General practice size determines participation in optional activities: cross-sectional analysis of a national primary care system

Background: There is widespread, unexplained variation in activity and outcome between general practices. <BR/> Aim: To explore the relationship between practice size and participation in optional activities, including the Quality and Outcomes Framework (QOF). <BR/> Design of study: Cross-sectional analyses of routinely available data on practice characteristics, QOF performance and optional activities including undergraduate teaching, postgraduate training, research, enhanced clinical data collection and service development. <BR/> Setting: All 1031 general practices were located in mainland Scotland. <BR/> Results: The most popular optional activity was undergraduate medical teaching, which involved 41% of all general practices. About a third of practices took part in postgraduate general practitioner training (29%), research (33%), enhanced clinical data collection through the Scottish Programme for Improving Clinical Effectiveness (31%) and the activities of the Scottish Primary Care Collaborative (33%). The most important driver of the number of activities undertaken by a practice is size with single handed, small and medium sized practices all undertaking a significantly lower number of activities than larger practices (P < 0.001). Deprivation had no overall effect, but was associated with lower rates of participation in postgraduate training. The average number of points achieved in the QOF ranged from 961 by the 18% of practices taking part in no optional activities, to 973 by 29% of practices taking part in one activity, 984 by 25% of practices taking part in two activities and 985 in 28% of practices taking part in three or more activities. Single handed practices in urban areas taking part in three or more additional activities had similar QOF point totals to larger practices taking part in three or more activities, and achieved 44 more QOF points than urban single-handed practices taking part in less than two additional activities. <BR/> Conclusions: Practice size is strongly related to participation in optional activities. There is a small but significant relationship between the practice size and number of QOF points achieved by practices taking part in less than two additional activities. Participation in optional activities is a possible indicator of cultural and organisational factors within practices, which constrain the volume and quality of services, which they are able to provide

Individuals Maintain Similar Rates of Protein Synthesis Over Time on the Same Plane of Nutrition Under Controlled Environmental Conditions

Consistent individual differences in animal performance drive individual fitness under variable environmental conditions and provide the framework through which natural selection can operate. Underlying this concept is the assumption that individuals will display consistent levels of performance in fitness-related traits and interest has focused on individual variation and broad sense repeatability in a range of behavioural and physiological traits. Despite playing a central role in maintenance and growth, and with considerable inter-individual variation documented, broad sense repeatability in rates of protein synthesis has not been assessed. In this study we show for the first time that juvenile flounder Platichthys flesus reared under controlled environmental conditions on the same plane of nutrition for 46 days maintain consistent whole-animal absolute rates of protein synthesis (As). By feeding meals containing 15N-labelled protein and using a stochastic end-point model, two non-terminal measures of protein synthesis were made 32 days apart (d14 and d46). As values (mass-corrected to a standard mass of 12 g) showed 2- to 3-fold variation between individuals on d14 and d46 but individuals showed similar As values on both days with a broad sense repeatability estimate of 0.684 indicating significant consistency in physiological performance under controlled experimental conditions. The use of non-terminal methodologies in studies of animal ecophysiology to make repeat measures of physiological performance enables known individuals to be tracked across changing conditions. Adopting this approach, repeat measures of protein synthesis under controlled conditions will allow individual ontogenetic changes in protein metabolism to be assessed to better understand the ageing process and to determine individual physiological adaptive capacity, and associated energetic costs of adaptation, to global environmental change

Action semantics in retrospect

This paper is a themed account of the action semantics project, which Peter Mosses has led since the 1980s. It explains his motivations for developing action semantics, the inspirations behind its design, and the foundations of action semantics based on unified algebras. It goes on to outline some applications of action semantics to describe real programming languages, and some efforts to implement programming languages using action semantics directed compiler generation. It concludes by outlining more recent developments and reflecting on the success of the action semantics project

Genome-Wide Association Study in BRCA1 Mutation Carriers Identifies Novel Loci Associated with Breast and Ovarian Cancer Risk

BRCA1-associated breast and ovarian cancer risks can be modified by common genetic variants. To identify further cancer risk-modifying loci, we performed a multi-stage GWAS of 11,705 BRCA1 carriers (of whom 5,920 were diagnosed with breast and 1,839 were diagnosed with ovarian cancer), with a further replication in an additional sample of 2,646 BRCA1 carriers. We identified a novel breast cancer risk modifier locus at 1q32 for BRCA1 carriers (rs2290854, P = 2.7×10-8, HR = 1.14, 95% CI: 1.09-1.20). In addition, we identified two novel ovarian cancer risk modifier loci: 17q21.31 (rs17631303, P = 1.4×10-8, HR = 1.27, 95% CI: 1.17-1.38) and 4q32.3 (rs4691139, P = 3.4×10-8, HR = 1.20, 95% CI: 1.17-1.38). The 4q32.3 locus was not associated with ovarian cancer risk in the general population or BRCA2 carriers, suggesting a BRCA1-specific associat

Protein profile changes in trout fed plant proteins

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