Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey.

OBJECTIVES: Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. DESIGN/SETTING: Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects. MAIN OUTCOME MEASURES: Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services. RESULTS: Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors. CONCLUSIONS: While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would 'cream-skim' by not enrolling patients from vulnerable socio-demographic groups.The study was funded by a grant from the UK Department of Healt

Spin correlations in Ca3Co2O6: A polarised-neutron diffraction and Monte Carlo study

We present polarised-neutron diffraction measurements of the Ising-like spin-chain compound Ca3Co2O6 above and below the magnetic ordering temperature TN. Below TN, a clear evolution from a single-phase spin-density wave (SDW) structure to a mixture of SDW and commensurate antiferromagnet (CAFM) structures is observed on cooling. For a rapidly-cooled sample, the majority phase at low temperature is the SDW, while if the cooling is performed sufficiently slowly, then the SDW and the CAFM structure coexist between 1.5 and 10 K. Above TN, we use Monte Carlo methods to analyse the magnetic diffuse scattering data. We show that both intra- and inter-chain correlations persist above TN, but are essentially decoupled. Intra-chain correlations resemble the ferromagnetic Ising model, while inter-chain correlations resemble the frustrated triangular-lattice antiferromagnet. Using previously-published bulk property measurements and our neutron diffraction data, we obtain values of the ferromagnetic and antiferromagnetic exchange interactions and the single-ion anisotropy.Comment: 10 pages, 7 figure

A robust system for RNA interference in the chicken using a modified microRNA operon

AbstractRNA interference (RNAi) provides an effective method to silence gene expression and investigate gene function. However, RNAi tools for the chicken embryo have largely been adapted from vectors designed for mammalian cells. Here we present plasmid and retroviral RNAi vectors specifically designed for optimal gene silencing in chicken cells. The vectors use a chicken U6 promoter to express RNAs modelled on microRNA30, which are embedded within chicken microRNA operon sequences to ensure optimal Drosha and Dicer processing of transcripts. The chicken U6 promoter works significantly better than promoters of mammalian origin and in combination with a microRNA operon expression cassette (MOEC), achieves up to 90% silencing of target genes. By using a MOEC, we show that it is also possible to simultaneously silence two genes with a single vector. The vectors express either RFP or GFP markers, allowing simple in vivo tracking of vector delivery. Using these plasmids, we demonstrate effective silencing of Pax3, Pax6, Nkx2.1, Nkx2.2, Notch1 and Shh in discrete regions of the chicken embryonic nervous system. The efficiency and ease of use of this RNAi system paves the way for large-scale genetic screens in the chicken embryo

Responsible participation and housing: restoring democratic theory to the scene

Tensions between individual liberty and collective social justice characterise many advanced liberal societies. These tensions are reflected in the challenges posed for representative democracy both by participatory democratic practices and by the current emphasis on (so-called) responsible participation. Based on the example of ‘community’ housing associations in Scotland, this paper explores these tensions. It is argued that the critique of responsibility may have been over-stated – that, in particular, ‘community’ housing associations offer the basis for relatively more inclusive and effective processes of decision-making than council housing, which relies on the traditional processes and institutions of representative local government for its legitimacy

“I Keep Hearing Reports on the News That it's a Real Problem at the Moment”: Public Health Nurses’ Understandings of Sexting Practices Among Young People

Over the past decade, the potential harms regarding young people's use of technology have attracted mounting political, media and research attention worldwide. One practice engaged in by many young people is that of “sexting” and the sharing of partially, or complete nude images (“selfies”). Such images are not always retained within private spaces and are prone to be shared, with significant psychosocial consequences for young people involved. A significant risk is the hidden nature of some online interactions, with potential for grooming and child sexual exploitation. As key professionals working with young people, public health nurses have potential to educate and explore the risks with them. Yet to date, to our knowledge there has been no research in relation to public health nurses’ understandings of the practices involved or their potential harms. A qualitative study was undertaken drawing theoretically on the common‐sense model (CSM) to frame the analysis. Eighteen semi‐structured interviews were conducted with public health nurses in a region of England in 2016. Data were analysed through thematic analysis, and mapped to the five domains of CSM. Public health nurses’ understandings of young people's sexting practices were shaped largely by media reports, rather than scientific, disciplinary knowledge. Sexting did not resonate with many public health nurses’ own experiences of being a young person and was therefore difficult to understand. All were able to express an opinion about the causes and consequences of sexting and we present these as a “perceived hierarchy of risk”. All public health nurses acknowledged the importance of their role in dealing with harm reduction associated with sexting among young people, but they need education and support to do this effectively and confidently. Findings can be transferred carefully to many contexts and countries because sexting is a practice among young people that transcends geographical boundaries

