Financial performance of English NHS trusts and variation in clinical outcomes: a longitudinal observational study

OBJECTIVES: To examine the association between financial performance as measured by operating margin (surplus/deficit as a proportion of turnover) and clinical outcomes in English National Health Service (NHS) trusts. SETTING: Longitudinal, observational study in 149 acute NHS trusts in England between the financial years 2011 and 2016. PARTICIPANTS: Our analysis focused on outcomes at individual NHS Trust-level (composed of one or more acute hospitals). PRIMARY AND SECONDARY OUTCOMES: Outcome measures included readmissions, inpatient satisfaction score and the following process measures: emergency department (Accident and Emergency (A&E)) waiting time targets, cancer referral and treatment targets and delayed transfers of care (DTOCs). RESULTS: There was a progressive increase in the proportion of trusts in financial deficit: 22% in 2011, 27% in 2012, 28% in 2013, 51% in 2014, 68% in 2015 and 91% in 2016. In linear regression analyses, there was no significant association between operating margin and clinical outcomes (readmission rate or inpatient satisfaction score). There was, however, a significant association between operating margin and process measures (DTOCs, A&E breaches and cancer waiting time targets). Between the best and worst financially performing Trusts, there was an approximately 2-fold increase in A&E breaches and DTOCs overall although this variation decreased over the 6 years. Between the best and worst performing trusts on cancer targets, the magnitude of difference was smaller (1.16 and 1.15-fold), although the variation slowly rose during the 6 years. CONCLUSIONS: Operating margins in English NHS trusts progressively worsened during 2011-2016, and this change was associated with poorer performance on several process measures but not with hospital readmissions or inpatient satisfaction. Significant variation exists between the best and worst financially performing Trusts. Further research is needed to examine the causal nature of relationships between financial performance, process measures and outcomes

Soil carbon and nitrogen dynamics in a tropical peatland

The conversion of peat swamp forest to oil palm cultivation has resulted in the loss of stored nutrients in the peat soil, especially to the atmosphere. Soil carbon and nitrogen are the two major nutrients that are found in large quantities in the peat soil. Therefore this chapter studies the dynamics of these two primary nutrients within the peatland and how their losses are influenced by seasonal changes. Detailed samplings were carried out in wet and dry periods, with samples collected at three different depths during the dry and wet seasons. The flash combustion method using the LECO analyzer was part of the analysis of carbon and nitrogen. The results of the analyses of the soil carbon obtained in triplicates showed that the soil carbon at the peat surface is higher than that below the surface. The soil carbon recorded at the surface (0.5. m) during the wet season was 47.29%, which is higher than that recorded at the surface during the dry period. 1.34% of the soil nitrogen was observed at the surface during the wet period compared to 1.2% recorded during the dry spell. Rainfall was considered to be the main driver of both soil carbon and nitrogen in the tropical peatland, coupled with the fact that more nutrients were observed at the soil surface due to microbial activities at the surface. Hence, sustaining tropical peatlands would mean that practices that encourage nutrient loss from the peatlands to be controlled and well managed so as not to aggravate the climate change process that is associated with the nutrients' loss to the atmosphere

Melissopalynological, physicochemical and antioxidant properties of honey from West Coast of Malaysia

Stingless bees are native to tropical region and produce honey which are high in moisture content. Compared to honey from honeybees, there are limited studies on honey derived from stingless bees. Hence, the aim of this study was to evaluate the chemical composition and antioxidant activities of stingless bee honey. Fifteen types of honey were collected from six states in West Coast of Malaysia and pollen analyses were carried out. Four types of unifloral honey samples produced by stingless bees were selected to determine their physicochemical and antioxidant activities including total phenolic, total flavonoid and ascorbic acid contents. Melissopalynological study of 15 honey samples collected from different states showed presence of both unifloral and multifloral origins. Honey samples collected from Apis mellifera (honeybee) combs had lower number of total pollen compared to samples collected from Heterotrigona itama and Geniotrigona thoracica (stingless bees). Jambul Merak honey contains the highest phenolic and flavonoid contents with greatest color intensity and has the highest antioxidant potential. This study highlights the chemical composition and biological activity of honey from stingless bees which may increase its commercial value or to be utilised as potential functional food ingredient

Genomic analysis of the causative agents of coccidiosis in domestic chickens

Global production of chickens has trebled in the past two decades and they are now the most important source of dietary animal protein worldwide. Chickens are subject to many infectious diseases that reduce their performance and productivity. Coccidiosis, caused by apicomplexan protozoa of the genus Eimeria, is one of the most important poultry diseases. Understanding the biology of Eimeria parasites underpins development of new drugs and vaccines needed to improve global food security. We have produced annotated genome sequences of all seven species of Eimeria that infect domestic chickens, which reveal the full extent of previously described repeat-rich and repeat-poor regions and show that these parasites possess the most repeat-rich proteomes ever described. Furthermore, while no other apicomplexan has been found to possess retrotransposons, Eimeria is home to a family of chromoviruses. Analysis of Eimeria genes involved in basic biology and host-parasite interaction highlights adaptations to a relatively simple developmental life cycle and a complex array of co-expressed surface proteins involved in host cell binding

Mangifera odorata (Anacardiaceae) is a hybrid

Volume: 54Start Page: 205End Page: 20

Mohamad Shah bin Hj Mohamad Noor

Volume: 55Start Page: 165End Page: 17

A new species of Monophyllaea (Gesneriaceae) from Borneo

Volume: 54Start Page: 243End Page: 24

Kizhakkedathu Mathai Kochummen

Volume: 51Start Page: 125End Page: 12