Regulatory incentives and financial reporting quality in public healthcare organisations

English National Health Service Foundation Trusts are subject to a regulatory regime in which the level of monitoring and intervention is determined by performance against two key performance metrics: a ‘financial risk rating’, based on a number of performance metrics, such as the reported surplus margin and return on assets, and a ‘prudential borrowing limit’. In this paper, we investigate the variation in financial reporting quality, proxied by discretionary accruals, with the incentives introduced by this regime. We find: first, that discretionary accruals are managed to report small surpluses; second, that, consistent with the avoidance of regulatory intervention in both the short and medium term, discretionary accruals are more positive when pre-managed performance is below intervention triggering thresholds and more negative when well above threshold; third, that, despite a move away from financial breakeven as the primary performance objective, there remains an aversion to small loss reporting. We further find that the level of discretionary accruals is driven by two metrics of strategic significance: the surplus margin (a measure of retained earnings) and the prudential borrowing limit (a measure of borrowing capacity)

Targeted monitoring for human pharmaceuticals in vulnerable source and final waters

A range of pharmaceuticals has been detected in soils, surface waters and groundwaters across the world. While the reported concentrations are generally low (i.e. sub μg l-1 in surface waters), the substances have been observed throughout the year across a variety of hydrological, climatic and land-use settings. As a result, questions have been raised over the potential for pharmaceuticals in surface waters to enter drinking water supplies and to affect consumers. In a previous Drinking Water Inspectorate (DWI) funded study, results from a simple exposure model were used alongside information on therapeutic doses of pharmaceuticals to identify pharmaceuticals that are likely to be of most concern in UK drinking water sources. However, this previous study was entirely desk-based and did not involve any experimental measurements of pharmaceutical concentrations. The current study was therefore performed to generate actual measurements on the occurrence of pharmaceuticals in source and treated waters in England. The study considered a range of pharmaceutical compounds and their metabolites that have either a) high predicted exposure concentrations; b) toxicological concerns; or c) a low predicted exposure to therapeutic dose ratio. An illicit drug and its major metabolite were also investigated. The study compounds (in total 17) covered a range of chemical classes and varied in terms of their physico-chemical properties. The study was done at four sites where concentrations in source water at the drinking water treatment abstraction point were predicted to be some of the greatest in England. The study therefore is likely to provide a ‘worst case’ assessment of potential human exposure to pharmaceuticals in drinking water in England and Wales. Ten of the 17 study compounds were detected in untreated source waters at sub-μg/l concentrations. Six of these compounds (namely, benzoylecgonine (a metabolite of cocaine), caffeine, carbamazepine (an antiepileptic medicine), carbamazepine epoxide (a metabolite of carbamazepine), ibuprofen and naproxen (both non-steroidal anti-inflammatory drugs) were also detected in treated drinking water. With the exception of carbamazepine epoxide, concentrations in treated drinking water were generally significantly lower than in source water. Even though England is a densely populated country and in some regions there is limited dilution of wastewater effluents, these observations, made at sites that were predicted to have some of the highest concentrations of pharmaceuticals in England and Wales, are in line with results from similar studies performed in other countries. Comparison of measured concentrations of the study compounds in drinking waters with information on therapeutic doses demonstrated that levels of these compounds in drinking water in England are many orders of magnitude lower than levels that are given to patients therapeutically. It would therefore appear that the low or non-detectable levels of pharmaceuticals and illicit drugs present in drinking waters in England and Wales do not pose an appreciable risk to human health

The reaction of Escherichia coli cytochrome bo with H202: Evidence for the formation of an oxyferryl species by two distinct routes

AbstractWe have re-examined the reaction of fast oxidised cytochrome bo with H2O2 in a stopped-flow spectrophotometer. Monitoring the reaction at 582 nm allows us to observe the formation and decay of a spectroscopically distinct intermediate which accumulates transiently prior to the formation of an oxyferryl species previously characterised in this laboratory (Watmough, N.J., Cheesman, M.R., Greenwood, C. and Thomson, A.J. (1994) Biochem. J. 300, 469–475 [1]). The reaction shows three distinct phases of which the fast and intermediate phases are bimolecular and show a marked pH dependence. Initially these results appeared incompatible with the report that only one equivalent of H2O2 is required to generate the oxyferryl species (Moody, A.J. and Rich, P.R. (1994) Eur. J. Biochem. 226, 731–737 [2]). However, these data can be reconciled by a branched reaction mechanism whose contributions differ according to the peroxide concentration used

The diversity of CM carbonaceous chondrite parent bodies explored using Lewis Cliff 85311

Lewis Cliff (LEW) 85311 is classified as a Mighei-like (CM) carbonaceous chondrite, yet it has some unusual properties that highlight an unrealised diversity within the CMs, and also questions how many parent bodies are sampled by the group. This meteorite is composed of rimmed chondrules, chondrule fragments and refractory inclusions that are set in a fine-grained phyllosilicate-rich matrix. The chondrules are of a similar size to those in the CMs, and have narrow fine-grained rims. LEW 85311 has been mildly aqueously altered, as evidenced by the preservation of melilite and kamacite, and X-ray diffraction results showing a low phyllosilicate fraction and a high ratio of cronstedtite to Fe,Mg serpentine. The chemical composition of LEW 85311 matrix, fine-grained rims, tochilinite and P-rich sulphides is similar to mildly aqueously altered CMs. LEW 85311 is enriched in refractory elements and REEs such that its CI-normalised profile falls between the CMs and CVs, and its oxygen isotopic composition plots in the CV-CK-CO field. Other distinctive properties of this meteorite include the presence of abundant refractory inclusions, and hundreds of micrometer size objects composed of needle-fibre calcite. LEW 85311 could come from part of a single CM parent body that was unusually rich in refractory inclusions, but more likely samples a different parent body to most other members of the group that accreted a subtly different mixture of materials. The mineralogical and geochemical evolution of LEW 85311 during subsequent aqueous alteration was similar to other CMs and was arrested at an early stage, corresponding to a petrologic subtype of CM2.7, probably due to an unusually low proportion of accreted ice. The CM carbonaceous chondrites sample multiple parent bodies whose similar size and inventory of accreted materials, including radiogenic isotopes, led to a comparable post-accretionary evolution

