Delivering reform in English healthcare: an ideational perspective

A variety of perspectives has been put forward to understand reform across healthcare systems. Recently, some have called for these perspectives to give greater recognition to the role of ideational processes. The purpose of this article is to present an ideational approach to understanding the delivery of healthcare reform. It draws on a case of English healthcare reform – the Next Stage Review led by Lord Darzi – to show how the delivery of its reform proposals was associated with four ideational frames. These frames built on the idea of “progress” in responding to existing problems; the idea of “prevailing policy” in forming part of a bricolage of ideas within institutional contexts; the idea of “prescription” as top-down structural change at odds with local contexts; and the idea of “professional disputes” in challenging the notion of clinical engagement across professional groups. The article discusses the implications of these ideas in furthering our understanding of policy change, conflict and continuity across healthcare settings

A method addressing signal occlusion by scene objects to quantify the 3D distribution of forest components from terrestrial lidar

SilviLaser 2015, La Grande Motte, FRA, 28-/09/2015 - 30/09/2015International audienceEstimating exact 3D distribution of canopy components using terrestrial lidar in forest is limited by signal occlusion. We propose a method to address this limitation: it uses voxels, beam returns and beam propagation through the scene. The proposed method was validated using simulated forest scenes and a lidar simulator

The sol-gel entrapment of noble metals in hybrid silicas: a molecular insight

BACKGROUND: Why are metal nanoparticles sol-gel entrapped in ORMOSIL so active and stable? In other words, why ORMOSIL-entrapped metal nanoparticles are more active and selective than many heterogenized counterparts, including silica-entrapped noble metals? RESULTS: Unveiling specific interactions between MNPs and the molecular structure of ORMOSIL, this work investigates subtle structural aspects through DRIFT spectroscopy. CONCLUSIONS: The results point to interactions between entrapped Pd and Pt nanocrystallites with the organosilica sol-gel cages similar to those taking place in enzymes

Enhanced heterogeneously catalyzed Suzuki–Miyaura reaction over SiliaCat Pd(0)

The SiliaCat Pd(0) solid catalyst can be efficiently employed in the Suzuki–Miyaura cross-coupling of an ample variety of haloarenes, including economically viable chloroarenes. The catalyst can be extensively recycled without loss of activity and with low leaching of valued palladium, opening the route to widespread utilization of the method to afford high yields of biaryls devoid of contaminating by-products

Efficient and Robust NK-Cell Transduction With Baboon Envelope Pseudotyped Lentivector

NK-cell resistance to transduction is a major technical hurdle for developing NK-cell immunotherapy. By using Baboon envelope pseudotyped lentiviral vectors (BaEV-LVs) encoding eGFP, we obtained a transduction rate of 23.0 ± 6.6% (mean ± SD) in freshly-isolated human NK-cells (FI-NK) and 83.4 ± 10.1% (mean ± SD) in NK-cells obtained from the NK-cell Activation and Expansion System (NKAES), with a sustained transgene expression for at least 21 days. BaEV-LVs outperformed Vesicular Stomatitis Virus type-G (VSV-G)-, RD114- and Measles Virus (MV)- pseudotyped LVs (p < 0.0001). mRNA expression of both BaEV receptors, ASCT1 and ASCT2, was detected in FI-NK and NKAES, with higher expression in NKAES. Transduction with BaEV-LVs encoding for CAR-CD22 resulted in robust CAR-expression on 38.3 ± 23.8% (mean ± SD) of NKAES cells, leading to specific killing of NK-resistant pre-B-ALL-RS4;11 cell line. Using a larger vector encoding a dual CD19/CD22-CAR, we were able to transduce and re-expand dual-CAR-expressing NKAES, even with lower viral titer. These dual-CAR-NK efficiently killed both CD19KO- and CD22KO-RS4;11 cells. Our results suggest that BaEV-LVs may efficiently enable NK-cell biological studies and translation of NK-cell-based immunotherapy to the clinic

