Reforming the public health system in England

The abolition of Public Health England (PHE) during the COVID-19 pandemic has raised concerns about the future of the public health system in the UK, particularly in England. The two new bodies established in haste to replace PHE prompt reflection on the executive agency's fate and the need to identify any lessons to ensure that a public health system is put in place that is fit for purpose. The UK COVID-19 Inquiry provides an opportunity to make recommendations, but it will need to act quickly to avoid recommendations being ignored. Two areas of concern are highlighted in this Viewpoint: the respective remits of the new bodies and their governance arrangements. Both issues demand urgent attention if the new structures are to succeed and avoid a similar fate to that which befell PHE. But underlying these concerns is a much larger challenge arising from the UK's broken political system. The political system in the UK suffers from several systemic weaknesses, including departmentalism, poor implementation, an inability or unwillingness of those in power to listen to the truth, and chronic short-termism at the expense of long-term planning. Overhauling the UK's dysfunctional political system is a prerequisite for successfully improving the public health system

The spatial dynamics of vertical migration by Microcystis aeruginosa in a eutrophic shallow lake: A case study using high spatial resolution time-series airborne remote sensing

Abstract: Time-series airborne remote sensing was used to monitor diurnal changes in the spatial distribution of a bloom of the potentially toxic cyanobacterium Microcystis aeruginosa in the shallow eutrophic waters of Barton Broad, United Kingdom. High spatial resolution images from the Compact Airborne Spectrographic Imager (CASI-2) were acquired over Barton Broad on 29 August 2005 at 09:30 h, 12:00 h, and 16:00 h Greenwich mean time. Semiempirical water-leaving radiance algorithms were derived for the quantification of chlorophyll a (R2 = 0.96) and C-phycocyanin (R2 = 0.95) and applied to the CASI-2 imagery to generate dynamic, spatially resolving maps of the M. aeruginosa bloom. The development of the bloom may have been fostered by a combination of the recent improvements in the ambient light environment of Barton Broad, allied to the acute depletion of bioavailable nutrient pools, and stable hydrodynamic conditions. The vertical distribution of M. aeruginosa was highly transient; buoyant colonies formed early morning and late afternoon near-surface aggregations across the lake during periods of nonturbulent mixing (wind speed <4 m s-1). However, the extent of these near-surface aggregations was highly spatially variable, and nearshore morphometry appeared to be crucial in creating localized regions of nonturbulent water in which pronounced and persistent near-surface aggregations were observed. The formation of these near-surface scums would have been vital in alleviating light starvation in the turbid waters of Barton Broad. The calm water refuges in which persistent near-surface accumulations occurred may have been an important factor in determining the persistence of the bloom

Haplotype analysis of common variants in the BRCA1 gene and risk of sporadic breast cancer

INTRODUCTION: Truncation mutations in the BRCA1 gene cause a substantial increase in risk of breast cancer. However, these mutations are rare in the general population and account for little of the overall incidence of sporadic breast cancer. METHOD: We used whole-gene resequencing data to select haplotype tagging single nucleotide polymorphisms, and examined the association between common haplotypes of BRCA1 and breast cancer in a nested case-control study in the Nurses' Health Study (1323 cases and 1910 controls). RESULTS: One haplotype was associated with a slight increase in risk (odds ratio 1.18, 95% confidence interval 1.02–1.37). A significant interaction (P = 0.05) was seen between this haplotype, positive family history of breast cancer, and breast cancer risk. Although not statistically significant, similar interactions were observed with age at diagnosis and with menopausal status at diagnosis; risk tended to be higher among younger, pre-menopausal women. CONCLUSIONS: We have described a haplotype in the BRCA1 gene that was associated with an approximately 20% increase in risk of sporadic breast cancer in the general population. However, the functional variant(s) responsible for the association are unclear

Public health by organizational fix?

