Health inequalities, multimorbidity, and primary care in Scotland

Scotland has an ageing population and the widest health inequalities in Western Europe. Multiple health conditions develop ∼10–15 years earlier in deprived areas than in affluent areas. General practice is central to the effective and safe management of such complex multiple health conditions, but the inverse care law has permeated deprived communities (‘Deep End’ general practices) for the past 50 years. A new, radical, Scottish GP contract was introduced in April 2018, which has a vision to improve quality of care through cluster working and expansion of the multidisciplinary team (MDT), enabling GPs to deliver ‘expert generalism’ to patients with complex needs. It states a specific intention to address health inequalities and also to support the integration of health and social care. Here, we discuss recent evidence for whether the ambition of the new GP contract, to reduce health inequalities, is being achieved

Suitability Evaluation of Three Tropical Pasture Species (Mulato II, Gatton Panic, and Rhodes Grass) for Cultivation under a Subtropical Climate of Australia

Exploring improved tropical forages is considered to be an important approach in delivering quality and consistent feed options for dairy cattle in tropical and subtropical regions. The present study aimed to study the suitability of three improved tropical grasses, Chloris gayana ‘Rhodes grass cv. Reclaimer’ (RR), Megathyrsus maximus ‘Gatton Panic’ (GP), and Brachiaria ruziziensis x B. decumbens x B. brizantha ‘Brachiaria Mulato II’ (BM) evaluating their carbon assimilation, canopy structure, herbage plant–part accumulation and quality parameters under irrigated conditions. An experiment was conducted at Gatton Research Dairy (27°54′ S, 152°33′ E, 89 m asl) Queensland, Australia, which has a predominantly subtropical climate. Photosynthesis biochemistry, canopy structure, herbage accumulation, plant part composition, and nutritive value were evaluated. Photosynthesis biochemistry differed between pasture species. Efficiency of CO2 assimilation was highest for GP and quantum efficiency was highest for BM. Pasture canopy structure was significantly affected by an interaction between pasture species and harvest. Forage biomass accumulation was highest in GP, while BM produced more leaf and less stem compared to both GP and RR. A greater leafy stratum and lower stemmy stratum depth were observed in the vertical sward structure of BM. Brachiaria Mulato II showed greater carbon partitioning to leaves, leaf: stem ratio, canopy, and leaf bulk density. It also demonstrated greater nutritive value (Total digestible nutrients (TDN), acid detergent fibre (ADF), neutral detergent fibre (NDF), neutral detergent insoluble protein (NDICP), Starch, nonfibre carbohydrates (NFC), metabolisable energy (ME), mineral profile (Mg, P, K, Fe, Zn) and dietary cation–anion difference (DCAD) for leaf, stem, and the whole plant. Greater quantum efficiency, leaf accumulation, and nutritive value of BM observed in the present study suggest BM as an attractive forage option for dairying that warrants further research in pasture-based systems in tropical and subtropical climates

Using Self-Determination Theory in research and evaluation in primary care

BACKGROUND: Multimorbidity (the co‐existence of two or more long‐term conditions within an individual) is a complex management challenge, with a very limited evidence base. Theories can help in the design and operationalization of complex interventions. OBJECTIVE: This article proposes self‐determination theory (SDT) as a candidate theory for the development and evaluation of interventions in multimorbidity. METHODS: We provide an overview of SDT, its use in research to date, and its potential utility in complex interventions for patients with multimorbidity based on the new MRC framework. RESULTS: SDT‐based interventions have mainly focused on health behaviour change in the primary prevention of disease, with limited use in primary care and chronic conditions management. However, SDT may be a useful candidate theory in informing complex intervention development and evaluation, both in randomized controlled trials and in evaluations of ‘natural experiments’. We illustrate how it could be used multimorbidity interventions in primary care by drawing on the example of CARE Plus (a primary care‐based complex intervention for patients with multimorbidity in deprived areas of Scotland). CONCLUSIONS: SDT may have utility in both the design and evaluation of complex interventions for multimorbidity. Further research is required to establish its usefulness, and limitations, compared with other candidate theories. PATIENT OR PUBLIC CONTRIBUTION: Our funded research programme, of which this paper is an early output, has a newly embedded patient and public involvement group of four members with lived experience of long‐term conditions and/or of being informal carers. They read and commented on the draft manuscript and made useful suggestions on the text. They will be fully involved at all stages in the rest of the programme of research

Wide Angle X-ray Sky Monitoring for Corroborating non-Electromagnetic Cosmic Transients

