Financing and Managing Public Services: An Assessment

Public services can be, and are, delivered according to a variety of different arrangements. The public sector can finance and provide a service itself, or contract with the private sector to participate in provision, or its role may be limited to regulating a private provider. In this paper we examine the features determining the effectiveness of public-service delivery, including incentives for employees and teams within organizations providing public services, the structure of the organization and the competitive framework that it faces, and the role of the private sector. We assess the reform programme in the UK, which has involved substantial reorganization of public services and increasing involvement of the private sector. Reforms focus on the improvement of incentives; but while incentives are critical, the special characteristics of public services (and the people who provide them) must be recognized in the implementation of new structures and incentive schemes.public services, public management

COVID-19 and Pneumonia: Increased Risk for Individuals with Intellectual and Developmental Disabilities during the Pandemic

Adults with intellectual and developmental disabilities (IDD) are more likely to develop pneumonia than adults without IDD. This brief describes the implications of higher rates of pneumonia among individuals with IDD for increased risk of serious complications (including death) from COVID-19

Speech Communication

Contains research objectives and summary of research.National Institutes of Health (Grant 2 RO1 NS04332-11)National Institutes of Health (Grant 5 RO1 NS04332-11)U. S. Navy Office of Naval Research (Contract ONR N00014-67-A-0204-0069

Deregulated expression of the 14q32 miRNA cluster in clear cell renal cancer cells

Clear cell renal cell carcinomas (ccRCC) are characterized by arm-wide chromosomal alterations. Loss at 14q is associated with disease aggressiveness in ccRCC, which responds poorly to chemotherapeutics. The 14q locus contains one of the largest miRNA clusters in the human genome; however, little is known about the contribution of these miRNAs to ccRCC pathogenesis. In this regard, we investigated the expression pattern of selected miRNAs at the 14q32 locus in TCGA kidney tumors and in ccRCC cell lines. We demonstrated that the miRNA cluster is downregulated in ccRCC (and cell lines) as well as in papillary kidney tumors relative to normal kidney tissues (and primary renal proximal tubule epithelial (RPTEC) cells). We demonstrated that agents modulating expression of DNMT1 (e.g., 5-Aza-deoxycytidine) could modulate 14q32 miRNA expression in ccRCC cell lines. Lysophosphatidic acid (LPA, a lysophospholipid mediator elevated in ccRCC) not only increased labile iron content but also modulated expression of a 14q32 miRNA. Through an overexpression approach targeting a subset of 14q32 miRNAs (specifically at subcluster A: miR-431-5p, miR-432-5p, miR-127-3p, and miR-433-3p) in 769-P cells, we uncovered changes in cellular viability and claudin-1, a tight junction marker. A global proteomic approach was implemented using these miRNA overexpressing cell lines which uncovered ATXN2 as a highly downregulated target. Collectively, these findings support a contribution of miRNAs at 14q32 in ccRCC pathogenesis

Predicting the risk of acute kidney injury in primary care: derivation and validation of STRATIFY-AKI

BACKGROUND: Antihypertensives reduce the risk of cardiovascular disease but are also associated with harms including acute kidney injury (AKI). Few data exist to guide clinical decision making regarding these risks. AIM: To develop a prediction model estimating the risk of AKI in people potentially indicated for antihypertensive treatment. DESIGN AND SETTING: Observational cohort study using routine primary care data from the Clinical Practice Research Datalink (CPRD) in England. METHOD: People aged ≥40 years, with at least one blood pressure measurement between 130 mmHg and 179 mmHg were included. Outcomes were admission to hospital or death with AKI within 1, 5, and 10 years. The model was derived with data from CPRD GOLD (n = 1 772 618), using a Fine-Gray competing risks approach, with subsequent recalibration using pseudo-values. External validation used data from CPRD Aurum (n = 3 805 322). RESULTS: The mean age of participants was 59.4 years and 52% were female. The final model consisted of 27 predictors and showed good discrimination at 1, 5, and 10 years (C-statistic for 10-year risk 0.821, 95% confidence interval [CI] = 0.818 to 0.823). There was some overprediction at the highest predicted probabilities (ratio of observed to expected event probability for 10-year risk 0.633, 95% CI = 0.621 to 0.645), affecting patients with the highest risk. Most patients (>95%) had a low 1- to 5-year risk of AKI, and at 10 years only 0.1% of the population had a high AKI and low CVD risk. CONCLUSION: This clinical prediction model enables GPs to accurately identify patients at high risk of AKI, which will aid treatment decisions. As the vast majority of patients were at low risk, such a model may provide useful reassurance that most antihypertensive treatment is safe and appropriate while flagging the few for whom this is not the case