Selective Hydrogenation of Furfural in a Proton Exchange Membrane Reactor Using Hybrid Pd/Pd Black on Alumina

Conventional thermocatalytic hydrogenation employs high temperatures and pressures and often exhibits low selectivity toward desired products. Electrochemical hydrogenation can reduce energy input by operating at ambient conditions and improving process control and selectivity; however, electrocatalysts face stability and conductivity limitations. To overcome these obstacles, we physically mixed a traditional electrocatalyst (Pd black) with a hydrogenation‐active metal (Pd) supported on a conventional metal oxide support (alumina, Al2O3) and investigated electrochemical hydrogenation of furfural, a model biomass compound. Experiments were conducted in a proton exchange membrane (PEM) reactor, in which synthesized electrocatalysts were used as cathodes. Catalysts with Pd black and varying loadings of Pd on Al2O3 were used to determine the impact of hydrogen spillover on electrocatalytic hydrogenation mechanisms, selectivity, and rates. Observed hydrogenation rates and selectivities were linked to structural and compositional properties of the catalyst mixtures. Of the Pd black cathodes tested, 5 wt % Pd/Al2O3 exhibited production rates as high as pure Pd black and higher selectivity towards completely hydrogenated products. Improved selectivity and rates were attributed to a synergistic interaction between Pd black and 5 wt % Pd/Al2O3 in which Pd/Al2O3 increased the number of active sites, while Pd black provided stable conductivity.Breaking away from convention: The performance of hybrid cathodes, consisting of a traditional electrocatalyst (Pd black) with a hydrogenation‐active metal (Pd) supported on a conventional metal oxide support (Al2O3), is investigated using electrochemical hydrogenation of furfural in a proton exchange membrane reactor. Varying loadings of Pd on Al2O3 within the hybrid cathode elucidates the impact of structural and compositional properties of the catalyst mixtures on hydrogenation rates and selectivities.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152702/1/celc201901314-sup-0001-misc_information.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152702/2/celc201901314.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152702/3/celc201901314_am.pd

Revisiting spin ice physics in the ferromagnetic Ising pyrochlore Pr2_2Sn2_2O7_7

Pyrochlore materials are characterized by their hallmark network of corner-sharing rare-earth tetrahedra, which can produce a wide array of complex magnetic ground states. Ferromagnetic Ising pyrochlores often obey the "two-in-two-out" spin ice rules, which can lead to a highly-degenerate spin structure. Large moment systems, such as Ho$_2$Ti$_2$O$_7$ and Dy$_2$Ti$_2$O$_7$, tend to host a classical spin ice state with low-temperature spin freezing and emergent magnetic monopoles. Systems with smaller effective moments, such as Pr$^{3+}$-based pyrochlores, have been proposed as excellent candidates for hosting a "quantum spin ice" characterized by entanglement and a slew of exotic quasiparticle excitations. However, experimental evidence for a quantum spin ice state has remained elusive. Here, we show that the low-temperature magnetic properties of Pr$_2$Sn$_2$O$_7$ satisfy several important criteria for continued consideration as a quantum spin ice. We find that Pr$_2$Sn$_2$O$_7$ exhibits a partially spin-frozen ground state with a large volume fraction of dynamic magnetism. Our comprehensive bulk characterization and neutron scattering measurements enable us to map out the magnetic field-temperature phase diagram, producing results consistent with expectations for a ferromagnetic Ising pyrochlore. We identify key hallmarks of spin ice physics, and show that the application of small magnetic fields ($\mu_0 H_c \sim$0.75T) suppresses the spin ice state and induces a long-range ordered magnetic structure. Together, our work clarifies the current state of Pr$_2$Sn$_2$O$_7$ and encourages future studies aimed at exploring the potential for a quantum spin ice ground state in this system