A case study of adapting a health insurance decision intervention from trial into routine cancer care

OBJECTIVE: This study adapted Improving Cancer Patients\u27 Insurance Choices (I Can PIC), an intervention to help cancer patients navigate health insurance decisions and care costs. The original intervention improved knowledge and confidence making insurance decisions, however, users felt limited by choices provided in insurance markets. Using decision trees and frameworks to guide adaptations, we modified I Can PIC to focus on using rather than choosing health insurance. The COVID-19 pandemic introduced unforeseen obstacles, prompting changes to study protocols. As a result, we allowed users outside of the study to use I Can PIC (\u3e 1050 guest users) to optimize public benefit. This paper describes the steps took to conduct the study, evaluating both the effectiveness of I Can PIC and the implementation process to improve its impact. RESULTS: Although I Can PIC users had higher knowledge and health insurance literacy compared to the control group, results were not statistically significant. This outcome may be associated with systems-level challenges as well as the number and demographic characteristics of participants. The publicly available tool can be a resource for those navigating insurance and care costs, and researchers can use this flexible approach to intervention delivery and testing as future health emergencies arise

Gas Accretion via Lyman Limit Systems

In cosmological simulations, a large fraction of the partial Lyman limit systems (pLLSs; 16<log N(HI)<17.2) and LLSs (17.2log N(HI)<19) probes large-scale flows in and out of galaxies through their circumgalactic medium (CGM). The overall low metallicity of the cold gaseous streams feeding galaxies seen in these simulations is the key to differentiating them from metal rich gas that is either outflowing or being recycled. In recent years, several groups have empirically determined an entirely new wealth of information on the pLLSs and LLSs over a wide range of redshifts. A major focus of the recent research has been to empirically determine the metallicity distribution of the gas probed by pLLSs and LLSs in sizable and representative samples at both low (z2) redshifts. Here I discuss unambiguous evidence for metal-poor gas at all z probed by the pLLSs and LLSs. At z<1, all the pLLSs and LLSs so far studied are located in the CGM of galaxies with projected distances <100-200 kpc. Regardless of the exact origin of the low-metallicity pLLSs/LLSs, there is a significant mass of cool, dense, low-metallicity gas in the CGM that may be available as fuel for continuing star formation in galaxies over cosmic time. As such, the metal-poor pLLSs and LLSs are currently among the best observational evidence of cold, metal-poor gas accretion onto galaxies.Comment: Invited review to appear in Gas Accretion onto Galaxies, Astrophysics and Space Science Library, eds. A. J. Fox & R. Dav\'e, to be published by Springe

Gas Accretion in Star-Forming Galaxies

Cold-mode gas accretion onto galaxies is a direct prediction of LCDM simulations and provides galaxies with fuel that allows them to continue to form stars over the lifetime of the Universe. Given its dramatic influence on a galaxy's gas reservoir, gas accretion has to be largely responsible for how galaxies form and evolve. Therefore, given the importance of gas accretion, it is necessary to observe and quantify how these gas flows affect galaxy evolution. However, observational data have yet to conclusively show that gas accretion ubiquitously occurs at any epoch. Directly detecting gas accretion is a challenging endeavor and we now have obtained a significant amount of observational evidence to support it. This chapter reviews the current observational evidence of gas accretion onto star-forming galaxies.Comment: Invited review to appear in Gas Accretion onto Galaxies, Astrophysics and Space Science Library, eds. A. J. Fox & R. Dav\'e, to be published by Springer. This chapter includes 22 pages with 7 Figure

A translational framework for public health research

&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;&lt;/p&gt; &lt;p&gt;The paradigm of translational medicine that underpins frameworks such as the Cooksey report on the funding of health research does not adequately reflect the complex reality of the public health environment. We therefore outline a translational framework for public health research.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Discussion&lt;/b&gt;&lt;/p&gt; &lt;p&gt;Our framework redefines the objective of translation from that of institutionalising effective interventions to that of improving population health by influencing both individual and collective determinants of health. It incorporates epidemiological perspectives with those of the social sciences, recognising that many types of research may contribute to the shaping of policy, practice and future research. It also identifies a pivotal role for evidence synthesis and the importance of non-linear and intersectoral interfaces with the public realm.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Summary&lt;/b&gt;&lt;/p&gt; &lt;p&gt;We propose a research agenda to advance the field and argue that resources for 'applied' or 'translational' public health research should be deployed across the framework, not reserved for 'dissemination' or 'implementation'.&lt;/p&gt

Population based absolute and relative survival to 1 year of people with diabetes following a myocardial infarction: A cohort study using hospital admissions data

