Rhetoric or reality? A critical investigation of the market model for community care

In the 1950s the term community care was associated with the movement of people with mental health problems from longstay institutions into the community. More recently, however, the term has applied to services to a much wider range of groups including older people. The thesis is concerned with community care services for this group and in particular, domiciliary care. It seeks to evaluate claims made in the White Paper: 'Caring for People' that its preferred model of community care can provide both increased service effectiveness for consumers and cost control. The thesis argues that community care policy was shaped by 'managerialist' assumptions and that improved performance could be delivered by organisational change, in particular the quasi-market and the use of managerialist techniques. Thus, the two phenomena of 'managerialism' and 'quasi markets' are conjoined, the latter offering to the former the possibility of competition between providers, which in turn is seen to provide greater user choice and value for money. Two key reports from the Audit Commission are analysed as exemplars of managerialism and community care. The connection between the reports and government policy is discussed and the evidence presented in them for community care, as a cost containment policy, is scrutinised. The consumer effectiveness argument for community care is examined by considering, in particular, the relationship between consumer choice and the market model of community care advocated in the Griffiths report: 'Community Care: Agenda for Action' (1988) and the White Paper: Caring for People (1989). It is argued that both the government proposals and much of the critical academic commentary fail to examine various underlying premises, in particular, the salience of 'choice' as a universally desirable objective. The themes outlined above are explored in empirical work undertaken in the case study local authority. The consumer effectiveness issue is analysed with reference to a survey of users of domiciliary care services. The survey is used to examine how far the assumptions made by both government and many academic commentators, with regard to user satisfaction, correspond to those of users. The analysis questions these assumptions showing that 'consumerist' notions of choice of service are much less significant than personal aspects of the service such as 'caring manner' and continuity of relation with carer. Cost control issues are examined by considering an example of 'value for money' auditing in the authority. Analysis of this project suggests the difficulties which such exercises have in generating appropriate norms for service provision in domiciliary care. The thesis concludes by relating the themes explored to current problems in community care policy, in particular the increasing significance of rationing and eligibility criteria

Neurohormonal modulation of the Limulus heart: amine actions on neuromuscular transmission and cardiac muscle

The responses of Limulus cardiac neuromuscular junctions and cardiac muscle cells to four endogenous amines were determined in order to identify the cellular targets underlying amine modulation of heartbeat amplitude. The amines increased the amplitude of the Limulus heartbeat, with dopamine (DA) being more potent than octopamine, epinephrine or norepinephrine. The effect of DA on heartbeat amplitude was not blocked by phentolamine. DA enhanced the contractility of deganglionated heart muscle, with time course and dose-dependence similar to its effect on the intact heart. The amines also enhanced neuromuscular transmission, with time course and dose-dependence similar to their effects upon the intact heart. The amplitude of unitary excitatory junction potentials (EJPs) and frequency of miniature excitatory junction potentials (mEJPs) were increased by DA, while mEJP amplitude was unchanged. Thus DA, and probably the other amines, had a presynaptic effect. Combined actions upon cardiac muscle and cardiac neuromuscular transmission account for the ability of these amines to increase the amplitude of the Limulus heartbeat

