Making sense of joint commissioning: three discourses of prevention, empowerment and efficiency

Background: In recent years joint commissioning has assumed an important place in the policy and practice of English health and social care. Yet, despite much being claimed for this way of working there is a lack of evidence to demonstrate the outcomes of joint commissioning. This paper examines the types of impacts that have been claimed for joint commissioning within the literature. Method: The paper reviews the extant literature concerning joint commissioning employing an interpretive schema to examine the different meanings afforded to this concept. The paper reviews over 100 documents that discuss joint commissioning, adopting an interpretive approach which sought to identify a series of discourses, each of which view the processes and outcomes of joint commissioning differently. Results: This paper finds that although much has been written about joint commissioning there is little evidence to link it to changes in outcomes. Much of the evidence base focuses on the processes of joint commissioning and few studies have systematically studied the outcomes of this way of working. Further, there does not appear to be one single definition of joint commissioning and it is used in a variety of different ways across health and social care. The paper identifies three dominant discourses of joint commissioning – prevention, empowerment and efficiency. Each of these offers a different way of seeing joint commissioning and suggests that it should achieve different aims. Conclusions: There is a lack of clarity not only in terms of what joint commissioning has been demonstrated to achieve but even in terms of what it should achieve. Joint commissioning is far from a clear concept with a number of different potential meanings. Although this ambiguity can be helpful in some ways in the sense that it can bring together disparate groups, for example, if joint commissioning is to be delivered at a local level then more specificity may be required in terms of what they are being asked to deliver

Learning to Selectively Transfer: Reinforced Transfer Learning for Deep Text Matching

Deep text matching approaches have been widely studied for many applications including question answering and information retrieval systems. To deal with a domain that has insufficient labeled data, these approaches can be used in a Transfer Learning (TL) setting to leverage labeled data from a resource-rich source domain. To achieve better performance, source domain data selection is essential in this process to prevent the "negative transfer" problem. However, the emerging deep transfer models do not fit well with most existing data selection methods, because the data selection policy and the transfer learning model are not jointly trained, leading to sub-optimal training efficiency. In this paper, we propose a novel reinforced data selector to select high-quality source domain data to help the TL model. Specifically, the data selector "acts" on the source domain data to find a subset for optimization of the TL model, and the performance of the TL model can provide "rewards" in turn to update the selector. We build the reinforced data selector based on the actor-critic framework and integrate it to a DNN based transfer learning model, resulting in a Reinforced Transfer Learning (RTL) method. We perform a thorough experimental evaluation on two major tasks for text matching, namely, paraphrase identification and natural language inference. Experimental results show the proposed RTL can significantly improve the performance of the TL model. We further investigate different settings of states, rewards, and policy optimization methods to examine the robustness of our method. Last, we conduct a case study on the selected data and find our method is able to select source domain data whose Wasserstein distance is close to the target domain data. This is reasonable and intuitive as such source domain data can provide more transferability power to the model.Comment: Accepted to WSDM 201

Intergenerational family caregiving in welfare policy context

Definition Intergenerational family caregiving refers to exchanges up and down family lines aimed at nurturing the needs of others. Caregiving is more than a task; it involves emotional and relationship work

Raised tone reveals ATP as a sympathetic neurotransmitter in the porcine mesenteric arterial bed

