Remuneration of primary dental care in England: a qualitative framework analysis of perspectives of a new service delivery model incorporating incentives for improved access, quality and health outcomes

Objective: This study aimed to describe stakeholder perspectives of a new service delivery model in primary care dentistry incorporating incentives for access, quality and health outcomes. Design: Data were collected through observations, interviews and focus groups. Setting: This was conducted under six UK primary dental care practices, three working under the incentive-driven contract and three working under the traditional activity-based contract. Participants: Observations were made of 30 dental appointments. Eighteen lay people, 15 dental team staff and a member of a commissioning team took part in the interviews and focus groups. Results: Using a qualitative framework analysis informed by Andersen’s model of access, we found oral health assessments influenced patients’ perceptions of need, which led to changes in preventive behaviour. Dentists responded to the contract, with greater emphasis on prevention, use of the disease risk ratings in treatment planning, adherence to the pathways and the utilisation of skill-mix. Participants identified increases in the capacity of practices to deliver more care as a result. These changes were seen to improve evaluated and perceived health and patient satisfaction. These outcomes fed back to shape people’s predispositions to visit the dentist. Conclusion: The incentive-driven contract was perceived to increase access to dental care, determine dentists’ and patients’ perceptions of need, their behaviours, health outcomes and patient satisfaction. Dentists face challenges in refocusing care, perceptions of preventive dentistry, deployment of skill mix and use of the risk assessments and care pathways. Dentists may need support in these areas and to recognise the differences between caring for individual patients and the patient-base of a practice

Practice Guideline Recommendations Summary: Treatment of Tics in People with Tourette Syndrome and Chronic Tic Disorders

Objective To make recommendations on the assessment and management of tics in people with Tourette syndrome and chronic tic disorders. Methods A multidisciplinary panel consisting of 9 physicians, 2 psychologists, and 2 patient representatives developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine–compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. Results Forty-six recommendations were made regarding the assessment and management of tics in individuals with Tourette syndrome and chronic tic disorders. These include counseling recommendations on the natural history of tic disorders, psychoeducation for teachers and peers, assessment for comorbid disorders, and periodic reassessment of the need for ongoing therapy. Treatment options should be individualized, and the choice should be the result of a collaborative decision among patient, caregiver, and clinician, during which the benefits and harms of individual treatments as well as the presence of comorbid disorders are considered. Treatment options include watchful waiting, the Comprehensive Behavioral Intervention for Tics, and medication; recommendations are provided on how to offer and monitor these therapies. Recommendations on the assessment for and use of deep brain stimulation in adults with severe, treatment-refractory tics are provided as well as suggestions for future research

The legacy of redlining in the effect of foreclosures on Detroit residents’ self-rated health

Historical practices, such as housing discrimination in Detroit, have been shown to have lasting impacts on communities. Perhaps the most explicit example is the practice of redlining in the 1930s, whereby lenders outlined financially undesirable neighborhoods, populated by minority families, on maps and prevented residents from moving to better resourced neighborhoods. Awareness of historical housing discrimination may improve research assessing the impacts of current neighborhood characteristics on health. Using the Detroit Neighborhood Health Study (DNHS), we assessed the association between two-year changes in home foreclosure rates following the 2007–2008 Great Recession, and residents’ five-year self-rated health trajectories (2008–2013); and estimated the confounding bias introduced by ignoring historical redlining practices in the city. We used both ecological and multilevel models to make inference about person- and community-level processes. In a neighborhood-level linear regression adjusted for confounders (including percent redlined); a 10%-point slower foreclosure rate recovery was associated with an increase in prevalence of poor self-rated health of 0.31 (95% CI:−0.02 to 0.64). At the individual level, it was associated with a within-person increase in probability of poor health of 0.45 (95% CI:0.15–0.72). Removing redlining from the model biased the estimated effect upward to 0.38 (95% CI:0.07–0.69) and 0.56 (95% CI:0.21–0.84) in the neighborhood and individual-level models, respectively. Stratum-specific foreclosure recovery effects indicate stronger influence in neighborhoods with a greater proportion of residents identifying as white and a greater degree of historic redlining. These findings support earlier theory suggesting a historical influence of structural discrimination on the association between current neighborhood characteristics and health, and suggests that historical redlining specifically may increase vulnerability to contemporary neighborhood foreclosures. Community interventions should consider historical discrimination in conjunction with current place-based indicators to more equitably improve population health

