Depoliticisation, Resilience and the Herceptin Post-code Lottery Crisis: Holding Back the Tide

This article: Covers new empirical terrain in the study of depoliticisation, with an in-depth case study of health technology regulation; Analyses depoliticisation from a novel analytical perspective, examining how depoliticised institutions are resilient to external pressure for politicisation; Posits a distinctive framework for analysing resilience, drawing on cognate literatures on policy networks and agencification; Raises interesting and distinctive questions about the nature of depoliticisation in advanced liberal democracies, arguing it is more contested than commonly acknowledged. Depoliticisation as a concept offers distinctive insights into how governments attempt to relieve political pressures in liberal democracies. Analysis has examined the effects of depoliticisation tactics on the public, but not how those tactics are sustained during moments of political tension. Drawing on policy networks and agencification literatures, this article examines how these tactics are resilient against pressure for politicisation. Using an in-depth case study of the controversial appraisal of cancer drug Herceptin in 2005/6 by the National Institute for Health and Clinical Excellence (NICE), the article examines how ‘resilient’ NICE was to external politicisation. It is argued that NICE was resilient because it was effectively ‘insulated’ by formal procedures and informal norms of deference to scientific expertise. This mechanism is termed ‘institutional double glazing’. The conclusion suggests developments to the conceptual and methodological framework of depoliticisation, and highlights theoretical insights into the nature of ‘anti-politics’ in contemporary democracies

An Interpretative Phenomenological Analysis of Service Users’ Experiences in a Psychosocial Addictions Intervention

© 2020 The Authors. This is the accepted version of the following article: Dawood, R. and Done, J. (2020), An interpretative phenomenological analysis of service users’ experiences in a psychosocial addictions intervention. Psychol Psychother Theory Res Pract. doi:10.1111/papt.12296, which has been published in final form at https://doi.org/10.1111/papt.12296.Objectives: The aim of this study was to explore the subjective experiences of participants who; a. received a psychosocial intervention as part of an addiction recovery research trial, b. responded to treatment through drug reduction, with the intention of eliciting qualitative change processes of recovery. Design: Data were collected using semi-structured interviews designed to capture detailed descriptions of participants’ experiences of recovery within the intervention. Methods: Eleven participants who had achieved drug abstinence or significant drug reduction by successfully completing the psychosocial intervention took part in the study. The data were analysed using Interpretative Phenomenological Analysis (IPA). Results: Five superordinate themes were identified relating to 1. An active, individualised and skills based intervention that validates a new way of being, 2. Staff that foster good working relationships based on trust and safety within services that do not stigmatise, 3. To be understood individually, historically and psychologically and with regards to the pernicious relationship with drugs, 4. Motivation is personal, intrinsic, requires vigilance and is driven forward by periods of success through abstinence, 5. Interpersonal connectedness is essential to recovery; family is a key reason to abstain and friendships can either facilitate or hinder success. Conclusions: These findings suggest that the success of the psychosocial intervention may be due to a combination of modality specific factors and also broader holistic aspects that were provided through intervention. Future research is required to generalise these findings to wider addictions populations.Peer reviewedFinal Accepted Versio

The four or more medicines (FOMM) support service:results from an evaluation of a new community pharmacy service aimed at over-65s

Background: 57% of all prescriptions dispensed in the UK in 2003 were for people aged ≥60, where ≥20% of them were prescribed ≥ five medicines. Inappropriate prescribing and non-adherence have a significant impact on hospital admissions and patient quality of life. The English government has identified that community pharmacy could make a significant contribution to reducing non-adherence and improving the quality of prescribing, reducing both hospital admissions and medicines wastage. Objective: To evaluate a community pharmacy service aimed at patients over the age of 65 years prescribed four or more medicines. Method: Patients were invited to participate in the service by the community pharmacy team. The pharmacist held regular consultations with the patient and discussed risk of falls, pain management, adherence and general health. They also reviewed the patient’s medication using STOPP/START criteria. Data wereas analysed for the first six months of participation in the service. Key findings: 620 patients were recruited with 441 (71.1%) completing the six month study period. Pharmacists made 142 recommendations to prescribers in 110 patients largely centred on potentially inappropriate prescribing of NSAIDs, PPIs or duplication of therapy. At follow-up there was a significant decrease in the total number of falls (mean -0.116 (-0.217 - -0.014)) experienced and a significant increase in medicines adherence (mean difference in MMAS-8: 0.513 (0.337 – 0.689)) and quality of life. Cost per QALY estimates ranged from £11,885 to £32,466 depending on the assumptions made. Conclusion: By focussing on patients over the age of 65 years with four or more medicines, community pharmacists can improve medicines adherence and patient quality of life