Can Forel–Ule Index Act as a Proxy of Water Quality in Temperate Waters? Application of Plume Mapping in Liverpool Bay, UK

The use of ocean colour classification algorithms, linked to water quality gradients, can be a useful tool for mapping river plumes in both tropical and temperate systems. This approach has been applied in operational water quality programs in the Great Barrier Reef to map river plumes and assess trends in marine water composition and ecosystem health during flood periods. In this study, we used the Forel–Ule colour classification algorithm for Sentinel-3 OLCI imagery in an automated process to map monthly, annual and long-term plume movement in the temperate coastal system of Liverpool Bay (UK). We compared monthly river plume extent to the river flow and in situ water quality data between 2017–2020. The results showed a strong positive correlation (Spearman’s rho = 0.68) between the river plume extent and the river flow and a strong link between the FUI defined waterbodies and nutrients, SPM, turbidity and salinity, hence the potential of the Forel–Ule index to act as a proxy for water quality in the temperate Liverpool Bay water. The paper discusses how the Forel–Ule index could be used in operational water quality programs to better understand river plumes and the land-based inputs to the coastal zones in UK waters, drawing parallels with methods that have been developed in the GBR and Citclops project. Overall, this paper provides the first insight into the systematic long-term river plume mapping in UK coastal waters using a fast, cost-effective, and reproducible workflow. The study created a novel water assessment typology based on the common physical, chemical and biological ocean colour properties captured in the Forel–Ule index, which could replace the more traditional eutrophication assessment regions centred around strict geographic and political boundaries. Additionally, the Forel–Ule assessment typology is particularly important since it identifies areas of the greatest impact from the land-based loads into the marine environment, and thus potential risks to vulnerable ecosystems

Shock compaction heating and collisional processes in the production of type 3 ordinary chondrites: Lessons from the (nearly) unique L3 chondrite melt breccia Northwest Africa 8709*

Northwest Africa (NWA) 8709 is a rare example of a type 3 ordinary chondrite melt breccia and provides critical information for the shock compaction histories of chondrites. An L3 protolith for NWA 8709 is inferred on the basis of oxygen isotope composition, elemental composition, diverse mineral chemistry, and overall texture. NWA 8709 is among the most strongly shocked type 3 chondrites known, and experienced complete melting of the matrix and partial melting of chondrules. Unmelted phases underwent FeO reduction and partial homogenization, with reduction possibly occurring by reaction of olivine and low‐Ca pyroxene with an S‐bearing gas that was produced by vaporization. Chondrules and metal grains became foliated by uniaxial compaction, and during compression, chondrules and fragments became attached to form larger clumps. This process, and possibly also melt incorporation into chondrules to cause “inflation,” may have contributed to anomalously large chondrule sizes in NWA 8709. The melt breccia character is attributed to strong shock affecting a porous precursor. Data‐model comparisons suggest that a precursor with 23% porosity that was impacted by a 3 km/s projectile could have produced the meteorite. The rarity of other type 3 ordinary chondrite melt breccias implies that the immediate precursors to such chondrites were lower in porosity than the NWA 8709 precursor, or experienced weaker shocks. Altogether, the data imply a predominantly “quiet” dynamical environment to form most type 3 ordinary chondrites, with compaction occurring in a series of relatively weak shock events

White matter damage and cognitive impairment after traumatic brain injury

White matter disruption is an important determinant of cognitive impairment after brain injury, but conventional neuroimaging underestimates its extent. In contrast, diffusion tensor imaging provides a validated and sensitive way of identifying the impact of axonal injury. The relationship between cognitive impairment after traumatic brain injury and white matter damage is likely to be complex. We applied a flexible technique—tract-based spatial statistics—to explore whether damage to specific white matter tracts is associated with particular patterns of cognitive impairment. The commonly affected domains of memory, executive function and information processing speed were investigated in 28 patients in the post-acute / chronic phase following traumatic brain injury and in 26 age-matched controls. Analysis of fractional anisotropy and diffusivity maps revealed widespread differences in white matter integrity between the groups. Patients showed large areas of reduced fractional anisotropy, as well as increased mean and axial diffusivities, compared with controls, despite the small amounts of cortical and white matter damage visible on standard imaging. A stratified analysis based on the presence or absence of microbleeds (a marker of diffuse axonal injury) revealed diffusion tensor imaging to be more sensitive than gradient-echo imaging to white matter damage. The location of white matter abnormality predicted cognitive function to some extent. The structure of the fornices was correlated with associative learning and memory across both patient and control groups, whilst the structure of frontal lobe connections showed relationships with executive function that differed in the two groups. These results highlight the complexity of the relationships between white matter structure and cognition. Although widespread and, sometimes, chronic abnormalities of white matter are identifiable following traumatic brain injury, the impact of these changes on cognitive function is likely to depend on damage to key pathways that link nodes in the distributed brain networks supporting high-level cognitive functions