Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study

Objective: To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study. Design: Cross-sectional survey and qualitative interviews. Setting: Scotland and North West England. Participants: Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees. Methods: Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data. Results: Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; p<0.001). Net agreement for provider incentives for breastfeeding targets was 44.1% (219/497) and net disagreement was 38.6% (192/497). Agreement was more likely for women (compared with men): OR 1.81 (1.09 to 3.00; p=0.023) and health visitors/maternity staff (compared with doctors): OR 2.54 (95% CI 1.65 to 3.91; p<0.001). Key emergent themes were 'moral tensions around acceptability', 'need for incentives', 'goals', 'collective or divisive action' and 'monitoring and proof'. While provider incentives can focus action and resources, tensions around the impact on relationships raised concerns. Pressure, burden of proof, gaming, box-ticking bureaucracies and health inequalities were counterbalances to potential benefits. Conclusions: Provider incentives are favoured by non-medical staff. Solutions which increase trust and collaboration towards shared goals, without negatively impacting on relationships or increasing bureaucracy are required

GeoVisual analytics: interactivity, dynamics, and scale

3D desktop-based virtual environments provide a means for displaying quantitative data in context. Data that is inherently spatial in three-dimensions may benefit from visual exploration and analysis in relation to the environment in which they were collected and to which they relate. We empirically evaluate how effectively and efficiently such data can be visually analyzed in relation to location and landform in 3D versus 2D visualizations. In two experiments, participants performed visual analysis tasks in 2D and 3D visualizations and reported insights and their confidence in them. The results showed only small differences between the 2D and 3D visualizations in the performance measures that we evaluated: task completion time, confidence, complexity, and insight plausibility. However, we found differences for different data sets and settings suggesting that 3D visualizations, or 2D representations respectively, may be more or less useful for particular data sets and contexts

Detailed equilibrium and dynamical tides: impact on circularization and synchronization in open clusters

Binary stars evolve into chemically-peculiar objects and are a major driver of the Galactic enrichment of heavy elements. During their evolution they undergo interactions, including tides, that circularize orbits and synchronize stellar spins, impacting both individual systems and stellar populations. Using Zahn's tidal theory and MESA main-sequence model grids, we derive the governing parameters $\lambda_{lm}$ and $E_2$, and implement them in the new MINT library of the stellar population code BINARY_C. Our MINT equilibrium tides are 2 to 5 times more efficient than the ubiquitous BSE prescriptions while the radiative-tide efficiency drops sharply with increasing age. We also implement precise initial distributions based on bias-corrected observations. We assess the impact of tides and initial orbital-parameter distributions on circularization and synchronization in eight open clusters, comparing synthetic populations and observations through a bootstrapping method. We find that changing the tidal prescription yields no statistically-significant improvement as both calculations typically lie within 0.5$\sigma$. The initial distribution, especially the primordial concentration of systems at $\log_{10}(P/{\rm d}) \approx 0.8, e\approx 0.05$ dominates the statistics even when artificially increasing tidal strength. This confirms the inefficiency of tides on the main sequence and shows that constraining tidal-efficiency parameters using the $e-\log_{10}(P/{\rm d})$ distribution alone is difficult or impossible. Orbital synchronization carries a more striking age-dependent signature of tidal interactions. In M35 we find twice as many synchronized rotators in our MINT calculation as with BSE. This measure of tidal efficiency is verifiable with combined measurements of orbital parameters and stellar spins.Comment: 24 pages, 29 figures includings appendices. Accepted for publication in MNRA

Direct characterization of the native structure and mechanics of cyanobacterial carboxysomes

Carboxysomes are proteinaceous organelles that play essential roles in enhancing carbon fixation in cyanobacteria and some proteobacteria. These self-assembling organelles encapsulate Ribulose 1,5-bisphosphate carboxylase/oxygenase (Rubisco) and carbonic anhydrase using a protein shell structurally resembling an icosahedral viral capsid. The protein shell serves as a physical barrier to protect enzymes from the cytosol and a selectively permeable membrane to mediate transport of enzyme substrates and products. The structural and mechanical nature of native carboxysomes remain unclear. Here, we isolate functional β-carboxysomes from the cyanobacterium Synechococcus elongatus PCC7942 and perform the first characterization of the macromolecular architecture and inherent physical mechanics of single β-carboxysomes using electron microscopy, atomic force microscopy (AFM) and proteomics. Our results illustrate that the intact β-carboxysome comprises three structural domains, a single-layered icosahedral shell, an inner layer and paracrystalline arrays of interior Rubisco. We also observe the protein organization of the shell and partial β-carboxysomes that likely serve as the β-carboxysome assembly intermediates. Furthermore, the topography and intrinsic mechanics of functional β-carboxysomes are determined in native conditions using AFM and AFM-based nanoindentation, revealing the flexible organization and soft mechanical properties of β-carboxysomes compared to rigid viruses. Our study provides new insights into the natural characteristics of β-carboxysome organization and nanomechanics, which can be extended to diverse bacterial microcompartments and are important considerations for the design and engineering of functional carboxysomes in other organisms to supercharge photosynthesis. It offers an approach for inspecting the structural and mechanical features of synthetic metabolic organelles and protein scaffolds in bioengineering