The Air-temperature Response to Green/blue-infrastructure Evaluation Tool (TARGET v1.0) : an efficient and user-friendly model of city cooling

The adverse impacts of urban heat and global climate change are leading policymakers to consider green and blue infrastructure (GBI) for heat mitigation benefits. Though many models exist to evaluate the cooling impacts of GBI, their complexity and computational demand leaves most of them largely inaccessible to those without specialist expertise and computing facilities. Here a new model called The Air-temperature Response to Green/blue-infrastructure Evaluation Tool (TARGET) is presented. TARGET is designed to be efficient and easy to use, with fewer user-defined parameters and less model input data required than other urban climate models. TARGET can be used to model average street-level air temperature at canyon-to-block scales (e.g. 100 m resolution), meaning it can be used to assess temperature impacts of suburb-to-city-scale GBI proposals. The model aims to balance realistic representation of physical processes and computation efficiency. An evaluation against two different datasets shows that TARGET can reproduce the magnitude and patterns of both air temperature and surface temperature within suburban environments. To demonstrate the utility of the model for planners and policymakers, the results from two precinct-scale heat mitigation scenarios are presented. TARGET is available to the public, and ongoing development, including a graphical user interface, is planned for future work

Probing the Masses of the PSR J0621+1002 Binary System Through Relativistic Apsidal Motion

Orbital, spin and astrometric parameters of the millisecond pulsar PSR J0621+1002 have been determined through six years of timing observations at three radio telescopes. The chief result is a measurement of the rate of periastron advance, omega_dot = 0.0116 +/- 0.0008 deg/yr. Interpreted as a general relativistic effect, this implies the sum of the pulsar mass, m_1, and the companion mass, m_2, to be M = m_1 + m_2 = 2.81 +/- 0.30 msun. The Keplerian parameters rule out certain combinations of m_1 and m_2, as does the non-detection of Shapiro delay in the pulse arrival times. These constraints, together with the assumption that the companion is a white dwarf, lead to the 68% confidence maximum likelihood values of m_1 = 1.70(+0.32 -0.29) msun and m_2 =0.97(+0.27 - 0.15) msun and to the 95% confidence maximum likelihood values of m_1 = 1.70(+0.59 -0.63) msun and m_2 = 0.97(+0.43 -0.24) msun. The other major finding is that the pulsar experiences dramatic variability in its dispersion measure (DM), with gradients as steep as 0.013 pc cm^{-3} / yr. A structure function analysis of the DM variations uncovers spatial fluctuations in the interstellar electron density that cannot be fit to a single power law, unlike the Kolmogorov turbulent spectrum that has been seen in the direction of other pulsars. Other results from the timing analysis include the first measurements of the pulsar's proper motion, mu = 3.5 +/- 0.3 mas / yr, and of its spin-down rate, dP/dt = 4.7 x 10^{-20}, which, when corrected for kinematic biases and combined with the pulse period, P = 28.8 ms, gives a characteristic age of 1.1 x 10^{10} yr and a surface magnetic field strength of 1.2 x 10^{9} G.Comment: Accepted by ApJ, 10 pages, 5 figure

Phytochemical studies, in vitro antioxidant and antiproliferative of the stem bark of Boswellia dalzielii hutch