The relative importance of ATP as a functional sympathetic neurotransmitter in blood vessels has been shown to be increased when the level of preexisting vascular tone or pressure is increased, in studies carried out in rat mesenteric arteries. The aim of the present study was to determine whether tone influences the involvement of ATP as a sympathetic cotransmitter with noradrenaline in another species. We used the porcine perfused mesenteric arterial bed and porcine mesenteric large, medium and small arteries mounted for isometric tension recording, because purinergic cotransmission can vary depending on the size of the blood vessel. In the perfused mesenteric bed at basal tone, sympathetic neurogenic vasocontractile responses were abolished by prazosin, an α1- adrenoceptor antagonist, but there was no significant effect of α,β-methylene ATP, a P2X receptor-desensitizing agent. Submaximal precontraction of the mesenteric arterial bed with U46619, a thromboxane A2 mimetic, augmented the sympathetic neurogenic vasocontractile responses; under these conditions, both α,β-methylene ATP and prazosin attenuated the neurogenic responses. In the mesenteric large, medium and small arteries, prazosin attenuated the sympathetic neurogenic contractile responses under conditions of both basal and U46619-raised tone. α,β-Methylene ATP was effective in all of these arteries only under conditions of U46619- induced tone, causing a similar inhibition in all arteries, but had no significant effect on sympathetic neurogenic contractions at basal tone. These data show thatATP is a cotransmitter with noradrenaline in porcine mesenteric arteries; the purinergic component was revealed under conditions of partial precontraction, which is more relevant to physiological conditions

Role of the gap junctions in the contractile response to agonists in pulmonary artery from two rat models of pulmonary hypertension

International audienceBackground: Pulmonary hypertension (PH) is characterized by arterial vascular remodelling and alteration in vascular reactivity. Since gap junctions are formed with proteins named connexins (Cx) and contribute to vasoreactivity, we investigated both expression and role of Cx in the pulmonary arterial vasoreactivity in two rat models of PH. Methods: Intrapulmonary arteries (IPA) were isolated from normoxic rats (N), rats exposed to chronic hypoxia (CH) or treated with monocrotaline (MCT). RT-PCR, Western Blot and immunofluorescent labelling were used to study the Cx expression. The role of Cx in arterial reactivity was assessed by using isometric contraction and specific gap junction blockers. Contractile responses were induced by agonists already known to be involved in PH, namely serotonin, endothelin-1 and phenylephrine. Results: Cx 37, 40 and 43 were expressed in all rat models and Cx43 was increased in CH rats. In IPA from N rats only, the contraction to serotonin was decreased after treatment with 37-43Gap27, a specific Cx-mimetic peptide blocker of Cx 37 and 43. The contraction to endothelin-1 was unchanged after incubation with 40Gap27 (a specific blocker of Cx 40) or 37-43Gap27 in N, CH and MCT rats. In contrast, the contraction to phenylephrine was decreased by 40Gap27 or 37-43Gap27 in CH and MCT rats. Moreover, the contractile sensitivity to high potassium solutions was increased in CH rats and this hypersensitivity was reversed following 37-43Gap27 incubation. Conclusion: Altogether, Cx 37, 40 and 43 are differently expressed and involved in the vasoreactivity to various stimuli in IPA from different rat models. These data may help to understand alterations of pulmonary arterial reactivity observed in PH and to improve the development of innovative therapies according to PH aetiology

A parametric control function approach to estimating the returns to schooling in the absence of exclusion restrictions: an application to the NLSY

An innovation which bypasses the need for instruments when estimating endogenous treatment effects is identification via conditional second moments. The most general of these approaches is Klein and Vella (2010) which models the conditional variances semiparametrically. While this is attractive, as identification is not reliant on parametric assumptions for variances, the non-parametric aspect of the estimation may discourage practitioners from its use. This paper outlines how the estimator can be implemented parametrically. The use of parametric assumptions is accompanied by a large reduction in computational and programming demands. We illustrate the approach by estimating the return to education using a sample drawn from the National Longitudinal Survey of Youth 1979. Accounting for endogeneity increases the estimate of the return to education from 6.8% to 11.2%

Female Labor Force Intermittency and Current Earnings: A Switching Regression Model with Unknown Sample Selection

Using the Health and Retirement Survey, this paper finds a 16 percent selectivity-corrected wage penalty among women who engage in intermittent labor market activity. This penalty is experienced at a low level of intermittent activity but appears not to play an important role in a woman’s decision to undertake such activity. In addition, employer preferences appear to play a larger role than human capital atrophy in the determination of the wage penalty