Describing pre‐appointment written materials as an intervention in the context of children’s NHS therapy services: A national survey

Context: Pre-appointment written materials, including letters and leaflets, are commonly used by healthcare organisations to deliver professional-patient interactions. The written materials potentially change patients’ knowledge and behaviour as part of a healthcare intervention but have received little investigation. Objective: To describe the content of pre-appointment written materials through a behaviour change intervention perspective. Design: Mixed methods study with an online questionnaire about pre-appointment written materials and an analysis of actual materials. Questionnaire data were analysed descriptively and pre-appointment materials by qualitative framework analysis. Setting and participants: Children's community/outpatient occupational therapy, physiotherapy and/or speech and language therapy services across the UK. Service managers/clinical leads provided data. Intervention: Pre-appointment written materials. Results: Questionnaire responses were received from n = 110 managers/clinical leads from n = 58 NHS organisations. Written materials (n = 64) were received from n = 24 organisations. Current materials are used by therapy services as a conduit to convey the therapy service's expectations related to: accessing the service, decision-making about care and help-giving. The materials enrol the parent and child to the therapy services’ expectations by behaviour change techniques. The materials configure the parent/child expectations, knowledge and behaviour towards the therapy services’ operational procedures. Conclusion: Pre-appointment written materials configure patients to organisations’ operational procedures. The written materials currently lack support for parent/child empowerment, shared decision-making and self-management to improve health. Patient Contribution: Four parents of children accessing therapy services were involved in the study. The parents shared their experiences to highlight the importance of the topic and contributed to the final research design and methods

Study of the doubly charmed tetraquark T+cc

Quantum chromodynamics, the theory of the strong force, describes interactions of coloured quarks and gluons and the formation of hadronic matter. Conventional hadronic matter consists of baryons and mesons made of three quarks and quark-antiquark pairs, respectively. Particles with an alternative quark content are known as exotic states. Here a study is reported of an exotic narrow state in the D0D0π+ mass spectrum just below the D*+D0 mass threshold produced in proton-proton collisions collected with the LHCb detector at the Large Hadron Collider. The state is consistent with the ground isoscalar T+cc tetraquark with a quark content of ccu⎯⎯⎯d⎯⎯⎯ and spin-parity quantum numbers JP = 1+. Study of the DD mass spectra disfavours interpretation of the resonance as the isovector state. The decay structure via intermediate off-shell D*+ mesons is consistent with the observed D0π+ mass distribution. To analyse the mass of the resonance and its coupling to the D*D system, a dedicated model is developed under the assumption of an isoscalar axial-vector T+cc state decaying to the D*D channel. Using this model, resonance parameters including the pole position, scattering length, effective range and compositeness are determined to reveal important information about the nature of the T+cc state. In addition, an unexpected dependence of the production rate on track multiplicity is observed

Digital Consumption Tax (D-CT)

Modern technology is dramatically changing the way consumption taxes are collected, but it is also changing the way policymakers assess the operation and impact of these taxes. Whether the design is a standard credit-invoice value added tax (VAT) of European design, or a retail sales tax (RST) of American design, or the credit subtraction VAT without invoices type of consumption tax (CT) of Japanese design, technology is having a profound impact. Government certified transaction software is in place in the United States. The Streamlined Sales Tax offers taxpayers in 18 states the option of having their retail sales tax determined in a manner that not only assures accuracy, but which carries with it audit immunity. The software is provided at no cost to the taxpayer in instances where the taxpayer volunteers to collect the tax on out-of-state sales. Similar software certification regimes are under consideration in the Organization for Economic Cooperation and Development (OECD) that would be global in scope and handle the whole range of VAT transaction for a multinational enterprise. Discussions have commenced in various forums with the International Monetary Fund (IMF) and the United States Aid for International Development (USAID) on applications of this technology in developing country contexts. Certification of transaction tax determinations and audit immunity are attributes of immense interest to multinational enterprises that are increasingly under pressure from securities and corporate governance regulations to assure accurate financial statements and operational cash flow figures. This pressure is global in scope, as indicated by: Sarbanes-Oxley Act in the U.S.; the Loi de Securite Financiere in France; the Companies Act of 2004 in the U.K.; the Corporate Law Economic Reform Program (part 9) (CLERP 9) in Australia; the Kouninkaikeishihou no ichibu wo kaisei suru houritsu 2004-4-1 (An Act to Amend Part of the Certified Public Accounting Law) in Japan; and the recent modifications to the E.U.\u27s Eighth Corporate Directive (84/253/EEC). But technology offers more than a linear application of digital processes to formerly paper based and manual systems. When certified transaction tax technology is merged with smart card technology in IDs that possess digitized biometric identity information an opportunity opens for hyper transformation of the consumption tax. It is entirely within the grasp of policymakers today to design a broad-based, single rate consumption tax that is truly and independently progressive. In many respects, this is the Holy Grail of consumption tax theory. Technology offers it to us today. This text begins and ends with a tax reform. It starts with a proposal to the President\u27s (George W. Bush\u27s) Advisory Panel on Federal Tax Reform, and ends with a proposal for the consideration of Prime Minister Junichiro Koizumi\u27s Tax Commission. Neither tax reform commission appears at the moment to be considering technological solutions, although both are critically interested in consumption taxes. In the U.S. case both of the identified structural barriers to a federal level VAT (federal-state coordination and regressivity) can be answered technologically. In the Japanese case a wholesale transformation of the CT is under consideration; one that would move the Japanese CT to an invoice system with multiple rates and a standard rate of 10 percent or higher. The structural departure that this proposal makes from the traditional Japanese CT need not be taken if technological solutions are applied, although the double digit rate increase seems to be a given for revenue reasons