This work aims to evaluate the total phenolic and flavonoid contents, and antioxidant and Antiproliferative activities of the stem bark of Boswellia dalzielii. Hundred gram (100 g) of methanolic extract was re-dissolved in 70% methanol and partitioned exhaustively with different solvent hexane and ethyl acetate in a separating funnel; and this method gave three fractions, hexane fraction, ethyl acetate fraction and aqueous extract. The ethyl acetate fraction was subjected to Accelerated Gradient Chromatographic due to its higher activity over the hexane fraction and four sub-fractions were obtained. Standard methods were used to determine flavonoid and phenolic contents of the methanolic, aqueous, ethyl acetate and hexane fractions and their sub-fractions. Standard methods were used to determine flavonoid and phenolic contents of the methanolic, aqueous, ethyl acetate and hexane extracts and their sub-fractions. The antioxidant property of the extracts was determined using DPPH radical scavenging and FRAP assay. Growth inhibitory activity was carried out on the crude extracts and sub-fractions using Sorghum bicolor seeds. The phenolic content was found to be highest in sub-fraction C (481.20 ± 10.13 mg GAE/g) and flavonoid contents were found to be highest in methanolic extract (142.17 ± 4.82 mg RE/g). Boswellia dalzielii stem bark exhibited antioxidant capacity; and the highest antioxidant activities were recorded from aqueous extract with the IC50 1.58 and methanol extract IC50 1.99 using DPPH. FRAP assay exhibited antioxidant capacity with EC50 1.00 for aqueous extract and sub-fraction D EC50 1.25. The antiproliferative, sub-fractions C and D at 125 µg/ml gave the highest percentage of inhibition (90%) followed by sub-fraction B (50%) at 250 µg/ml. These results further showed that the stem bark of Boswellia dalzielii has antioxidant activities and antiproliferative activity on the seeds of Sorghum bicolor; and therefore possess likely an anticancer component which needs further anticancer screening

Determination of complex subclonal structures of hematological malignancies by multiplexed genotyping of blood progenitor colonies.

Current next-generation sequencing (NGS) technologies allow unprecedented insights into the mutational profiles of tumors. Recent studies in myeloproliferative neoplasms have further demonstrated that, not only the mutational profile, but also the order in which these mutations are acquired is relevant for our understanding of the disease. Our ability to assign mutation order from NGS data alone is, however, limited. Here, we present a strategy of highly multiplexed genotyping of burst forming unit-erythroid colonies based on NGS results to assess subclonal tumor structure. This allowed for the generation of complex clonal hierarchies and determination of order of mutation acquisition far more accurately than was possible from NGS data alone.Work in ARG lab has been supported by the Leukemia and Lymphoma Society (grant 7001-12), the National Institute of Health Research (grant NF-SI-0512-10079) and core support grants by the MRC and Wellcome Trust to the Cambridge Institute for Medical Research (100140/Z/12/Z) and Wellcome Trust-MRC Cambridge Stem Cell Institute (097922/Z/11/Z). Work in ARG's laboratory has in addition been supported by Cancer Research UK (grants C1163/A12765 and C1163/A21762), Bloodwise (grant 13003) and the Wellcome Trust (grant 104710/Z/14/Z

Development and delivery of an exercise programme for falls prevention: the Prevention of Falls Injury Trial (PreFIT)

This paper describes the development and implementation of an exercise intervention to prevent falls within The Prevention of Fall Injury Trial (PreFIT), which is a large multi-centred randomised controlled trial based in the UK National Health Service (NHS).Using the template for intervention description and replication (TIDieR) checklist, to describe the rationale and processes for treatment selection and delivery of the PreFIT exercise intervention.Based on the results of a validated falls and balance survey, participants were eligible for the exercise intervention if they were at moderate or high risk of falling.Intervention development was informed using the current evidence base, published guidelines, and pre-existing surveys of clinical practice, a pilot study and consensus work with therapists and practitioners. The exercise programme targets lower limb strength and balance, which are known, modifiable risk factors for falling. Treatment was individually tailored and progressive, with seven recommended contacts over a six-month period. Clinical Trials Registry (ISCTRN 71002650)