Can food vouchers improve nutrition and reduce health inequalities in low-income mothers and young children: A multi-method evaluation of the experiences of beneficiaries and practitioners of the Healthy Start programme in England

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Good nutrition is important during pregnancy, breastfeeding and early life to optimise the health of women and children. It is difficult for low-income families to prioritise spending on healthy food. Healthy Start is a targeted United Kingdom (UK) food subsidy programme that gives vouchers for fruit, vegetables, milk, and vitamins to low-income families. This paper reports an evaluation of Healthy Start from the perspectives of women and health practitioners. Methods. The multi-method study conducted in England in 2011/2012 included focus group discussions with 49 health practitioners, an online consultation with 620 health and social care practitioners, service managers, commissioners, and user and advocacy groups, and qualitative participatory workshops with 85 low-income women. Additional focus group discussions and telephone interviews included the views of 25 women who did not speak English and three women from Traveller communities. Results: Women reported that Healthy Start vouchers increased the quantity and range of fruit and vegetables they used and improved the quality of family diets, and established good habits for the future. Barriers to registration included complex eligibility criteria, inappropriate targeting of information about the programme by health practitioners and a general low level of awareness among families. Access to the programme was particularly challenging for women who did not speak English, had low literacy levels, were in low paid work or had fluctuating incomes. The potential impact was undermined by the rising price of food relative to voucher value. Access to registered retailers was problematic in rural areas, and there was low registration among smaller shops and market stalls, especially those serving culturally diverse communities. Conclusions: Our evaluation of the Healthy Start programme in England suggests that a food subsidy programme can provide an important nutritional safety net and potentially improve nutrition for pregnant women and young children living on low incomes. Factors that could compromise this impact include erosion of voucher value relative to the rising cost of food, lack of access to registered retailers and barriers to registering for the programme. Addressing these issues could inform the design and implementation of food subsidy programmes in high income countries. © 2014 McFadden et al.; licensee BioMed Central Ltd.The Policy Research Programme in the Department of Health, UK

Verifying the Safety of a Flight-Critical System

This paper describes our work on demonstrating verification technologies on a flight-critical system of realistic functionality, size, and complexity. Our work targeted a commercial aircraft control system named Transport Class Model (TCM), and involved several stages: formalizing and disambiguating requirements in collaboration with do- main experts; processing models for their use by formal verification tools; applying compositional techniques at the architectural and component level to scale verification. Performed in the context of a major NASA milestone, this study of formal verification in practice is one of the most challenging that our group has performed, and it took several person months to complete it. This paper describes the methodology that we followed and the lessons that we learned.Comment: 17 pages, 5 figure

Does training on inhibitory tasks influence alcohol consumption and attitudes?

Response inhibition - the suppression of a prepotent or ongoing action - is an executive function central to the regulation of behaviour. Response inhibition can be assessed in the laboratory using the Go/No-go or Stop-Signal tasks which both assess the capacity to withhold an inappropriate response. In the Go/No-go task, participants are required to respond rapidly to Go stimuli but to withhold that response upon No-go stimuli. In the Stop-Signal task, participants are required to respond to Go stimuli but to withhold the response when an auditory stop signal occurs subsequent to the Go stimulus

Formal Verification of a Rover Anti-collision System

In this paper, we integrate inductive proof, bounded model checking, test case generation and equivalence proof techniques to verify an embedded system. This approach is implemented using Systerel Smart Solver (S3) toolset. It is applied to verify properties at system, software, and code levels. The verification process is illustrated on an anti-collision system (ARP for Automatic Rover Protection) implemented on-board a rover. Focus is placed on the verification of safety and functional properties and the proof of equivalence between the design model and the generated code