In August 2020 the UK government announced without warning the abolition of Public Health England (PHE), the principal UK agency for the promotion and protection of public health. We undertook a research programme seeking to understand the factors surrounding this decision. While the underlying issues are complex two competing interpretations have emerged: an 'official' explanation, which highlights the failure of PHE to scale up its testing capacity in the early weeks of the COVID-19 pandemic as the fundamental reason for closing it down and a 'sceptical' interpretation, which ascribes the decision to blame-avoidance behaviour on the part of leading government figures. This paper reviews crucial claims in these two competing explanations exploring the arguments for and against each proposition. It concludes that neither is adequate and that the inability adequately to address the problem of testing (which triggered the decision to close PHE) lies deeper in the absence of the norms of responsible government in UK politics and the state. However our findings do provide some guidance to the two new organizations established to replace PHE to maximize their impact on public health. We hope that this information will contribute to the independent national COVID inquiry

The Mitochondrial A10398G Polymorphism, Interaction with Alcohol Consumption, and Breast Cancer Risk

Polymorphisms in the mitochondrial genome are hypothesized to be associated with risk of various diseases, including cancer. However, there has been conflicting evidence for associations between a common polymorphism in the mitochondrial genome (A10398G, G10398A in some prior reports) and breast cancer risk. Reactive oxygen species, a by-product of mitochondrial energy production, can lead to oxidative stress and DNA damage in both the mitochondria and their cells. Alcohol consumption, which may also lead to oxidative stress, is associated with breast cancer risk. Therefore, we hypothesized that polymorphisms in the mitochondrial genome interact with alcohol consumption to alter breast cancer risk. We genotyped the A10398G polymorphism in a case-control study nested within the Nurses' Health Study (NHS, 1,561 cases, 2,209 controls). We observed an interaction between alcohol consumption (yes/no) and A10398G on breast cancer risk (p-int = 0.03). The risk associated with alcohol consumption was limited to carriers of the 10398G allele (Odds Ratio 1.52, 95% Confidence Interval 1.10–2.08 comparing drinkers to non-drinkers). However, we were unable to replicate these findings in the Women's Health Study (WHS, 678 cases, 669 controls), although the power to detect this interaction in the WHS was low (power = 0.57). Further examination of this interaction, such as sufficiently powered epidemiological studies of cancer risk or associations with biomarkers of oxidative stress, may provide further evidence for GxE interactions between the A10398G mitochondrial polymorphism and alcohol consumption on breast cancer risk

Explicit Modeling of Ancestry Improves Polygenic Risk Scores and BLUP Prediction

Polygenic prediction using genome-wide SNPs can provide high prediction accuracy for complex traits. Here, we investigate the question of how to account for genetic ancestry when conducting polygenic prediction. We show that the accuracy of polygenic prediction in structured populations may be partly due to genetic ancestry. However, we hypothesized that explicitly modeling ancestry could improve polygenic prediction accuracy. We analyzed three GWAS of hair color (HC), tanning ability (TA), and basal cell carcinoma (BCC) in European Americans (sample size from 7,440 to 9,822) and considered two widely used polygenic prediction approaches: polygenic risk scores (PRSs) and best linear unbiased prediction (BLUP). We compared polygenic prediction without correction for ancestry to polygenic prediction with ancestry as a separate component in the model. In 10-fold cross-validation using the PRS approach, the R(2) for HC increased by 66% (0.0456-0.0755; P < 10(-16)), the R(2) for TA increased by 123% (0.0154 to 0.0344; P < 10(-16)), and the liability-scale R(2) for BCC increased by 68% (0.0138-0.0232; P < 10(-16)) when explicitly modeling ancestry, which prevents ancestry effects from entering into each SNP effect and being overweighted. Surprisingly, explicitly modeling ancestry produces a similar improvement when using the BLUP approach, which fits all SNPs simultaneously in a single variance component and causes ancestry to be underweighted. We validate our findings via simulations, which show that the differences in prediction accuracy will increase in magnitude as sample sizes increase. In summary, our results show that explicitly modeling ancestry can be important in both PRS and BLUP prediction