Crab cavities for linear colliders

Crab cavities have been proposed for a wide number of accelerators and interest in crab cavities has recently increased after the successful operation of a pair of crab cavities in KEK-B. In particular crab cavities are required for both the ILC and CLIC linear colliders for bunch alignment. Consideration of bunch structure and size constraints favour a 3.9 GHz superconducting, multi-cell cavity as the solution for ILC, whilst bunch structure and beam-loading considerations suggest an X-band copper travelling wave structure for CLIC. These two cavity solutions are very different in design but share complex design issues. Phase stabilisation, beam loading, wakefields and mode damping are fundamental issues for these crab cavities. Requirements and potential design solutions will be discussed for both colliders.Comment: 3 pages. To be published in proceedings of LINAC 2008, Victoria, Canad

Demography of Dialysis and Transplantation in Children in Europe, 1985: Report from the European Dialysis and Transplant Association Registry

At the end of 1985 there were 5482 patients known to the Registry who started renal replacement therapy (RRT) between the ages of 6 months and 15 years. Of these, approximately 25% had died, 30% were still aged less than 15 years, and the other 45% were older. The acceptance rate of new patients over the last 10 years has slowly but steadily increased; six new paediatric patients per million child population probably represents the likely needs of the near future. Hospital haemodialysis remained the main form of renal replacement therapy in new patients, while 3 years after start of RRT, transplantation became the most frequently used replacement therapy; CAPD appeared to be used mainly in children with a short waiting time for transplantation. Out of the 384 grafts reported in 1985, only 16% were from living related donors; among 321 cadaver grafts, 24% were second and only 3% were third grafts. Glomerulonephritis and pyelonephritis accounted for 50% of all primary renal diseases. During the last 5 years, the proportion with glomerulonephritis seems to have decreased slightly. Hyperkalaemia and fluid overload have still to be considered the main causes of death. Only in 17% of all cases was the cause of death reported as unknown or undetermine

Survival on Renal Replacement Therapy: Data from the EDTA Registry

Extensive survival data are presented from the EDTA Registry's files for patients who started renal replacement therapy in 1970-1974 compared to 1980-1984. The contribution of the different treatment modalities (haemodialysis, continuous peritoneal dialysis, and transplantation) to the survival of patients according to geographical region is also shown. Survival on renal replacement therapy, irrespective of treatment modality and of primary renal disease, was best in the 10-14-year-old patients, with 58% at 10 years and 52% at 15 years, and decreased with rising age to 28% at 10 years and 16% at 15 years in patients aged 45-54 when they commenced therapy in 1970-1974. When comparing the 0-4-year-old with the 10-14-year-old cohort of the paediatric patients, 5-year survival rates for patients starting renal replacement therapy in the early eighties declined from 85% to 70% with decreasing age. Treatment policy, as reflected by the proportion of patients on different modes of therapy, varied markedly between European regions but affected survival to a small extent only. The large population with diabetic nephropathy incurred annual mortality rates 2-3 times greater than those observed in patients with ‘standard' primary renal diseases. Haemodialysis and continuous peritoneal dialysis, although not comparable because of important differences in selection policy, yielded similar survival rates. Patient and graft survival rates have improved markedly when comparing patients starting renal replacement therapy in the early seventies with the eighties; particularly for cadaveric transplantation. Patient survival after second grafting was similar to that after first grafting, with 83% at 5 years after second cadaveric grafting in the 15-44-year-old cohort, vs 85% after first cadaver transplantation in 1980-1984. Second cadaveric graft survival was superior to average first-graft survival for those recipients whose first graft had been functioning for more than 1 year. However, second-graft survival in rapid rejectors of a first graft as well as third cadaveric graft survival were curtailed by the large number of early losses, with only 52% of third grafts functioning at 1 year. For living related donor transplantation, parents were mostly used in children whilst identical siblings predominated in adults older than 45. In the early eighties, patient survival was 92% at 5 years for recipients younger than 15, 87% for the 15-45 year old cohort and 72% for those aged 45 or older. From the overall survival rates on renal replacement therapy obtained at 5 years in the early eighties, it appears safe to predict that at least 65% of young adults and 25% of patients aged 55-64 will be surviving at 10 years after starting therap

EDTA Registry Centre Survey, 1986: Report from the European Dialysis and Transplant Association Registry

This paper summarises the information given on the 1986 EDTA Registry centre questionnaire which was returned by 82% of the 2,065 known dialysis and transplant centres in 33 European countries. Information is given on the number of patients alive on haemodialysis according to the type of dialysis facilities available where the patient was receiving dialysis and the number of patients receiving special types of dialysis. The centre questionnaire also included questions on testing for HIV infection, serological evidence or symptoms of AIDS and the diagnosis of hepatitis B in patients and staff. The data given in response to these questions are presented together with data on the involvement of dietitians and social workers in the treatment of patients with end stage renal failure. Finally, information on transplant activity in Europe and the treatment policies of transplanting centres is provide