System-level Non-interference for Constant-time Cryptography

International audienceCache-based attacks are a class of side-channel attacks that are particularly effective in virtualized or cloud-based en-vironments, where they have been used to recover secret keys from cryptographic implementations. One common ap-proach to thwart cache-based attacks is to use constant-time implementations, i.e. which do not branch on secrets and do not perform memory accesses that depend on secrets. How-ever, there is no rigorous proof that constant-time implemen-tations are protected against concurrent cache-attacks in virtualization platforms with shared cache; moreover, many prominent implementations are not constant-time. An alter-native approach is to rely on system-level mechanisms. One recent such mechanism is stealth memory, which provisions a small amount of private cache for programs to carry po-tentially leaking computations securely. Stealth memory in-duces a weak form of constant-time, called S-constant-time, which encompasses some widely used cryptographic imple-mentations. However, there is no rigorous analysis of stealth memory and S-constant-time, and no tool support for check-ing if applications are S-constant-time. We propose a new information-flow analysis that checks if an x86 application executes in constant-time, or in S-constant-time. Moreover, we prove that constant-time (resp. S-constant-time) programs do not leak confidential infor-mation through the cache to other operating systems exe-cuting concurrently on virtualization platforms (resp. plat-forms supporting stealth memory). The soundness proofs are based on new theorems of independent interest, includ-ing isolation theorems for virtualization platforms (resp. plat-forms supporting stealth memory), and proofs that constant-time implementations (resp. S-constant-time implementa-tions) are non-interfering with respect to a strict information flow policy which disallows that control flow and memory ac-cesses depend on secrets. We formalize our results using the Coq proof assistant and we demonstrate the effectiveness of our analyses on cryptographic implementations, including PolarSSL AES, DES and RC4, SHA256 and Salsa20

The criterion validity of willingness to pay methods: A systematic review and meta-analysis of the evidence

© 2019 The Authors. Background: The contingent valuation (CV) method is used to estimate the willingness to pay (WTP) for services and products to inform cost benefit analyses (CBA). A long-standing criticism that stated WTP estimates may be poor indicators of actual WTP, calls into question their validity and the use of such estimates for welfare evaluation, especially in the health sector. Available evidence on the validity of CV studies so far is inconclusive. We systematically reviewed the literature to (1) synthesize the evidence on the criterion validity of WTP/willingness to accept (WTA), (2) undertake a meta-analysis, pooling evidence on the extent of variation between stated and actual WTP values and, (3) explore the reasons for the variation. Methods: Eight electronic databases were searched, along with citations and reference reviews. 50 papers detailing 159 comparisons were identified and reviewed using a standard proforma. Two reviewers each were involved in the paper selection, review and data extraction. Meta-analysis was conducted using random effects models for ratios of means and percentage differences separately. Meta-bias was investigated using funnel plots. Results: Hypothetical WTP was on average 3.2 times greater than actual WTP, with a range of 0.7–11.8 and 5.7 (0.0–13.6) for ratios of means and percentage differences respectively. However, key methodological differences between surveys of hypothetical and actual values were found. In the meta-analysis, high levels of heterogeneity existed. The overall effect size for mean summaries was 1.79 (1.56–2.04) and 2.37 (1.93–2.80) for percent summaries. Regression analyses identified mixed results on the influence of the different experimental protocols on the variation between stated and actual WTP values. Results indicating publication bias did not account for differences in study design. Conclusions: The evidence on the criterion validity for CV studies is more mixed than authors are representing because substantial differences in study design between hypothetical and actual WTP/WTA surveys are not accounted for.Brunel University London, Health Economics Research Group

The play's the thing

For very understandable reasons phenomenological approaches predominate in the field of sensory urbanism. This paper does not seek to add to that particular discourse. Rather it takes Rorty’s postmodernized Pragmatism as its starting point and develops a position on the role of multi-modal design representation in the design process as a means of admitting many voices and managing multidisciplinary collaboration. This paper will interrogate some of the concepts underpinning the Sensory Urbanism project to help define the scope of interest in multi-modal representations. It will then explore a range of techniques and approaches developed by artists and designers during the past fifty years or so and comment on how they might inform the question of multi-modal representation. In conclusion I will argue that we should develop a heterogeneous tool kit that adopts, adapts and re-invents existing methods because this will better serve our purposes during the exploratory phase(s) of any design project that deals with complexity