Impact of ultraviolet radiation on marine crustacean zooplankton and ichthyoplankton: a synthesis of results from the estuary and Gulf of St. Lawrence, Canada

The objectives of the research program reported upon here were (1) to measure ambient levels of UV radiation and determine whichvariables most strongly affected its attenuation in the waters of the estuary and Gulf of St. Lawrence, Canada; and (2) to investigate the potential direct impacts of W radiation on species of crustacean zooplankton and fish whose early life stages are planktonic. In this geographic region, productivity-determining biophysical interactions occur in the upper 0 to 30 m of the water column. Measurements of the diffuse attenuation coefficients for ultraviolet-B radiation (W-B, 280 to 320 nm) at various locations in this region indicated maximum 10% depths (the depth to which 10% of the surface energy penetrates at a given wavelength) of 3 to 4 m at a wavelength of 310 nm. Organisms residing in this layer-including the eggs and larvae of Calanus finmarchicus and Atlantic cod Gadus morhua-are exposed to biologically damaging levels of W radiation. As a result of these physical and biological characteristics, this system offered a relevant opportunity to assess the impacts of UV on subarctic marine ecosystems. Eggs of C. finmarchicus were incubated under the sun, with and without the W-B and/or UV-A (320 to 400 nm) wavebands. W-exposed eggs exhibited low percent hatchmg compared to those protected from W : W radiation had a strong negative impact on C. finmarchicus eggs. Further, percent hatching in W-B-exposed eggs was not significantly lower than that in eggs exposed to UV-A only: under natural sunlight, UV-A radiation appeared to be more detrimental to C. finmarchicus embryos than was UV-B. In analogous experiments with Atlantic cod eggs, exposure to UV-B produced a significant negative effect. However, UV-A had no negative effect on cod eggs. Additional experiments using a solar simulator (SS) revealed high wavelength-dependent mortality in both C. finmarchicus and cod embryos exposed to UV. The strongest effects occurred under exposures to wavelengths below 312 nm. At the shorter wavelengths (<305 nm) UV-B-induced mortality was strongly dose-dependent, but (for both C. finmarchicus and cod) not significantly influenced by dose-rate. Thus, at least within the limits of the exposures under which the biological weighting functions (BWFs) were generated, reciprocity held. The BWFs derived for UV-B-induced mortality in C. finmarchicus and cod eggs were similar in shape to the action spectrum for UV-B effects on naked DNA. Further, the wavelengthdependence of DNA damage was similar to that for the mortality effect. These observations suggest that W-induced mortality in C. finmarchicus and cod eggs is a direct result of DNA damage. There was no evidence of a detrimental effect of UV-A radiation in these SS-derived results. A mathematical model that includes the BWFs, vertical mixing of eggs, meteorological and hydrographic conditions, and ozone depletion, indicates that W-induced mortality in the C. finmarchicus egg population could be as high as 32.5 %, while the impact on the cod egg population was no more than 1.2%. Variability in cloud cover, water transparency (and the variables that affect it), and vertical distribution and displacement of planktonic organisms within the mixed layer can all have a greater effect on the flux of UV-B radiation to which they are exposed than will ozone layer depletion at these latitudes. Our observations indicate that C, finmarchicus and cod eggs present in the first meter of the water column (likely only a small percentage of the total egg populations) are susceptible to W radiation. However, although exposure to UV can negatively impact crustacean zooplankton and ichthyoplankton populations, these direct effects are likely minimal within the context of all the other environmental factors that produce the very high levels of mortality typically observed in their planktonic early life stages. The impact of indnect effects-which may well be of much greater import-has yet to be evaluated

