Evaluation of the personal health budget pilot programme

1. The personal health budget initiative is a key aspect of personalisation across health care services in England. Its aim is to improve patient outcomes, by placing patients at the centre of decisions about their care. Giving people greater choice and control, with patients working alongside health service professionals to develop and execute a care plan, given a known budget, is intended to encourage more responsiveness of the health and care system. 2. The personal health budget programme was launched by the Department of Health in 2009 after the publication of the 2008 Next Stage Review. An independent evaluation was commissioned alongside the pilot programme with the aim of identifying whether personal health budgets ensured better health and care outcomes when compared to conventional service delivery and, if so, the best way for personal health budgets to be implemented

Wearable mobile sensor and communication platform for the in-situ monitoring of lower limb health in amputees

Monitoring the health of a residual limb in prosthesis is key to detect early signs of tissue injury, and could improve patient quality of life. However, monitoring at skin level could induce possible discomfort and irritation, making the skin susceptible for breakdown. The use of non-invasive sensor technologies within the flexible liner of the prosthetic device can alleviate these issues. The rehabilitation of lower limb prosthesis wearers can be greatly improved by a reliable continuous monitoring system that can alert both the user and health authority by early warning of the development of tissue damage. In this work, we have created a wearable sensor platform for lower limb amputees that is capable of gathering data from the sensors (placed on the elastomer), and store and transmit to a central health database, for the purpose of analyzing it. This paper explores the architecture used, as well as some of the challenges encountered when handling such quantities of data as experienced in this project

Effect of moisture on leaf litter decomposition and its contribution to soil respiration in a temperate forest

The degree to which increased soil respiration rates following wetting is caused by plant (autotrophic) versus microbial (heterotrophic) processes, is still largely uninvestigated. Incubation studies suggest microbial processes play a role but it remains unclear whether there is a stimulation of the microbial population as a whole or an increase in the importance of specific substrates that become available with wetting of the soil. We took advantage of an ongoing manipulation of leaf litter <sup>14</sup>C contents at the Oak Ridge Reservation, Oak Ridge, Tennessee, to (1) determine the degree to which an increase in soil respiration rates that accompanied wetting of litter and soil, following a short period of drought, could be explained by heterotrophic contributions; and (2) investigate the potential causes of increased heterotrophic respiration in incubated litter and 0–5 cm mineral soil. The contribution of leaf litter decomposition increased from 6 ± 3 mg C m<sup>−2</sup> hr<sup>−1</sup> during a transient drought, to 63 ± 18 mg C m<sup>−2</sup> hr<sup>−1</sup> immediately after water addition, corresponding to an increase in the contribution to soil respiration from 5 ± 2% to 37 ± 8%. The increased relative contribution was sufficient to explain all of the observed increase in soil respiration for this one wetting event in the late growing season. Temperature (13°C versus 25°C) and moisture (dry versus field capacity) conditions did not change the relative contributions of different decomposition substrates in incubations, suggesting that more slowly cycling C has at least the same sensitivity to decomposition as faster cycling organic C at the temperature and moisture conditions studied

Historic landscape management: a validation of quantitative soil thin-section analyses

The archaeological interpretation of past land management practices can be greatly enhanced through examination of soil thin sections. Features relating to manuring practice are among those key to interpreting agricultural practices. The sources and the pro¬cesses leading to the distribution of these manure materials may further improve knowledge of the past landscape utilisation. The use of quantitative analyses to examine soil thin sections opens the possibility of considering these relationships between manured areas in greater detail and to extract more subtle spatial and temporal changes in past management. In this study the validation of this methodology has been tested with quantitative image analysis methods used to examine manure inputs to a well-documented historical landscape of Papa Stour, Shetland, where intensive manuring has been practised until the 1960s. By using both historic and ethnographic evidence to validate the image analysis protocol, differences in spatial and temporal distribution are examined for the practices of manuring with both fuel residues and with turf. The validation of the hypotheses expected from ethnographic and historical data that quantitative soils-based evidence allows the definition of variations in manuring strategies and provides a more secure basis from which to interpret manuring management strategies in archaeological landscapes

