Building on Julian Tudor Hart's example of anticipatory care

The prevention and delay of chronic disease is an increasing priority in all advanced health-care systems, but sustainable, effective and equitable approaches remain elusive. In a famous pioneering example in the UK, Julian Tudor Hart combined reactive and anticipatory care within routine consultations in primary medical care, while applying a population approach to delivery and audit. This approach combined the structural advantages of UK general practice, including universal coverage and the absence of user fees, with his long-term commitment to individual patients, and was associated with a 28% reduction in premature mortality over a 25-year period. The more recent, and comprehensively evaluated Scottish National Health Service demonstration project, ‘Have a Heart Paisley’, took a different approach to cardiovascular prevention and health improvement, using population screening for ascertainment, health coaches and referral to specific health improvement programmes for diet, smoking and exercise. We draw from both examples to construct a conceptual framework for anticipatory care, based on active ingredients, programme pathways and whole system approaches. While the strengths of a family practice approach are coverage, continuity, co-ordination and longterm relationships, the larger health improvement programme offered additional resources and expertise. As theory and evidence accrue, the challenge is to combine the strengths of primary medical care and health improvement, in integrated, sustainable systems of anticipatory care, addressing the heterogeneity of individual needs and solutions, while achieving high levels of coverage, continuity, co-ordination and outcome

Comparing Firm Performance Using Transitive Productivity Index Numbers in a Meta-frontier Framework

The meta-frontier framework has been used extensively for evaluating the technical efficiency of heterogeneous production units that can be classified into different groups. This paper shows how the framework can also be used to make total factor productivity (TFP) comparisons within and across groups. The paper develops a new measure of the distance between a group frontier and the meta-frontier (the so-called ‘technology gap’). It then shows how a spatially- and temporally-transitive TFP index can be decomposed into measures of global technical change (measuring movements in the metafrontier), local technical change (measuring movements in the group frontiers) and efficiency change (measuring movements towards or around the group frontiers). To illustrate the methodology, the paper examines the productive performance of road authorities responsible for maintaining interstate highways in the US state of Virginia.

A biogenic amine and a neuropeptide act identically: tyramine signals through calcium in drosophila tubule stellate cells

Insect osmoregulation is subject to highly sophisticated endocrine control. In Drosophila, both Drosophila kinin and tyramine act on the Malpighian (renal) tubule stellate cell to activate chloride shunt conductance, and so increase the fluid production rate. Drosophila kinin is known to act through intracellular calcium, but the mode of action of tyramine is not known. Here, we used a transgenically encoded GFP::apoaequorin translational fusion, targeted to either principal or stellate cells under GAL4/UAS control, to demonstrate that tyramine indeed acts to raise calcium in stellate, but not principal cells. Furthermore, the EC(50) tyramine concentration for half-maximal activation of the intracellular calcium signal is the same as that calculated from previously published data on tyramine-induced increase in chloride flux. In addition, tyramine signalling to calcium is markedly reduced in mutants of NorpA (a phospholipase C) and itpr, the inositol trisphosphate receptor gene, which we have previously shown to be necessary for Drosophila kinin signalling. Therefore, tyramine and Drosophila kinin signals converge on phospholipase C, and thence on intracellular calcium; and both act to increase chloride shunt conductance by signalling through itpr. To test this model, we co-applied tyramine and Drosophila kinin, and showed that the calcium signals were neither additive nor synergistic. The two signalling pathways thus represent parallel, independent mechanisms for distinct tissues (nervous and epithelial) to control the same aspect of renal function

InGaN epilayer characterization by microfocused x-ray reciprocal space mapping

We report the use of microfocused three-dimensional x-ray reciprocal space mapping to study InGaN epilayers with average InN content 20%-22%. Analysis of the full volume of reciprocal space, while probing samples on the microscale with a focused x-ray beam, allowed us to gain valuable information about the nanostructure of InN-rich InGaN epilayers. It is found that “seed” InGaN mosaic nanocrystallites are twisted with respect to the ensemble average and strain-free. The initial stages of InGaN-on-GaN epitaxial growth, therefore, conform to the Volmer-Weber growth mechanism with “seeds” nucleated on strain fields generated by the a-type edge dislocations

Do Nearctic migrant birds compete with residents at army ant raids? A geographic and seasonal analysis