Behavioral thermoregulation in the American lobster Homarus americanus

It is generally accepted that water temperature has a strong influence on the behavior of the American lobster Homarus americanus. However, there is surprisingly little behavioral evidence to support this view. To haracterize the behavioral responses of lobsters to thermal gradients, three different experiments were conducted. In the first, 40 lobsters acclimated to summer water temperatures (summer-acclimated, 15.5±0.2 °C, mean ±S.E.M.) were placed individually in an experimental shelter, and the temperature in the shelter was gradually raised until the lobster moved out. Lobsters avoided water warmer than 23.5±0.4 °C, which was an increase of 8.0±0.4 °C from ambient summer temperatures. When this experiment was repeated with lobsters acclimated to winter temperatures (winter-acclimated, 4.3±0.1 °C), the lobsters (N=30) did not find temperature increases of the same magnitude (∆T=8.0±0.4 °C) aversive. The second experiment was designed to allow individual summer-acclimated lobsters (N=22) to select one of five shelters, ranging in temperature from 8.5 to 25.5 °C. After 24 h, 68 % of the lobsters occupied the 12.5 °C shelter, which was slightly above the ambient temperature (approximately 11 °C). In a similar experiment, winter-acclimated lobsters (N=30) were given a choice between two shelters, one at ambient temperature (4.6±0.2 °C) and one at a higher temperature (9.7±0.3 °C). Winter-acclimated lobsters showed a strong preference (90 %) for the heated shelter. In the final experiment, summer-acclimated lobsters (N=9) were allowed to move freely in a tank having a thermal gradient of approximately 10 °C from one end to the other. Lobsters preferred a thermal niche of 16.5±0.4 °C and avoided water that was warmer than 19 °C or colder than 13 °C. When standardized for acclimation temperature, lobsters preferred water 1.2±0.4 °C above their previous ambient temperature. Collectively, the results of these studies indicate that lobsters are capable of sensing water temperature and use this information to thermoregulate behaviorally. The implications of these findings for lobster behavior and distribution in their natural habitat are discussed

Stage-Specific and Interactive Effects of Sedimentation and Trout on a Headwater Stream Salamander

In species with complex life cycles, stage-specific effects of environmental conditions combine with factors regulating stage-specific recruitment to determine population-level response to habitat disturbance. The abundance of the stream salamander Gyrinophilus porphyriticus(Plethodontidae) is negatively related to both logging-associated sedimentation and brook trout (Salvelinus fontinalis) in headwater streams throughout New Hampshire, USA. To understand the mechanisms underlying these patterns, we investigated stage-specific and interactive effects of sedimentation and brook trout on G. porphyriticus. We conducted quantitative surveys of salamanders, brook trout, and substrate embeddedness in 15 first-order streams and used a controlled experiment to test the direct and interactive effects of these factors on larval growth and survival. G. porphyriticus larvae and adults had opposite patterns of response to sediment and brook trout. Multiple regression analysis of our survey data indicated that abundance of larvae was negatively related to brook trout abundance, but unrelated to substrate embeddedness. In contrast, abundance of adults was primarily related to substrate embeddedness. Consistent with the field pattern of larval abundance, brook trout had a negative effect on growth and survival of larvae in the experiment. However, there was no effect of sediment and no interaction between brook trout and sediment. Larval and adult abundances were not significantly correlated in the study streams, indicative of the independent effects of sedimentation and brook trout on G. porphyriticus populations. These results suggest that adult resistance to fish may facilitate G. porphyriticus coexistence with brook trout, and that larval resistance to sedimentation can buffer populations from extinction in fishless streams impacted by logging. In streams with brook trout, where larval abundances are low, reductions in adult abundance caused by logging impacts may pose a risk to species persistence. Our findings underscore the value of information on species life history, demography, and community ecology in assessing sensitivity to anthropogenic perturbation

The influence of disease course and surgery on quality of life in children with focal cortical dysplasia and long-term epilepsy-associated tumours: A systematic review and meta-analysis

Introduction: Carefully selected patients with lesional epilepsy, including focal cortical dysplasia (FCD) and long-term epilepsy-associated tumours (LEAT), can benefit from epilepsy surgery. The influence of disease course and subsequent epilepsy surgery on quality of life (QoL) and intelligence quotient (IQ) is not well understood. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting QoL or IQ measures in paediatric patients with FCD and LEAT at epilepsy onset, at establishment of drug resistance (pre-operative/non-surgically managed) and post-operatively were included. To evaluate the “effect size” and clinical significance of surgery, a meta-analysis of the data was conducted using fixed effects models for weighted mean differences, 95% confidence intervals and sensitivity analyses. Results: Nineteen eligible studies (911 patients) were included, 17 assessing IQ and 2 evaluating QoL. Twelve studies reported preoperative and postoperative IQ measures and five reported IQ in non-surgically managed cohorts after drug resistance was established; no papers reported IQ at epilepsy onset. No significant IQ/DQ changes were detected after surgery (pre-operative pooled mean 69.32; post-operative pooled mean 69.98; p = 0.32). Age at epilepsy surgery, type of surgery and epilepsy-related pathology did not influence the post-operative IQ. QoL was reported in 2 studies with the pooled mean estimates for pre- and post-operative QoL being 42.52 and 55.50, respectively. Conclusions: The present study demonstrated no statistical change in IQ and QoL following surgery in paediatric patients with FCD and LEAT. There was no data on IQ and QoL at disease onset. Attempting to understand the impact of epilepsy, ongoing seizures and surgery on IQ and QoL will facilitate planning of future studies that aim to optimise quality of life and developmental outcomes in these children. Studies assessing children at epilepsy onset with longitudinal follow-up are required to optimise the timing of epilepsy surgery on QoL and IQ