Luminance contrast provides metric depth information

The perception of depth from retinal images depends on information from multiple visual cues. One potential depth cue is the statistical relationship between luminance and distance; darker points in a local region of an image tend to be farther away than brighter points. We establish that this statistical relationship acts as a quantitative cue to depth. We show that luminance variations affect depth in naturalistic scenes containing multiple cues to depth. This occurred when the correlation between variations of luminance and depth was manipulated within an object, but not between objects. This is consistent with the local nature of the statistical relationship in natural scenes. We also showed that perceived depth increases as contrast is increased, but only when the depth signalled by luminance and binocular disparity are consistent. Our results show that the negative correlation between luminance and distance, as found under diffuse lighting, provides a depth cue that is combined with depth from binocular disparity, in a way that is consistent with the simultaneous estimation of surface depth and reflectance variations. Adopting more complex lighting models such as ambient occlusion in computer rendering will thus contribute to the accuracy as well as the aesthetic appearance of three-dimensional graphics

A Further Look at Potential Impact of Satlets on Design, Production, and Cost of Satellite Systems

For the past 50 years, the morphology for satellites has remained fundamentally unchanged despite evolutions in manufacturing, communications, and software occurring in other industries. Primary spacecraft support systems—power, attitude control, and others—are designed in the same way, whether in space telescopes, large communications satellites, interplanetary spacecraft, or Cubesats. This paradigm has been the status quo in spacecraft design and construction and has precluded any industry-wide, large-scale cost savings while maintaining performance. To change this trend and ensure performance and utility at low cost, that can scale, DARPA postulated the concept of a cellularized satellite, or “satlet,” as a satellite architectural unit. In this new morphology, each satlet would provide some fraction of the overall functions that, when aggregated via hardware and software, provide spacecraft space system with its complete required capabilities. The DARPA Phoenix program has developed this satlet morphology in Phase I and plans to validate and demonstrate it in a series of steps that exercise various applications and levels of configuration flexibility enabled by a satlet architecture. The first system experiment is planned to be conducted on orbit in 2015. This paper aims to take a deeper look at the potential impact of space systems with cellular based designs, and using historical data showcases how design, production and ultimately cost can form the foundation for next generation spacecraft opportunities. A first order analysis conducted in a previous paper indicated that U.S.-launched satellites alone could create a market demand for 2,000-8,000 satlets flown per year, while the overall annual world satellite market could create demand for 10,000-40,000 satlets. This paper explores the instantiation of a cellular morphology to design, production and development to further quantify the impact of this revolutionary space system capability

Public Involvement in Health Priority Setting: Future Challenges for Policy, Research and Society

AbstractPurposeThe article reflects on the findings of this special issue and discusses the futurechallenges for policy, research and society. The findings suggest that challengesemerge as a result of legitimacy deficits of both consensus and contestatory modes of public involvement in health priority setting.Design/Methodology/ApproachThe article draws on the discussions and findings presented in this special issue. It seeks to bring the country experiences and case studies together to draw conclusions for policy, research and society.FindingsAt least two recurring themes emerge. An underlying theme is the importance, but also the challenge, of establishing legitimacy in health priority setting. The country experiences suggest that we understand very little about the conditions under which representative, or authentic, participation generates legitimacy and under which it will be regarded as insufficient. A second observation is that public participation takes a variety of forms that depend on the opportunity structures in a given national context. Given this variety the conceptualization of public participation needs to be expanded to account for the many forms of public participation.Originality/ValueThe article concludes that the challenges of public involvement are closely linked to the question of how legitimate processes and decisions can be generated in priority setting. This suggests that future research must focus more narrowly on conditions under which legitimacy are generated in order to expand our understanding of public involvement in health prioritization.KeywordsPublic participation, priority setting, legitimacy, authentic representation, equitable health coverageArticle ClassificationGeneral Revie