<p>Abstract</p> <p>Background</p> <p>People with diabetes who experience an acute myocardial infarction (AMI) have a higher risk of death and recurrence of AMI. This study was commissioned by the Department for Transport to develop survival tables for people with diabetes following an AMI in order to inform vehicle licensing.</p> <p>Methods</p> <p>A cohort study using data obtained from national hospital admission datasets for England and Wales was carried out selecting all patients attending hospital with an MI for 2003-2006 (inclusion criteria: aged 30+ years, hospital admission for MI (defined using ICD 10 code I21-I22). STATA was used to create survival tables and factors associated with survival were examined using Cox regression.</p> <p>Results</p> <p>Of 157,142 people with an MI in England and Wales between 2003-2006, the relative risk of death or recurrence of MI for those with diabetes (n = 30,407) in the first 90 days was 1.3 (95%CI: 1.26-1.33) crude rates and 1.16 (95%CI: 1.1-1.2) when controlling for age, gender, heart failure and surgery for MI) compared with those without diabetes (n = 129,960). At 91-365 days post AMI the risk was 1.7 (95% CI 1.6-1.8) crude and 1.50 (95%CI: 1.4-1.6) adjusted. The relative risk of death or re-infarction was higher at younger ages for those with diabetes and directly after the AMI (Relative risk; RR: 62.1 for those with diabetes and 28.2 for those without diabetes aged 40-49 [compared with population risk]).</p> <p>Conclusions</p> <p>This is the first study to provide population based tables of age stratified risk of re-infarction or death for people with diabetes compared with those without diabetes. These tables can be used for giving advice to patients, developing a baseline to compare intervention studies or developing license or health insurance guidelines.</p

Who needs what from a national health research system: Lessons from reforms to the English Department of Health's R&D system

This article has been made available through the Brunel Open Access Publishing Fund.Health research systems consist of diverse groups who have some role in health research, but the boundaries around such a system are not clear-cut. To explore what various stakeholders need we reviewed the literature including that on the history of English health R&D reforms, and we also applied some relevant conceptual frameworks. We first describe the needs and capabilities of the main groups of stakeholders in health research systems, and explain key features of policymaking systems within which these stakeholders operate in the UK. The five groups are policymakers (and health care managers), health professionals, patients and the general public, industry, and researchers. As individuals and as organisations they have a range of needs from the health research system, but should also develop specific capabilities in order to contribute effectively to the system and benefit from it. Second, we discuss key phases of reform in the development of the English health research system over four decades - especially that of the English Department of Health's R&D system - and identify how far legitimate demands of key stakeholder interests were addressed. Third, in drawing lessons we highlight points emerging from contemporary reports, but also attempt to identify issues through application of relevant conceptual frameworks. The main lessons are: the importance of comprehensively addressing the diverse needs of various interacting institutions and stakeholders; the desirability of developing facilitating mechanisms at interfaces between the health research system and its various stakeholders; and the importance of additional money in being able to expand the scope of the health research system whilst maintaining support for basic science. We conclude that the latest health R&D strategy in England builds on recent progress and tackles acknowledged weaknesses. The strategy goes a considerable way to identifying and more effectively meeting the needs of key groups such as medical academics, patients and industry, and has been remarkably successful in increasing the funding for health research. There are still areas that might benefit from further recognition and resourcing, but the lessons identified, and progress made by the reforms are relevant for the design and coordination of national health research systems beyond England.This article is available through the Brunel Open Access Publishing Fund

The Connection between a Lyman Limit System, a very strong OVI Absorber, and Galaxies at z~0.203

With a column density log N(OVI) = 14.95+/-0.05, the OVI absorber at z_abs~0.2028 observed toward the QSO PKS0312-77 (z_em=0.223) is the strongest yet detected at z<0.5. At nearly identical redshift (z_abs=0.2026), we also identify a Lyman limit system (LLS, log N(HI)=18.22). Combining FUV and NUV spectra of PKS0312-77 with optical observations of galaxies in the surrounding field (15'x32'), we present an analysis of these absorbers and their connection to galaxies. The observed OI/HI ratio and photoionization modelling of other low ions indicate the metallicity of the LLS is [Z/H]_LLS=-0.6 and that the LLS is nearly 100% photoionized. In contrast, the OVI-bearing gas is collisionally ionized at T~(3-10)x10^5 K as derived from the high-ion ratios and profile broadenings. Our galaxy survey reveals 13 (0.3<L/L*<1.6) galaxies at \rho<2 h^{-1}_{70} Mpc and |\delta v|<1100 km/s from the LLS. A probable origin for the LLS is debris from a galaxy merger, which led to a 0.7L* galaxy ([Z/H]_gal=+0.15) at\rho~38 h^{-1}_{70} kpc. Outflow from this galaxy may also be responsible for the supersolar ([Z/H]_abs=+0.15), fully ionized absorber at z_abs=0.2018 (-190 km/s from the LLS). The hot OVI absorber likely probes coronal gas about the 0.7 L* galaxy and/or (~0.1 keV) intragroup gas of a spiral-rich system. The association of other strong OVI absorbers with LLS suggests they trace galactic and not intergalactic structures.Comment: Accepted for publication in the Ap