A species-centered approach for uncovering generalities in organism responses to habitat loss and fragmentation

Theoretical models predict strong influences of habitat loss and fragmentation on species distributions and demography, but empirical studies have shown relatively inconsistent support across species and systems. We argue that species' responses to landscape-scale habitat loss and fragmentation are likely to appear less idiosyncratic if it is recognized that species perceive the same landscapes in different ways. We present a new quantitative approach that uses species distribution models (SDMs) to measure landscapes (e.g. patch size, isolation, matrix amount) from the perspective of individual species. First, we briefly summarize the few efforts to date demonstrating that once differences in habitat distributions are controlled, consistencies in species' responses to landscape structure emerge. Second, we present a detailed example providing step-by-step methods for application of a species-centered approach using freely available land-cover data and recent statistical modeling approaches. Third, we discuss pitfalls in current applications of the approach and recommend avenues for future developments. We conclude that the species-centered approach offers considerable promise as a means to test whether sensitivity to habitat loss and fragmentation is mediated by phylogenetic, ecological, and life-history traits. Cross-species generalities in responses to habitat loss and fragmentation will be challenging to uncover unless landscape mosaics are defined using models that reflect differing species-specific distributions, functional connectivity, and domains of scale. The emergence of such generalities would not only enhance scientific understanding of biotic processes driving fragmentation effects, but would allow managers to estimate species sensitivities in new regions.this study was supported by US National Science Foundation grants (NSF-ARC-0941748 and DEB-1050954

IRAS F02044+0957: radio source in interacting system of galaxies

The steep spectrum of IRAS F02044+0957 was obtained with the RATAN-600 radio telescope at four frequencies. Optical spectroscopy of the system components, was carried out with the 2.1m telescope of the Guillermo Haro Observatory. Observational data allow us to conclude that this object is a pair of interacting galaxies, a LINER and a HII galaxy, at $z=0.093$.Comment: 2 pages, 2 EPS-figures, uses newpasp.sty. To appear in Proc. IAU Colloq. 184, AGN Surveys, ed. R. F. Green, E. Ye. Khachikian, & D. B. Sanders (San Francisco: ASP

CT Angiography in The Detection of Carotid Body Enlargement in Patients with Hypertension and Heart Failure

Introduction: The carotid body (CB) has previously been found to be enlarged and hyperactive in various disease states such as heart failure (HF), hypertension (HTN), and respiratory disease. Evaluation of CB size in these disease states using imaging has not been performed. The purpose of this case–control study was to compare CB sizes in patients with HF and HTN with those of controls using CT angiography. Methods: A retrospective review was performed on 323 consecutive patients who had neck computed tomography angiography (CTA) exams in 2011. Following extensive review, 17 HF and HTN patients and 14 controls were identified. Two radiologists blinded to the patient disease status made consensus bilateral carotid body (CB) measurements on the CTA exams using a previously described standardized protocol. CB axial cross-sectional areas were compared between HF and HTN cases and controls using a paired t test. Results: The right CB demonstrated a mean cross-sectional area of 2.79 mm2 in HF and HTN patients vs. 1.40 mm2 in controls (p = 0.02). The left CB demonstrated a mean cross-sectional area of 3.13 mm2 in HF and HTN patients vs. 1.53 mm in controls (p = 0.03). Conclusion: Our results provide imaging evidence that the carotid bodies are enlarged in patients with HF and HTN. Our case–control series suggests that this enlargement can be detected on neck CTA

The Infrared Continuum of Active Galaxies

We discuss the different physical processes contributing to the infrared continuum of AGN, assuming that both photoionization from the active center and shocks ionize and heat the gas and dust contained in an ensemble of clouds surrounding the nucleus. Radiation transfer of primary and secondary radiation throughout a cloud is calculated consistently with collisional processes due to the shock. We consider that the observed continuum corresponds to reprocessed radiation from both dust and gas in the clouds. The model is applied to the continuum of Seyfert galaxies from which best estimate of the nuclear, stellar subtracted, emission is available. The results show that radiation-dominated high velocity clouds are more numerous in Seyfert 1-1.5 whereas shock-dominated low velocity clouds are dominant in Seyfert type 2 in full agreement with the unified model for AGN. In type 2 objects, radiation is partly suppressed by a central dusty medium with a high dust-to-gas ratio. A grid of models is used to provide a phenomenological analysis of the observed infrared spectral energy distribution.Comment: 14 pages, 10 figures. in press in MNRA