Gravitational waves (GW) can be emitted from coalescing neutron star (NS) and black hole-neutron star (BH-NS) binaries, which are thought to be the sources of short hard gamma ray bursts (SHBs). The gamma ray fireballs seem to be beamed into a small solid angle and therefore only a fraction of detectable GW events is expected to be observationally coincident with SHBs. Similarly ultrahigh energy (UHE) neutrino signals associated with gamma ray bursts (GRBs) could fail to be corroborated by prompt gamma-ray emission if the latter is beamed in a narrower cone than the neutrinos. Alternative ways to corroborate non-electromagnetic signals from coalescing neutron stars are therefore all the more desirable. It is noted here that the extended X-ray tails (XRT) of SHBs are similar to X-ray flashes (XRFs), and that both can be attributed to an off-axis line of sight and thus span a larger solid angle than the hard emission. It is proposed that a higher fraction of detectable GW events may be coincident with XRF/XRT than with hard gamma-rays, thereby enhancing the possibility to detect it as a GW or neutrino source. Scattered gamma-rays, which may subtend a much larger solid angle that the primary gamma ray jet, are also candidates for corroborating non-electromagnetic signals.Comment: 13 pages, accepted for publication in Astrophysical Journal Letter

A mixed-methods evaluation of patients’ views on primary care multi-disciplinary teams in Scotland

BackgroundExpanding primary care multi-disciplinary teams (MDTs) was a key component of the 2018 Scottish GP contract, with over 4,700 MDT staff appointed since then.AimTo explore patients’ views on primary care MDT expansion in Scotland.Design and methods(1) Survey of patients recently consulting a GP in deprived-urban, affluent-urban and remote/rural areas, assessing awareness of five MDT roles and attitudes towards receptionist signposting; (2) 30 individual interviews exploring MDT-care experiences.ResultsOf 1,053 survey respondents, most were unaware of the option of MDT rather than GP consultations for three out of five roles (69% unaware of link worker appointments; 68% mental health nurse; 58% pharmacist). Reception signposting was less popular in deprived-urban areas (34% unhappy vs 29% in remote/rural vs 21% affluent-urban; p&lt;0.001), and in patients with multimorbidity (31% unhappy vs 24% in non-multimorbid; p&lt;0.05).Two-thirds of interviewees had multimorbidity and almost all reported positive MDT-care experiences. However, MDT-care was generally seen as a supplement rather than a substitute for GP care. Around half of patients expressed concerns about reception signposting. These patients were more likely to also express concerns about GP access in general. Both of these concerns were more common in deprived-urban areas than in remote/rural or affluent-urban areas.ConclusionMDT-care has expanded in Scotland with limited patient awareness. Although patients understand its potential value, many are unhappy with reception signposting to first-contact MDT care, especially those in deprived-urban areas living with multimorbidity. This represents a barrier to the aims of the new GP contract.<br/

Design and simulation of a high-gain organic operational amplifier for use in quantification of cholesterol in low-cost point-of-care devices

© The Institution of Engineering and Technology. This paper presents circuit design and simulations of a high gain organic Op-Amp, for use in quantification of real cholesterol, in the range of 1-9 mM. A 7-stage inverter chain is added onto the design so as to enhance the amplifier gain. The circuit adapts p-channel transistors only (PMOS) design architecture with saturated loads, simulated on a conventional platform, using appropriate OTFT model and associated parameters. The effect of variation in threshold voltage on circuit operation is also examined. For a supply voltage of ±15 V, the DC output voltage is found to be within an acceptable range of -1 V to -12.5 V, with a highest open loop gain of 83 dB. The closed loop gain is also in agreement with theoretical values, in the range of 1.5 dB to 39 dB, with corresponding bandwidths of 770 Hz to 275 Hz respectively. The latter gain of 39 dB and/or gain-bandwidth product of 10.63 kHz is currently the highest reported in the literature, for this lower supply voltage. The amplifier offers adequate quantification factor, with linear sensitivity of -0.7 V/mM. This paper is the first to adapt organic circuit designs in quantification of cholesterol, with promising outputs, for implementation in low-cost sensor systems

Primary care transformation in Scotland:qualitative evaluation of the views of patients

BackgroundThe new Scottish GP contract introduced in April 2018 aims to improve quality of care through expansion of the multidisciplinary team (MDT) to enable GPs to spend more time as expert medical generalist with patients with complex needs.AimTo explore patients’ views on the changes in general practice in Scotland since the inception of the new contract.Design and SettingQualitative study with 30 patients (10 living in urban deprived areas, 10 living in urban affluent/mixed urban areas, and 10 living in remote and rural areas).MethodsIn-depth semi-structured interviews with thematic analysis. ResultsPatients were generally unaware of the new GP contract, attributing recent changes in general practice to the COVID-19 pandemic. Ongoing concerns included access to GP consultations (especially face-to-face ones), short consultation length with GPs, and damage to continuity of care and the GP-patient relationship. Most patients spoke positively about consultations with MDT staff but still wanted to see a known GP for health concerns that they considered potentially serious. These issues were especially concerning for patients with multiple complex problems, particularly those from deprived areas. ConclusionFollowing the introduction of the new Scottish GP contract, patients in our sample were accepting of first contact care from the MDT but still wanted continuity of care and longer face-to-face consultations with GPs. These findings suggest that the expert generalist role of the GP is not being adequately supported by the new contract, especially in deprived areas, though further quantitative research is required to confirm this. Key words: Primary care transformation, reform, GP contract, patients’ views, multimorbidity, deprivation<br/