TSIS-1 SIM V09 Solar Spectral Irradiance

NASA&rsquo;s Total and Spectral Solar Irradiance Sensor-1 (TSIS-1) operates on the International Space Station. TSIS-1 provides absolute measurements of the total solar irradiance (TSI) and spectral solar irradiance (SSI), important for accurate scientific models of climate change and solar variability. TSIS-1 is comprised of two instruments, the Total Irradiance Monitor (TIM), and the Spectral Irradiance Monitor (SIM). This repository archives Version 9 (V09) of the TSIS-1 SIM Level 3 (L3) data release, and contains SSI in two cadences, 12-hour and 24-hour. The TSIS-1 SIM L3 V09 data release contains data from 2018-03-14 to 2022-11-11. TSIS-1 SIM data obtained between 2022-03-19 and 2022-05-19 were affected by an anomaly of the sun-pointing sensor (HFSS-B), which offset pointing by ~1 arcminute. V08 introduced a spectral correction for this period, and V09 introduced the ADDITIONAL_UNCERTAINTY column in the data release which reflects the additional irradiance uncertainty associated with the spectral correction. See the attached TSIS_SIM_V09_Release_Notes.pdf or the TSIS SIM Data Products Release Notes page (https://lasp.colorado.edu/tsis/data/ssi-data/sim-ssi-release-notes/) for further details. Data is archived in ASCII, netCDF, and IDL SAVfile format. Creator Penton, Steven Chambliss, Michael Richard, Erik B&eacute;land, St&eacute;phane Brooks, Keira Charbonneau, Luke Coddington, Odele </ul

The combined influence of distance and neighbourhood deprivation on Emergency Department attendance in a large English population: a retrospective database study

YesThe frequency of visits to Emergency Departments (ED) varies greatly between populations. This may reflect variation in patient behaviour, need, accessibility, and service configuration as well as the complex interactions between these factors. This study investigates the relationship between distance, socio-economic deprivation, and proximity to an alternative care setting (a Minor Injuries Unit (MIU)), with particular attention to the interaction between distance and deprivation. It is set in a population of approximately 5.4 million living in central England, which is highly heterogeneous in terms of ethnicity, socio-economics, and distance to hospital. The study data set captured 1,413,363 ED visits made by residents of the region to National Health Service (NHS) hospitals during the financial year 2007/8. Our units of analysis were small units of census geography having an average population of 1,545. Separate regression models were made for children and adults. For each additional kilometre of distance from a hospital, predicted child attendances fell by 2.2% (1.7%-2.6% p<0.001) and predicted adult attendances fell by 1.5% (1.2% -1.8%, p<0.001). Compared to the least deprived quintile, attendances in the most deprived quintile more than doubled for children (incident rate ratio (IRR) = 2.19, (1.90-2.54, p<0.001)) and adults (IRR 2.26, (2.01-2.55, p<0.001)). Proximity of an MIU was significant and both adult and child attendances were greater in populations who lived further away from them, suggesting that MIUs may reduce ED demand. The interaction between distance and deprivation was significant. Attendance in deprived neighbourhoods reduces with distance to a greater degree than in less deprived ones for both adults and children. In conclusion, ED use is related to both deprivation and distance, but the effect of distance is modified by deprivation

Regulatory Constructivism: Application of Q Methodology in Italy and China

Conventional view holds that beliefs play an important role in the development of regulations but there is little evidence to support this claim. We use Comparative Q Methodology to systematically map out and compare the beliefs of public officers in China and Italy, two countries with contrasting sets of institutions but have both adopted similar ideas about integrated water resource management. We find some similarities and differences in the beliefs of public officers in both countries. In particular, we find that in both countries beliefs on the regulation of water utilities are diverse and fragmented on issues such as ownership structure of water utilities, how water infrastructure development should be funded, and how tariffs should be regulated. Our findings have two implications for theory, methods and practice. First, the Q methodology is a useful tool for systematically mapping out the beliefs of regulators and managers. Second, systematically mapping out beliefs will help facilitate the development of an alternative regime of regulation such as negotiated rule making. This alternative regime can provide substantial benefits such as more efficient rule making, more cost effective enforcement and compliance, and more equitable in terms of balancing the interests of stakeholders