GONG third generation camera: Detector selection and feasibility study

Aging GONG second generation cameras (Silicon Mountain Design(TM) cameras) were planned to be replaced after their long service of more than a decade. This prompted a market-wide search for a potential replacement detector to meet the GONG science requirements. This report provides some history of the search process, a comparison between CMOS and CCD type sensors and then a quantitative evaluation of potential candidates to arrive at final selection. Further, a feasibility study of the selected sensor for adaptation to GONG optical system was done and sensor characteristics were independently verified in the laboratory. This technical report gives description of these studies and tests.Comment: 13 pages, 12 figure

Research shapes policy: but the dynamics are subtle

Major policy initiatives such as the Quality and Outcomes Framework (QOF) in the national contract for UK general practitioners might variably be informed by evidence at their inception, implementation and subsequent evolution. But what evidence gets admitted into these policy debates—and what is left out? Using QOF as an example, this article demonstrates what an analysis of the relationship between policy and the associated research can tell us about the underlying policy assumptions and about the role of evidence in policy debates

High yielding biomass ideotypes of willow (Salix spp.) show differences in below ground biomass allocation.

Willows (Salix spp.) grown as short rotation coppice (SRC) are viewed as a sustainable source of biomass with a positive greenhouse gas (GHG) balance due to their potential to fix and accumulate carbon (C) below ground. However, exploiting this potential has been limited by the paucity of data available on below ground biomass allocation and the extent to which it varies between genotypes. Furthermore, it is likely that allocation can be altered considerably by environment. To investigate the role of genotype and environment on allocation, four willow genotypes were grown at two replicated field sites in southeast England and west Wales, UK. Above and below ground biomass was intensively measured over two two-year rotations. Significant genotypic differences in biomass allocation were identified, with below ground allocation differing by up to 10% between genotypes. Importantly, the genotype with the highest below ground biomass also had the highest above ground yield. Furthermore, leaf area was found to be a good predictor of below ground biomass. Growth environment significantly impacted allocation; the willow genotypes grown in west Wales had up to 94% more biomass below ground by the end of the second rotation. A single investigation into fine roots showed the same pattern with double the volume of fine roots present. This greater below ground allocation may be attributed primarily to higher wind speeds, plus differences in humidity and soil characteristics. These results demonstrate that the capacity exists to breed plants with both high yields and high potential for C accumulation

Seasonal Carbohydrate Dynamics and Climatic Regulation of Senescence in the Perennial Grass, Miscanthus

Miscanthus is a perennial energy grass predominantly used for combustion but there is increasing interest in fermenting the cell-wall carbohydrates or green-cutting for soluble sugars to produce bioethanol. Our aims were to: (1) quantify non-structural carbohydrates (NSC), (2) observe the timing of seasonal shifts in the stems and rhizome, and (3) identify developmental and/or climatic conditions that promoted carbohydrate remobilization from the stems to the rhizome during senescence. Two genotypes of Miscanthus sinensis, a Miscanthus sacchariflorus and a Miscanthus × giganteus were grown at replicated field sites in Aberystwyth, West Wales and Harpenden, South East England. NSC were quantified from the rhizome and aboveground organs and then correlated with climatic data collected from on-site weather stations. PAR and maximum daily temperatures were higher at Harpenden throughout the year, but daily minimum temperatures were lower. Senescence was accelerated at Harpenden. Carbohydrates were retained within the stems of non-flowering genotypes, at both sites, in winter and were still present after a frost event to −2 °C. Rhizome starch concentrations were at least equal to the previous winter’s levels (February 2011) by September. Lower daily minimum temperatures accelerate the rate of senescence and warmer daily maximum temperatures cannot counteract this effect. At current yields, M. × giganteus, could produce 0.7 t ha−1 of NSC in addition to ligno-cellulosic biomass in November but with concerted breeding efforts this could be targeted for improvement as has been achieved in other crops. Shifting harvests forward to November would not leave the rhizome depleted of carbohydrates

Protecting children from secondhand smoke: a mixed-methods feasibility study of a novel smoke-free homes intervention