Army ant swarm raids in Neotropical montane forest are attended by diverse flocks of foraging birds that can include residents year-round and overwintering Nearctic migrants. We asked whether migrants and residents affect each other's ability to forage at army ant raids. We quantified variation in raid attendance by three guilds of birds: wintering migrants, regular and obligate raid attending residents (ant-following residents), and facultative raid attending residents. To test whether wintering migrants and residents were negatively associated at raids, we collected data on raid attendance in four adjacent life zones in the Tilarán Mountains of Costa Rica and in different seasons (when migrants were present and absent). We first compared the guilds' raid attendance among life zones. There was little geographic overlap of migrants and ant-following residents at raids, and raid attendance frequencies were strongly correlated with the estimated local abundances of these bird guilds in each life zone. We then analyzed resident bird flock size and species makeup in the life zones where migrants attended raids most often (Premontane and Lower Montane Wet forests). If migrants affected raid attendance by facultative resident birds, we expected resident numbers or species richness at raids to decrease with migrant presence. Resident flock size and species richness did not differ between times of year with and without migrants, and species identities differed little between seasons. Furthermore, resident flock composition in migrant presence season was similar at raids with and without migrants. We conclude migrants had no measurable effect on resident bird army ant exploitation. Migrants were smaller on average and less likely than residents to capture prey from the ground at raids. These body size and foraging substrate differences between residents and migrants may mitigate inter-guild competition for food at raids.Thanks to the Organization for Tropical Studies (OTS) for research support, including assistance in obtaining permits. This project was supported by an ALCOR Fellowship (University of Washington Psychology) and an OTS Post-Course Award to A.K., and University of Washington Royalty Research Fund, National Geographic/Waitt Foundation, and Drexel University start-up grants to S. O'D

Army ant raid attendance and bivouac-checking behavior by neotropical montane forest birds

We quantified resident and migrant bird attendance at army ant swarm raids (n = 48) in a neotropical montane forest. All observations were during seasons when Nearctic migrant birds are present. Bird species differed in army ant raid-attending behavior. Resident bird species attended 2 to 54% of raids, while migrants attended at lower maximum frequencies (2 to 21% of raids attended per species). Some resident and migrant bird species attended raids more frequently than expected based on capture rates in mist-net studies and point-count density surveys. Army ant raid attendance may be a regular element of foraging behavior for some resident species, and important in the wintering ecology of some Nearctic migrant species. The bird species that attended raids most frequently were predicted to show behavioral specializations for exploiting army ant swarms. Eight resident bird species (but no migrants) performed a specialized behavior, bivouac checking, by which birds sample army ant activity. Resident bird species' frequencies of raid attendance were positively associated with frequency of checking bivouacs (r = 0.68). We hypothesize the absence of obligate army ant-following birds in montane forests has favored performance of specialized behaviors for exploiting army ant raids by some resident birds. © 2010 by the Wilson Ornithological Society.This project was supported by a University of Washington ALCOR Fellowship and an OTS Post-Course Award to AK, and University of Washington Royalty Research Fund and NSF grants (IBN-0347315) to SO’D. National Geographic Television also supported the field research. Research was partially supported by the National Science Foundation while SO’D was working at the foundation

Motor deficits in schizophrenia quantified by nonlinear analysis of postural sway.

Motor dysfunction is a consistently reported but understudied aspect of schizophrenia. Postural sway area was examined in individuals with schizophrenia under four conditions with different amounts of visual and proprioceptive feedback: eyes open or closed and feet together or shoulder width apart. The nonlinear complexity of postural sway was assessed by detrended fluctuation analysis (DFA). The schizophrenia group (n = 27) exhibited greater sway area compared to controls (n = 37). Participants with schizophrenia showed increased sway area following the removal of visual input, while this pattern was absent in controls. Examination of DFA revealed decreased complexity of postural sway and abnormal changes in complexity upon removal of visual input in individuals with schizophrenia. Additionally, less complex postural sway was associated with increased symptom severity in participants with schizophrenia. Given the critical involvement of the cerebellum and related circuits in postural stability and sensorimotor integration, these results are consistent with growing evidence of motor, cerebellar, and sensory integration dysfunction in the disorder, and with theoretical models that implicate cerebellar deficits and more general disconnection of function in schizophrenia