically more central regions to overall brain structure - specifically frontal and parietal volumes thought to be part of the central executive network - tended to be somewhat more susceptible towards age (r = -0.27). We demonstrate the moderate genetic overlap between the first PC underlying each of several structural brain networks and general cognitive ability (rg  = 0.17-0.21), which was not specific to a particular subset of the canonical networks examined. We provide a multivariate framework integrating covariance across multiple brain regions and the genome, revealing moderate shared genetic etiology between brain-wide morphometry and cognitive ageing

Hospital recruitment for a pragmatic cluster-randomized clinical trial: Lessons learned from the COMPASS study

Abstract Background Pragmatic randomized clinical trials are essential to determine the effectiveness of interventions in “real-world” clinical practice. These trials frequently use a cluster-randomized methodology, with randomization at the site level. Despite policymakers’ increased interest in supporting pragmatic randomized clinical trials, no studies to date have reported on the unique recruitment challenges faced by cluster-randomized pragmatic trials. We investigated key challenges and successful strategies for hospital recruitment in the Comprehensive Post-Acute Stroke Services (COMPASS) study. Methods The COMPASS study is designed to compare the effectiveness of the COMPASS model versus usual care in improving functional outcomes, reducing the numbers of hospital readmissions, and reducing caregiver strain for patients discharged home after stroke or transient ischemic attack. This model integrates early supported discharge planning with transitional care management, including nurse-led follow-up phone calls after 2, 30, and 60 days and an in-person clinic visit at 7–14 days involving a functional assessment and neurological examination. We present descriptive statistics of the characteristics of successfully recruited hospitals compared with all eligible hospitals, reasons for non-participation, and effective recruitment strategies. Results We successfully recruited 41 (43%) of 95 eligible North Carolina hospitals. Leading, non-exclusive reasons for non-participation included: insufficient staff or financial resources (n = 33, 61%), lack of health system support (n = 16, 30%), and lack of support of individual decision-makers (n = 11, 20%). Successful recruitment strategies included: building and nurturing relationships, engaging team members and community partners with a diverse skill mix, identifying gatekeepers, finding mutually beneficial solutions, having a central institutional review board, sharing published pilot data, and integrating contracts and review board administrators. Conclusions Although we incorporated strategies based on the best available evidence at the outset of the study, hospital recruitment required three times as much time and considerably more staff than anticipated. To reach our goal, we tailored strategies to individuals, hospitals, and health systems. Successful recruitment of a sufficient number and representative mix of hospitals requires considerable preparation, planning, and flexibility. Strategies presented here may assist future trial organizers in implementing cluster-randomized pragmatic trials. Trial registration Clinicaltrials.gov, NCT02588664 . Registered on 23 October 2015

Colloquium: Measuring the neutron star equation of state using x-ray timing

One of the primary science goals of the next generation of hard x-ray timing instruments is to determine the equation of state of matter at supranuclear densities inside neutron stars by measuring the radius of neutron stars with different masses to accuracies of a few percent. Three main techniques can be used to achieve this goal. The first involves waveform modeling. The flux observed from a hotspot on the neutron star surface offset from the rotational pole will be modulated by the star's rotation, and this periodic modulation at the spin frequency is called a pulsation. As the photons propagate through the curved spacetime of the star, information about mass and radius is encoded into the shape of the waveform (pulse profile) via special and general-relativistic effects. Using pulsations from known sources (which have hotspots that develop either during thermonuclear bursts or due to channeled accretion) it is possible to obtain tight constraints on mass and radius. The second technique involves characterizing the spin distribution of accreting neutron stars. A large collecting area enables highly sensitive searches for weak or intermittent pulsations (which yield spin) from the many accreting neutron stars whose spin rates are not yet known. The most rapidly rotating stars provide a clean constraint, since the limiting spin rate where the equatorial surface velocity is comparable to the local orbital velocity, at which mass shedding occurs, is a function of mass and radius. However, the overall spin distribution also provides a guide to the torque mechanisms in operation and the moment of inertia, both of which can depend sensitively on dense matter physics. The third technique is to search for quasiperiodic oscillations in x-ray flux associated with global seismic vibrations of magnetars (the most highly magnetized neutron stars), triggered by magnetic explosions. The vibrational frequencies depend on stellar parameters including the dense matter equation of state, and large-area x-ray timing instruments would provide much improved detection capability. An illustration is given of how these complementary x-ray timing techniques can be used to constrain the dense matter equation of state and the results that might be expected from a 10 m2 instrument are discussed. Also discussed are how the results from such a facility would compare to other astronomical investigations of neutron star properties