London and beyond: essays in honour of Derek Keene

This volume contains selected papers from a major conference held in October 2008 to celebrate the 20th anniversary of the setting up of the Centre for Metropolitan History at the IHR, and the contribution of Professor Derek Keene to the Centre, the IHR and the wider world of scholarship. 'One of the pioneer volumes in the handsomely produced new Institute of Historical Research Conference series, this book serves as a fitting tribute to one of the most influential urban historians of our time.' - Ian Archer, Urban History, May 2013

Does oral sodium bicarbonate therapy improve function and quality of life in older patients with chronic kidney disease and low-grade acidosis (the BiCARB trial)? Study protocol for a randomized controlled trial

Date of acceptance: 01/07/2015 © 2015 Witham et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Acknowledgements UK NIHR HTA grant 10/71/01. We acknowledge the financial support of NHS Research Scotland in conducting this trial.Peer reviewedPublisher PD

Increasing physical activity levels : designing a referral pathway to a community- and volunteer-based physical activity programme

Funding: Funded by NHS Fife Endowment Fund.Background/Aim: The NICE guideline on exercise referral schemes to promote physical activity suggests that referral to activities based outside of the gym may be linked to improved adherence. We aim to design and pilot a process of referring patients attending primary care to community-based jogscotland groups and to examine the barriers and facilitators of such a process for health professionals and patients. Methods: GPs and nurses from over 20 practices across Fife have expressed interest in the study. Exploratory interviews with health professionals and patients of primary care practices in Fife will be conducted (N=15-25 primary care registered patients with no physical health barriers to engage in physical activity and N=15-25 GPs/Nurses). These interviews will be guided by Theoretical Domains Framework and analysed using thematic analysis. Informed by findings from the interviews, a process of referral to jogscotland will be designed around how community-based programmes can acceptably be introduced through GP/nurse consultations. Lastly, a feasibility study testing this method of offering referral to jogscotland will be conducted. Results: The findings will enable the design of a full trial to test a community-based approach to physical activity participation that would be scalable cross Scotland. Conclusion: This project will link primary care patients to a structured and volunteer-led physical activity programme in their community that is not gym-based. Given these factors, it has the strong potential of being successful in maintaining behaviour change and achieving positive health outcomes for patients. This project additionally provides a unique opportunity to develop a partnership between primary care and community-based physical activity groups.OtherNon peer reviewe

The evolution of quantitative sensitivity

This work was supported by the National Science Foundation Graduate Research Fellowship Programme grant no. DGE-1419118 to S.E.K., and NSF 2000759 from the Division of Research on Learning in Formal and Informal Settings (DRL) to S.T.P., the Austrian Science Fund (FWF project no. P33928_B) to F.R., the Alfred P. Sloan Foundation Fellowship grant no. 220020300 to J.F.C., National Institutes of Health grant no. R01 HD085996 to J.F.C. and S.T.P. and the James S. McDonnell Foundation.The ability to represent approximate quantities appears to be phylogenetically widespread, but the selective pressures and proximate mechanisms favouring this ability remain unknown. We analysed quantity discrimination data from 672 subjects across 33 bird and mammal species, using a novel Bayesian model that combined phylogenetic regression with a model of number psychophysics and random effect components. This allowed us to combine data from 49 studies and calculate the Weber fraction (a measure of quantity representation precision) for each species. We then examined which cognitive, socioecological and biological factors were related to variance in Weber fraction. We found contributions of phylogeny to quantity discrimination performance across taxa. Of the neural, socioecological and general cognitive factors we tested, cortical neuron density and domain-general cognition were the strongest predictors of Weber fraction, controlling for phylogeny. Our study is a new demonstration of evolutionary constraints on cognition, as well as of a relation between species-specific neuron density and a particular cognitive ability. This article is part of the theme issue 'Systems neuroscience through the lens of evolutionary theory'.Publisher PDFPeer reviewe