Potential economic impacts from improving breastfeeding rates in the UK

This article has been made available through the Brunel Open Access Publishing Fund.RATIONALE: Studies suggest that increased breastfeeding rates can provide substantial financial savings, but the scale of such savings in the UK is not known. OBJECTIVE: To calculate potential cost savings attributable to increases in breastfeeding rates from the National Health Service perspective. DESIGN AND SETTINGS: Cost savings focussed on where evidence of health benefit is strongest: reductions in gastrointestinal and lower respiratory tract infections, acute otitis media in infants, necrotising enterocolitis in preterm babies and breast cancer (BC) in women. Savings were estimated using a seven-step framework in which an incidence-based disease model determined the number of cases that could have been avoided if breastfeeding rates were increased. Point estimates of cost savings were subject to a deterministic sensitivity analysis. RESULTS: Treating the four acute diseases in children costs the UK at least £89 million annually. The 2009-2010 value of lifetime costs of treating maternal BC is estimated at £959 million. Supporting mothers who are exclusively breast feeding at 1 week to continue breast feeding until 4 months can be expected to reduce the incidence of three childhood infectious diseases and save at least £11 million annually. Doubling the proportion of mothers currently breast feeding for 7-18 months in their lifetime is likely to reduce the incidence of maternal BC and save at least £31 million at 2009-2010 value. CONCLUSIONS: The economic impact of low breastfeeding rates is substantial. Investing in services that support women who want to breast feed for longer is potentially cost saving

The effectiveness and cost-effectiveness of a complex community sport intervention to increase physical activity: An interrupted time series design

© Author(s) (or their employer(s)) 2018. Objectives: An effectiveness and cost-effectiveness analyses of two-staged community sports interventions, taster sports sessions compared with portfolio of community sport sessions. Design: Quasi-experiment using an interrupted time series design. Setting: Community sports projects delivered by eight lead partners in London Borough of Hounslow, United Kingdom Participants: Inactive people aged 14 plus years (n=246) were recruited between May 2013–February 2014. Interventions: Community sports interventions delivered in two stages, 6-week programme of taster sport sessions (Stage1) and 6-week programme of portfolio of community sporting sessions delivered by trained coaches (Stage2). Primary and secondary outcome measures: Change in days with ≥30 min of self-reported vigorous intensity physical activity (PA), moderate intensity PA, walking, sport, subjective wellbeing, and EQ5D5L quality-adjusted life-years (QALYs) Methods: Interrupted time series analysis evaluated the effectiveness of the two sports programmes. Cost-effectiveness analysis compares Stage 2 with Stage 1 from a provider’s perspective, reporting outcomes of incremental cost per Quality Adjusted Life Year (QALY) (2015/16 price year). Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Results: Compared with Stage1, counterfactual change at 21 days in PA was lower for vigorous (log odds: -0.52; 95% CI -1, -0.03), moderate PA (-0.50; CI 0.94, -0.05) and sport (-0.56; CI -1.02, -0.10). Stage 2 increased walking (0.28; CI 0.3, 0.52). Effect overtime was similar. Counterfactual change at 21 days in wellbeing was positive particularly for ‘happiness’ (0.29; CI 0.06, 0.51). Stage2 was more expensive (£101 per participant) but increased QALYs (0.001; CI -0.034, 0.036). Cost per QALY for Stage2 was £50000 and has 29% chance of being cost effective (£30000 threshold). Conclusion: Community based sport interventions could increase PA among inactive people. Less intensive sports sessions may be more effective and cost-effective

Social technologies for online learning: theoretical and contextual issues

Three exemplars are presented of social technologies deployed in educational contexts: wikis; a photo-sharing environment; and a social bookmarking tool. Students were found to engage with the technologies selectively, sometimes rejecting them, in the light of their prior conceptions of education. Some students (a minority in all the studies) were unsympathetic to the educational philosophy underpinning the technology’s adoption. The paper demonstrates, through an examination of in-context use, the importance of socio-cultural factors in relation to education, and the non-deterministic nature of educational technology. The academic study of technology has increasingly called into question the deterministic views which are so pervasive in popular discourse and among policy makers. Instead, socio-cultural factors play a crucial role in shaping and defining technology and educational technology is no exception, as the examples in the paper show. The paper concludes by drawing out some implications of the examples for the use of social technologies in education