Background Globally, 40% of children under 14 years are regularly exposed to secondhand smoke (SHS), typically in their home. There is limited evidence of the effectiveness of interventions to reduce children’s SHS exposure and so the aim of this study was to test the feasibility and acceptability (rather than the efficacy) of a novel intervention to help parents and carers (caregivers) to reduce their children’s exposure to SHS at home. MethodsA novel multi-component intervention to support caregivers to reduce their children’s SHS exposure at home was tested in a two-phase feasibility study. The 12 week intensive intervention delivered in the home consisted of three components: behavioural support, nicotine replacement therapy (NRT) for temporary abstinence, and feedback on levels of SHS exposure in the form of children’s salivary cotinine (phase 1) or home air quality (PM2.5) (phase 2). Participants were caregivers who smoked inside their home and had at least one child under the age of five years living with them the majority of the time. Mixed-methods were used to explore the acceptability and feasibility of the intervention as well as processes, particularly around recruitment and retention, for an exploratory efficacy trial.ResultsTwelve caregivers completed the study and all received personalised feedback on SHS exposure, behavioural support to help them to make their homes smoke-free, and the majority at least tried NRT. Saliva cotinine results were variable in phase 1 and therefore measures of PM2.5 were used for feedback in phase 2. Behavioural support was well received with personalised feedback reported as being the key motivator for initiating and maintaining behaviour change. ConclusionsRecruiting disadvantaged caregivers was labour intensive but once recruited this novel intervention was both feasible and acceptable in supporting caregivers to reduce their children’s exposure to SHS at home. It is appropriate to test the efficacy of this novel intervention in an exploratory randomised controlled trial. <br/

General practitioners and emergency departments (GPED) - Efficient models of care: A mixed-methods study protocol

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ. Introduction Pressure continues to grow on emergency departments in the UK and throughout the world, with declining performance and adverse effects on patient outcome, safety and experience. One proposed solution is to locate general practitioners to work in or alongside the emergency department (GPED). Several GPED models have been introduced, however, evidence of effectiveness is weak. This study aims to evaluate the impact of GPED on patient care, the primary care and acute hospital team and the wider urgent care system. Methods and analysis The study will be divided into three work packages (WPs). WP-A; Mapping and Taxonomy: Mapping, description and classification of current models of GPED in all emergency departments in England and interviews with key informants to examine the hypotheses that underpin GPED. WP-B; Quantitative Analysis of National Data: Measurement of the effectiveness, costs and consequences of the GPED models identified in WP-A, compared with a no-GPED model, using retrospective analysis of Hospital Episode Statistics Data. WP-C; Case Studies: Detailed case studies of different GPED models using a mixture of qualitative and quantitative methods including: non-participant observation of clinical care, semistructured interviews with staff, patients and carers; workforce surveys with emergency department staff and analysis of available local routinely collected hospital data. Prospective case study sites will be identified by completing telephone interviews with sites awarded capital funding by the UK government to implement GPED initiatives. The study has a strong patient and public involvement group that has contributed to study design and materials, and which will be closely involved in data interpretation and dissemination. Ethics and dissemination The study has been approved by the National Health Service East Midlands - Leicester South Research Ethics Committee: 17/EM/0312. The results of the study will be disseminated through peer-reviewed journals, conferences and a planned programme of knowledge mobilisation

Consensus proposals for classification of the family hepeviridae

The family Hepeviridae consists of positive-stranded RNA viruses that infect a wide range of mammalian species, as well as chickens and trout. A subset of these viruses infects humans and can cause a self-limiting acute hepatitis that may become chronic in immunosuppressed individuals. Current published descriptions of the taxonomical divisions within the family Hepeviridae are contradictory in relation to the assignment of species and genotypes. Through analysis of existing sequence information, we propose a taxonomic scheme in which the family is divided into the genera Orthohepevirus (all mammalian and avian hepatitis E virus (HEV) isolates) and Piscihepevirus (cutthroat trout virus). Species within the genus Orthohepevirus are designated Orthohepevirus A (isolates from human, pig, wild boar, deer, mongoose, rabbit and camel), Orthohepevirus B (isolates from chicken), Orthohepevirus C (isolates from rat, greater bandicoot, Asian musk shrew, ferret and mink) and Orthohepevirus D (isolates from bat). Proposals are also made for the designation of genotypes within the human and rat HEVs. This hierarchical system is congruent with hepevirus phylogeny, and the three classification levels (genus, species and genotype) are consistent with, and reflect discontinuities in the ranges of pairwise distances between amino acid sequences. Adoption of this system would include the avoidance of host names in taxonomic identifiers and provide a logical framework for the assignment of novel variants