Extremely metal-poor gas at a redshift of 7

In typical astrophysical environments, the abundance of heavy elements ranges from 0.001 to 2 times the solar value. Lower abundances have been seen in selected stars in the Milky Way’s halo and in two quasar absorption systems at redshift z = 3 (ref. 4). These are widely interpreted as relics from the early Universe, when all gas possessed a primordial chemistry. Before now there have been no direct abundance measurements from the first billion years after the Big Bang, when the earliest stars began synthesizing elements. Here we report observations of hydrogen and heavy-element absorption in a spectrum of a quasar at z =  7.04, when the Universe was just 772 million years old (5.6 per cent of its present age). We detect a large column of neutral hydrogen but no corresponding metals (defined as elements heavier than helium), limiting the chemical abundance to less than 1/10,000 times the solar level if the gas is in a gravitationally bound proto-galaxy, or to less than 1/1,000 times the solar value if it is diffuse and unbound. If the absorption is truly intergalactic, it would imply that the Universe was neither ionized by starlight nor chemically enriched in this neighbourhood at z ≈ 7. If it is gravitationally bound, the inferred abundance is too low to promote efficient cooling, and the system would be a viable site to form the predicted but as yet unobserved massive population III stars

HERALD (Health Economics using Routine Anonymised Linked Data)

&lt;b&gt;Background&lt;/b&gt; Health economic analysis traditionally relies on patient derived questionnaire data, routine datasets, and outcomes data from experimental randomised control trials and other clinical studies, which are generally used as stand-alone datasets. Herein, we outline the potential implications of linking these datasets to give one single joined up data-resource for health economic analysis.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Method&lt;/b&gt; The linkage of individual level data from questionnaires with routinely-captured health care data allows the entire patient journey to be mapped both retrospectively and prospectively. We illustrate this with examples from an Ankylosing Spondylitis (AS) cohort by linking patient reported study dataset with the routinely collected general practitioner (GP) data, inpatient (IP) and outpatient (OP) datasets, and Accident and Emergency department data in Wales. The linked data system allows: (1) retrospective and prospective tracking of patient pathways through multiple healthcare facilities; (2) validation and clarification of patient-reported recall data, complementing the questionnaire/routine data information; (3) obtaining objective measure of the costs of chronic conditions for a longer time horizon, and during the pre-diagnosis period; (4) assessment of health service usage, referral histories, prescribed drugs and co-morbidities; and (5) profiling and stratification of patients relating to disease manifestation, lifestyles, co-morbidities, and associated costs.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; Using the GP data system we tracked about 183 AS patients retrospectively and prospectively from the date of questionnaire completion to gather the following information: (a) number of GP events; (b) presence of a GP 'drug' read codes; and (c) the presence of a GP 'diagnostic' read codes. We tracked 236 and 296 AS patients through the OP and IP data systems respectively to count the number of OP visits; and IP admissions and duration. The results are presented under several patient stratification schemes based on disease severity, functions, age, sex, and the onset of disease symptoms.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusion&lt;/b&gt; The linked data system offers unique opportunities for enhanced longitudinal health economic analysis not possible through the use of traditional isolated datasets. Additionally, this data linkage provides important information to improve diagnostic and referral pathways, and thus helps maximise clinical efficiency and efficiency in the use of resources

Does dissemination extend beyond publication: a survey of a cross section of public funded research in the UK

Background: In the UK, most funding bodies now expect a commitment or effort on the part of grant holders to disseminate the findings of their research. The emphasis is on ensuring that publicly funded research is made available, can be used to support decision making, and ultimately improve the quality and delivery of healthcare provided. In this study, we aimed to describe the dissemination practices and impacts of applied and public health researchers working across the UK.Methods: We conducted a survey of 485 UK-based principal investigators of publicly funded applied and public health research. Participants were contacted by email and invited to complete an online questionnaire via an embedded URL. Gift vouchers were given to all participants who completed the questionnaire. Four reminder emails were sent out to non-respondents at one, two, three, and four weeks; a fifth postal reminder was also undertaken.Results: A total of 243/485 (50%) questionnaires were returned (232 completed, 11 declining to participate). Most researchers recognise the importance of and appear committed to research dissemination. However, most dissemination activity beyond the publishing of academic papers appears to be undertaken an ad hoc fashion. There is some evidence that access to dissemination advice and support may facilitate more policy interactions; though access to such resources is lacking at an institutional level, and advice from funders can be variable. Although a minority of respondents routinely record details about the impact of their research, when asked about impact in relation to specific research projects most were able to provide simple narrative descriptions.Conclusions: Researchers recognise the importance of and appear committed to disseminating the findings of their work. Although researchers are focussed on academic publication, a range of dissemination activities are being applied albeit in an ad hoc fashion. However, what constitutes effective dissemination (in terms of impact and return on investment) remains unclear. Researchers need greater and clearer guidance on how best to plan, resource, and facilitate their dissemination activities