Crossing the `Yellow Void' -- Spatially Resolved Spectroscopy of the Post- Red Supergiant IRC+10420 and Its Circumstellar Ejecta

IRC +10420 is one of the extreme hypergiant stars that define the empirical upper luminosity boundary in the HR diagram. During their post--RSG evolution, these massive stars enter a temperature range (6000-9000 K) of increased dynamical instability, high mass loss, and increasing opacity, a semi--forbidden region, that de Jager and his collaborators have called the `yellow void'. We report HST/STIS spatially resolved spectroscopy of IRC +10420 and its reflection nebula with some surprising results. Long slit spectroscopy of the reflected spectrum allows us to effectively view the star from different directions. Measurements of the double--peaked Halpha emission profile show a uniform outflow of gas in a nearly spherical distribution, contrary to previous models with an equatorial disk or bipolar outflow. Based on the temperature and mass loss rate estimates that are usually quoted for this object, the wind is optically thick to the continuum at some and possibly all wavelengths. Consequently the observed variations in apparent spectral type and inferred temperature are changes in the wind and do not necessarily mean that the underlying stellar radius and interior structure are evolving on such a short timescale. To explain the evidence for simultaneous outflow and infall of material near the star, we propose a `rain' model in which blobs of gas condense in regions of lowered opacity outside the dense wind. With the apparent warming of its wind, the recent appearance of strong emission, and a decline in the mass loss rate, IRC +10420 may be about to shed its opaque wind, cross the `yellow void', and emerge as a hotter star.Comment: To appear in the Astronomical Journal, August 200

No effect of focused attention whilst eating on later snack food intake: Two laboratory experiments

Focusing attention on food during a meal has been shown to reduce later snack consumption. We report the results of two studies that aimed to replicate this effect and to elucidate the underlying mechanisms. We hypothesised that focused attention during a lunchtime meal would improve visual memory and/or memory for the satiating effects of the meal, and that this would reduce later food intake. In Study 1, participants (N = 108, 52.8% female, BMI M = 25.75 kg/m²) were randomly allocated to eat a fixed lunchtime meal while listening to instructions that encouraged them to pay attention to the sensory properties of the meal (focused attention condition), or to one of two control conditions. To determine whether the effect of focused attention on later food intake is influenced by meal satisfaction, in a second study, participants (N = 147, 100% female, BMI M = 25.15 kg/m²) were given either a satisfying or dissatisfying lunch. In both studies, after 3 h participants ate snack food ad libitum and completed assessments of their memory for the recent lunch. In both studies there was no effect of focused attention on later food intake. In Study 2, the effect of focused attention on later food intake was not moderated by meal satisfaction. In both studies focused attention did not improve memory for the lunch meal. The present studies failed to replicate the effect of focused attention on later food intake and this may be because focused attention did not improve memory for the lunchtime meal. Further research should examine the conditions under which attention during eating influences memory encoding and food intake

Tinnitus Perception and Distress Is Related to Abnormal Spontaneous Brain Activity as Measured by Magnetoencephalography

BACKGROUND: The neurophysiological mechanisms underlying tinnitus perception are not well understood. Surprisingly, there have been no group studies comparing abnormalities in ongoing, spontaneous neuronal activity in individuals with and without tinnitus perception. METHODS AND FINDINGS: Here, we show that the spontaneous neuronal activity of a group of individuals with tinnitus (n = 17) is characterised by a marked reduction in alpha (8–12 Hz) power together with an enhancement in delta (1.5–4 Hz) as compared to a normal hearing control group (n = 16). This pattern was especially pronounced for temporal regions. Moreover, correlations with tinnitus-related distress revealed strong associations with this abnormal spontaneous activity pattern, particularly in right temporal and left frontal areas. Overall, effects were stronger for the alpha than for the delta frequency band. A data stream of 5 min, recorded with a whole-head neuromagnetometer under a resting condition, was sufficient to extract the marked differences. CONCLUSIONS: Despite some limitations, there are arguments that the regional pattern of abnormal spontaneous activity we found could reflect a tinnitus-related cortical network. This finding, which suggests that a neurofeedback approach could reduce the adverse effects of this disturbing condition, could have important implications for the treatment of tinnitus