How a universal health system reduces inequalities: lessons from England

Background: Provision of universal coverage is essential for achieving equity in healthcare, but inequalities still exist in universal healthcare systems. Between 2004/5 and 2011/12 the English NHS, which has provided universal coverage since 1948, made sustained efforts to reduce health inequalities by strengthening primary care. We provide the first comprehensive assessment of trends in socioeconomic inequalities of primary care access, quality and outcomes during this period. Methods: Whole-population small area longitudinal study, based on 32,482 neighbourhoods of approximately 1,500 people in England from 2004/5 to 2011/12. We measured slope indices of inequality in four indicators: (i) patients per family doctor (ii) primary care quality (iii) preventable emergency hospital admissions and (iv) mortality from conditions considered amenable to healthcare. Results: Between 2004/5 and 2011/12 there were larger absolute improvements on all indicators in more deprived neighbourhoods. The modelled gap between the most and least deprived neighbourhoods in England decreased by: 193 patients per family doctor (95% confidence interval 173 to 213), 3.29 percentage points of primary care quality (3.13 to 3.45), 0.42 preventable hospitalisations per 1,000 people (0.29 to 0.55) and 0.23 amenable deaths per 1,000 people (0.15 to 0.31). By 2011/12 inequalities in primary care supply and quality were almost eliminated but socio-economic inequality was still associated with 158,396 preventable hospitalisations and 37,983 deaths amenable to healthcare. Conclusions: Between 2004/5 and 2011/12 the NHS succeeded in substantially reducing socioeconomic inequalities in primary care access and quality but made only modest reductions in healthcare outcome inequalities

Enhancing communication through gesture and naming therapy

Purpose: This study investigated whether gesture, naming and strategic treatment improved the communication skills of 14 people with severe aphasia. Method: All participants received 15 hours of gesture and naming treatment (reported in a companion paper). Half the group received a further 15 hours of strategic therapy, while the remaining seven participants received no further input. The effects of therapy on communication were assessed with two novel measures. These required participants to convey simple messages and narratives to their communication partner. In both assessments a subset of the stimuli featured items that had been targets in gesture or naming treatment. Results: Performance on the communication measures was stable over two baseline assessments, but improved after gesture and naming treatment. Those who received additional strategic therapy made further gains on the message but not the narrative task. Communication gains were not specific to the stimuli featuring trained items. Conclusions: This study suggests that gesture and naming treatments can benefit interactive communication. The additional benefits of strategic therapy were less clear cut, but did impact on the transmission of simple messages. Gains seem to reflect the development of general communication skills, rather than the use of trained gestures and/or words

Do general practitioners working in or alongside the emergency department improve clinical outcomes or experience? A mixed-methods study

OBJECTIVES: To examine the effect of general practitioners (GPs) working in or alongside the emergency department (GPED) on patient outcomes and experience, and the associated impacts of implementation on the workforce. DESIGN: Mixed-methods study: interviews with service leaders and NHS managers; in-depth case studies (n=10) and retrospective observational analysis of routinely collected national data. We used normalisation process theory to map our findings to the theory's four main constructs of coherence, cognitive participation, collective action and reflexive monitoring. SETTING AND PARTICIPANTS: Data were collected from 64 EDs in England. Case site data included: non-participant observation of 142 clinical encounters; 467 semistructured interviews with policy-makers, service leaders, clinical staff, patients and carers. Retrospective observational analysis used routinely collected Hospital Episode Statistics alongside information on GPED service hours from 40 hospitals for which complete data were available. RESULTS: There was disagreement at individual, stakeholder and organisational levels regarding the purpose and potential impact of GPED (coherence). Participants criticised policy development and implementation, and staff engagement was hindered by tensions between ED and GP staff (cognitive participation). Patient 'streaming' processes, staffing and resource constraints influenced whether GPED became embedded in routine practice. Concerns that GPED may increase ED attendance influenced staff views. Our quantitative analysis showed no detectable impact on attendance (collective action). Stakeholders disagreed whether GPED was successful, due to variations in GPED model, site-specific patient mix and governance arrangements. Following statistical adjustment for multiple testing, we found no impact on: ED reattendances within 7 days, patients discharged within 4 hours of arrival, patients leaving the ED without being seen; inpatient admissions; non-urgent ED attendances and 30-day mortality (reflexive monitoring). CONCLUSIONS: We found a high degree of variability between hospital sites, but no overall evidence that GPED increases the efficient operation of EDs or improves clinical outcomes, patient or staff experience. TRIAL REGISTRATION NUMBER: ISCRTN5178022