The UK quality and outcomes framework pay-for-performance scheme and spirometry: rewarding quality or just quantity? A cross-sectional study in Rotherham, UK

Background: Accurate spirometry is important in the management of COPD. The UK Quality and Outcomes Framework pay-for-performance scheme for general practitioners includes spirometry related indicators within its COPD domain. It is not known whether high achievement against QOF spirometry indicators is associated with spirometry to BTS standards. Methods: Data were obtained from the records of 3,217 patients randomly sampled from 5,649 patients with COPD in 38 general practices in Rotherham, UK. Severity of airflow obstruction was categorised by FEV1 (% predicted) according to NICE guidelines. This was compared with clinician recorded COPD severity. The proportion of patients whose spirometry met BTS standards was calculated in each practice using a random sub-sample of 761 patients. The Spearman rank correlation between practice level QOF spirometry achievement and performance against BTS spirometry standards was calculated. Results: Spirometry as assessed by clinical records was to BTS standards in 31% of cases (range at practice level 0% to 74%). The categorisation of airflow obstruction according to the most recent spirometry results did not agree well with the clinical categorisation of COPD recorded in the notes (Cohen's kappa = 0.34, 0.30 - 0.38). 12% of patients on COPD registers had FEV1 (% predicted) results recorded that did not support the diagnosis of COPD. There was no association between quality, as measured by adherence to BTS spirometry standards, and either QOF COPD9 achievement (Spearman's rho = -0.11), or QOF COPD10 achievement (rho = 0.01). Conclusion: The UK Quality and Outcomes Framework currently assesses the quantity, but not the quality of spirometry

Entwicklung, Bedeutung und Erfolgsfaktoren von Bio- Vermarktungsinitiativen in der Schweiz, Österreich und Deutschland

Problemstellung/Ziele: In Rahmen des EU Projektes "Organic Marketing Initiatives and Rural Development" (OMIaRD; QLK5-2000-01124) wurden in neun verschiedenen Ländern Untersuchungen zur Bedeutung von Vermarktungsprojekten für die Entwicklung des Biomarktes und des ländlichen Raums durchgeführt. Die entsprechenden Projektergebnisse aus den deutschsprachigen Ländern (DE, AT, CH) sollen in diesem Beitrag vorgestellt werden. Fazit: Die Untersuchung zeigt, dass Bio-Vermarktungsinitiativen erfolgreich am Markt operieren können und dies auch bei unterschiedlichem Grad äusserer Benachteiligung (Klima, Boden, Topographie, Marktferne). Als wichtige Faktoren wurden eine strategische und straffe Unternehmensführung, kompetentes Management, eine qualitäts-orientierte Produktpolitik, eine solide und angemessene Finanzstrategie vor allem auch eine vertrauensvolle Kooperation und Koordination mit den Marktpartnern, herausgearbeitet

Building Food Democracy: Exploring Civic Food Networks and Newly Emerging Forms of Food Citizenship

In recent years new types of consumer-producer cooperation in food networks have emerged in which consumers play an active role in the operation and thereby clearly go beyond food provisioning as such. Examples include consumer co-ops and solidarity buying groups of local and organic food, communitysupported agriculture and collective urban gardening initiatives. These initiatives raise important new questions that cannot be adequately resolved within existing theoretical perspectives based on concepts such as 'alternative food networks', 'short food supply chains' or 'local food systems'. This article explores possible new analytical frameworks for the study of contemporary dynamics in food networks and develops the concept of 'civic food networks' as an overarching concept to explore contemporary dynamics and sources of innovation within agri-food networks. Building on the empirical diversity of initiatives, this introduction to the Special Issue argues that the role of civil society as a governance mechanism for agri-food networks has increased in significance compared to market and state actors. Moreover, expressions of 'food citizenship' are reshaping the relation between food practices and the market as well as with public institutions in ways that go beyond material and economic exchange and that contribute to a 'moralization' (or even 'civilization') of food economie

A behavioral genetic study of humor styles in an Australian sample

The present study investigated the extent to which individual differences in humor styles are attributable to genetic and/or environmental factors in an Australian sample. Participants were 934 same-sex pairs of adult twins from the Australian Twin Registry (546 monozygotic pairs, 388 dizygotic pairs) who completed the Humor Styles Questionnaire (HSQ). The HSQ measures four distinct styles of humor - affiliative, self-enhancing, aggressive, and self-defeating. Results revealed that additive genetic and non-shared environmental factors accounted for the variance in all four humor styles, thus replicating results previously obtained in a sample of twins from the United Kingdom. However, a study conducted with a U.S. sample produced different results and we interpret these findings in terms of cross-cultural differences in humor

Limiting mechanisms for photon recycling in thin-film GaAs solar cells

Photon recycling mechanisms in single junction thin-film GaAs solar cells are evaluated in this study. Modelling supported by experimentally obtained results is used in order to correlate the reflectance of the cell's rear layers, the photon recycling probability, and the solar cell performance. Solar cells with different top and bottom metallization configurations are produced, and their performance is analyzed from the optical and electrical point of view. It is shown that the photon recycling probability increases with the rear mirror reflectance and solar cell thickness, which results in the increase of the devices open circuit voltage. However, the front grid coverage, usually disregarded in rear mirror focused studies, strongly reduces the photon recycling probability. Furthermore, perimeter and interface recombination hinder the internal radiative efficiency of the solar cells, preventing further increase of the devices' open circuit voltage as a result of improvements of the rear mirror reflectivity. In order to exploit the significant benefit of increased photon recycling probability to the solar cell performance, these limiting mechanisms need to be properly addressed

Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial

OBJECTIVE To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients' management of exacerbations, and self efficacy (secondary objectives) in patients with chronic obstructive pulmonary disease (COPD) in general practice. DESIGN 24 month, multicentre, investigator blinded, three arm, pragmatic, randomised controlled trial. SETTING 15 general practices in the eastern part of the Netherlands. PARTICIPANTS Patients with COPD confirmed by spirometry and treated in general practice. Patients with very severe COPD or treated by a respiratory physician were excluded. INTERVENTIONS A comprehensive self management programme as an adjunct to usual care, consisting of four tailored sessions with ongoing telephone support by a practice nurse; routine monitoring as an adjunct to usual care, consisting of 2-4 structured consultations a year with a practice nurse; or usual care alone (contacts with the general practitioner at the patients' own initiative). OUTCOME MEASURES The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory questionnaire total score. Secondary outcomes were chronic respiratory questionnaire domain scores, frequency and patients' management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system, and self efficacy measured with the COPD self-efficacy scale. RESULTS 165 patients were allocated to self management (n=55), routine monitoring (n=55), or usual care alone (n=55). At 24 months, adjusted treatment differences between the three groups in mean chronic respiratory questionnaire total score were not significant. Secondary outcomes did not differ, except for exacerbation management. Compared with usual care, more exacerbations in the self management group were managed with bronchodilators (odds ratio 2.81, 95% confidence interval 1.16 to 6.82) and with prednisolone, antibiotics, or both (3.98, 1.10 to 15.58). CONCLUSIONS Comprehensive self management or routine monitoring did not show long term benefits in terms of quality of life or self efficacy over usual care alone in COPD patients in general practice. Patients in the self management group seemed to be more capable of appropriately managing exacerbations than did those in the usual care group. TRIAL REGISTRATION Clinical trials NCT00128765.This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw) and Partners in Care Solutions for COPD (PICASSO). The funding sources had no role in the design, conduct, or reporting of the stud

Quaternary Deformation Along the Wharekauhau Fault System, North Island, New Zealand: Implications for an Unstable Linkage Between Active Strike-Slip and Thrust Faults

The southern Wairarapa region of the North Island of New Zealand preserves a variably deformed late Quaternary stratigraphic sequence that provides insight into the temporal variability in the partitioning of contraction onto faults in the upper plate of an obliquely convergent margin. Detailed mapping, stratigraphic data, and new radiocarbon and optically stimulated luminescence ages from Quaternary units reveal the interaction between tectonics and sedimentation from ∼125 ka to(i.e., Wharekauhau fault system) at the southern end of the Wairarapa fault zone, a major oblique-slip fault in the upper plate of the Hikurangi Margin. The Wharekauhau thrust accommodated a minimum of 280 ± 60 m of horizontal shortening from ∼70 to 20 ka. The inferred shortening rate, 3.5–8.4 mm/yr, may have accounted for 11–30% of margin-normal plate motion. By ∼20 ka, the thrust was abandoned. Subsequent deformation at shallow levels occurred on a segmented fault system that accommodated/yr shortening. Active deformation in the region is partitioned between slip on (1) the more western Wairarapa-Mukamuka fault system (dominantly dextral slip but also causing local uplift of the coast); (2) a series of discontinuously expressed strike-slip faults and linking blind oblique-reverse thrusts near the trace of the inactive Wharekauhau thrust; and (3) a blind thrust fault farther to the east. The spatial and temporal complexity of the Wharekauhau fault system and the importance it has had in accommodating upper plate deformation argue for an unsteady linkage between upper plate faults and between these faults and the plate interface

Regional and temporal variability of melts during a Cordilleran magma pulse: Age and chemical evolution of the Jurassic arc, eastern Mojave Desert, California

Intrusive rock sequences in the central and eastern Mojave Desert segment of the Jurassic Cordilleran arc of the western United States record regional and temporal variations in magmas generated during the second prominent pulse of Mesozoic continental arc magmatism. U/Pb zircon ages provide temporal control for describing variations in rock and zircon geochemistry that reflect differences in magma source components. These source signatures are discernible through mixing and fractionation processes associated with magma ascent and emplacement. The oldest well-dated Jurassic rocks defining initiation of the Jurassic pulse are a 183 Ma monzodiorite and a 181 Ma ignimbrite. Early to Middle Jurassic intrusive rocks comprising the main stage of magmatism include two high-K calc-alkalic groups: to the north, the deformed 183–172 Ma Fort Irwin sequence and contemporaneous rocks in the Granite and Clipper Mountains, and to the south, the 167–164 Ma Bullion sequence. A Late Jurassic suite of shoshonitic, alkali-calcic intrusive rocks, the Bristol Mountains sequence, ranges in age from 164 to 161 Ma and was emplaced as the pulse began to wane. Whole-rock and zircon trace-element geochemistry defines a compositionally coherent Jurassic arc with regional and secular variations in melt compositions. The arc evolved through the magma pulse by progressively greater input of old cratonic crust and lithospheric mantle into the arc magma system, synchronous with progressive regional crustal thickening