Integrated health and care systems in England : can they help prevent disease?

Objectives: Over the past 12 months, there has been increasing policy rhetoric regarding the role of the NHS in preventing disease and improving population health. In particular, the NHS Long Term Plan sees integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) as routes to improving disease prevention. Here, we place current NHS England integrated care plans in their historical context and review evidence on the relationship between integrated care and prevention. We ask how the NHS Long Term Plan may help prevent disease and explore the role of the 2019 ICS and STP plans in delivering this change. Methods: We reviewed the evidence underlying the relationship between integrated care and disease prevention, and analysed 2016 STP plans for content relating to disease prevention and population health. Results: The evidence of more integrated care leading to better disease prevention is weak. Although nearly all 2016 STP plans included a prevention or population health strategy, fewer than half specified how they will work with local government public health teams, and there was incomplete coverage across plans about how they would meet NHS England prevention priorities. Plans broadly focused on individual-level approaches to disease prevention, with few describing interventions addressing social determinants of health. Conclusions: For ICSs and STPs to meaningfully prevent disease and improve population health, they need to look beyond their 2016 plans and fill the gaps in the Long Term Plan on social determinants

Dedication to Pierre Lallemand on the Occasion of His Retirement

The fourth international conference for mesoscopic methods in engineering and science (http://www.icmmes. org), held in Munich, Germany, 16–20 July 2007, was closed with a celebration honouring Dr Pierre Lallemand on the occasion of his retirement from the Centre National de la Recherche Scientifique (CNRS) after more than 40 years of service

Itokawa's Opposition Surge seen by Hayabusa/AMICA

Using images acquired by the Hayabusa/AMICA instrument, along with Lederer et al.'s (2008) ground-based observations, we re-examine Itokawa's disk-integrated phase curve. The AMICA images provide critical opposition measurements (between 0.7deg - 9.3deg phase at 540 nm). Using Hapke's model (2012), we fit the updated phase curves at 5 different wavelengths. Preliminary modeling results show a range of porosity values commensurate with those in the literature (Ostro et al. 2004, Gundlach and Blum, 2012, Kiuchi and Nakamura 2014) based on an impact-generated grain size distribution function and grain size range evaluations from the AMICA data (Yano et al. 2006). This wide range on a global porosity is indicative of a highly variable porosity across the surface. The derived transport mean free path and the generally forward scattering nature of the global regolith are indicative of scattering centers (such as cracks, bubbles, and inclusions) that are small compared to the observational wavelengths. The derived regolith properties are compared with the imaging and sample analysis results, providing a test of the predictive capabilities of global disk-integrated measurements. This work suggests that the sub-pixel grain information could be extracted from the photometry, especially around opposition

Osteoprotegerin and Myocardial Fibrosis in Patients with Aortic Stenosis

Left ventricular myocardial fibrosis in patients with aortic stenosis (AS) confers worse prognosis. Plasma osteoprotegerin (OPG), a cytokine from the TNF receptor family, correlates with the degree of valve calcification in AS, reflecting the activity of the tissue RANKL/RANK/OPG (receptor activator of nuclear factor κΒ ligand/RANK/osteoprotegerin) axis, and is associated with poorer outcomes in AS. Its association with myocardial fibrosis is unknown. We hypothesised that OPG levels would reflect the extent of myocardial fibrosis in AS. We included 110 consecutive patients with AS who had undergone late-gadolinium contrast enhanced cardiovascular magnetic resonance (LGE-CMR). Patients were characterised according to pattern of fibrosis (no fibrosis, midwall fibrosis, or chronic myocardial infarction fibrosis). Serum OPG was measured with ELISA and compared between groups defined by valve stenosis severity. Some 36 patients had no fibrosis, 38 had midwall fibrosis, and 36 had chronic infarction. Patients with midwall fibrosis did not have higher levels of OPG compared to those without fibrosis (6.78 vs. 5.25 pmol/L, p = 0.12). There was no difference between those with midwall or chronic myocardial infarction fibrosis (6.78 vs. 6.97 pmol/L, p = 0.27). However, OPG levels in patients with chronic myocardial infarction fibrosis were significantly higher than those without fibrosis (p = 0.005)

Spectral Photometric Properties of the Moon

We modeled the solar phase curves of the moon at a series of wavelengths using the full disk telescopic observations [1]. We endeavored to keep the database self-contained, that is, to use the values derived for the solar magnitude and phase curves of the disk-integrated [1]. These observations were made in a suite of 10 narrowband filters between 0.315 microns and 1.06 microns, and in the broad band Johnson UBV filters, as part of a larger program to obtain photoelectric photometry of the larger planets. Two aspects of the lunar observations are unique. First, the observations cover phase angles from 6deg through 120deg. More importantly, the observers used a special 20-mm diameter f/15 fused quartz lens constructed solely for this purpose. The lens reduced the whole lunar image in the focal plane to a size comparable to the planets observed as part of the same program. This image was fed directly into the photometer. Thus, these observations constitute the only existing set of phase curves of the entire lunar disk over a range of wavelengths. Table 1 lists the values of the Hapke model parameters which fit the data. Figure 1 is an example of the model fits to the data

Chronic hepatitis in end-stage renal disease: Comparison of HBsAg-negative and HBsAg-positive patients

Chronic hepatitis in end-stage renal disease: Comparison of HBsAg-negative and HBsAg-positive patients. To determine the outcome of chronic hepatitis in ESRD we studied all 358 renal transplant recipients and 295 hemodialysis patients treated for > 1 year since 1970. The incidence of chronic hepatitis (elevated SGOT for > 1 year) was 15% (N = 54) in transplanted and 3.4% (N = 10) in dialysis patients. Forty-eight percent (26) of transplanted and 50% (5) of dialysis patients were HBsAg positive. In the transplanted group, the clinical outcome of chronic hepatitis was significantly better in HBsAg-negative compared to HBsAg-positive patients; 11% died, none from liver disease, and 32% remitted after a mean follow-up from start of liver disease of 77.3 ± 8.2 months, whereas in the HBsAg-positive group 54% (14) died, nine from liver disease, and one remitted after a follow-up of 90.2 ± 8.9 months. Adverse prognostic factors (age, duration of diabetes, and heart disease) present before ESRD treatment began were similar in both groups, as was duration of follow-up. Only 14% (2/14) of HBsAg-negative patients progressed to chronic active hepatitis on liver biopsy compared to 71% (15/21) of HBsAg-positive patients. Histological stability in those with serial biopsies occurred in 66% (4/6) of HBsAg-negative patients, but in only 18% (13/16) of HBsAg-positive patients with a similar duration of follow-up. No dialysis patients died from liver disease. We conclude that chronic hepatitis occurs more frequently in transplanted than dialyzed patients, and that HBsAg-negative chronic hepatitis has a more benign, clinical, and histological outcome than chronic HBsAg-positive hepatitis in renal transplant recipients