The Tumor Suppressor HHEX Inhibits Axon Growth when Prematurely Expressed in Developing Central Nervous System Neurons

Neurons in the embryonic and peripheral nervoussystem respond to injury by activating transcriptional programs supportive of axon growth, ultimately resulting in functional recovery. In contrast, neurons in the adult central nervous system (CNS) possess a limited capacity to regenerate axons after injury, fundamentally constraining repair. Activating pro-regenerative gene expression in CNS neurons is a promising therapeutic approach, but progress is hampered by incomplete knowledge of the relevant transcription factors. An emerging hypothesis is that factors implicated in cellular growth and motility outside the nervous system may also control axon growth in neurons. We therefore tested sixty-nine transcription factors, previously identified as possessing tumor suppressive or oncogenic properties in non-neuronal cells, in assays of neurite outgrowth. This screen identified YAP1 and E2F1 as enhancers of neurite outgrowth, and PITX1, RBM14, ZBTB16, and HHEX as inhibitors. Follow-up experiments are focused on the tumor suppressor HHEX, one of the strongest growth inhibitors. HHEX is widely expressed in adult CNS neurons, including corticospinal tract neurons after spinal injury, but is present only in trace amounts in immature cortical neurons and adult peripheral neurons. HHEX overexpression in early postnatal cortical neurons reduced both initial axonogenesis and the rate of axon elongation, and domain deletion analysis strongly implicated transcriptional repression as the underlying mechanism. These findings suggest a role for HHEX in restricting axon growth in the developing CNS, and substantiate the hypothesis that previously identified oncogenes and tumor suppressors can play conserved roles in axon extension

Wind-driven mixing causes a reduction in the strength of the continental shelf carbon pump in the Chukchi Sea

The Chukchi Sea is thought to be a globally important sink of atmospheric CO2 due to the summertime drawdown of surface pCO2 by phytoplankton and subsequent shelf-to-basin transport of CO2-enriched subsurface waters into the upper halocline of the Arctic Ocean. Here we show that annually occurring storm-induced mixing events during autumn months disrupt water column stratification and stir up remineralized carbon from subsurface waters to the surface, leading to CO2 outgassing to the atmosphere. Our analysis provides a new understanding of the dynamics of carbon cycling in the region and suggests that late season wind events are strong and frequent enough to significantly decrease the carbon sink strength of the Chukchi Sea on a scale of relevance to the global carbon cycle. These results highlight the importance of obtaining data with more complete seasonal and spatial coverage in order to accurately constrain regional to basin-scale carbon flux budgets

Linking the 8.2 ka Event and its Freshwater Forcing in the Labrador Sea

The 8.2 ka event was the last deglacial abrupt climate event. A reduction in the Atlantic meridional overturning circulation (AMOC) attributed to the drainage of glacial Lake Agassiz may have caused the event, but the freshwater signature of Lake Agassiz discharge has yet to be identified in (delta)18O of foraminiferal calcite records from the Labrador Sea, calling into question the connection between freshwater discharge to the North Atlantic and AMOC strength. Using Mg/Ca-paleothermometry, we demonstrate that approx. 3 C of near-surface ocean cooling masked an 1.0 % decrease in western Labrador Sea (delta)18O of seawater concurrent with Lake Agassiz drainage. Comparison with North Atlantic (delta)18O of seawater records shows that the freshwater discharge was transported to regions of deep-water formation where it could perturb AMOC and force the 8.2 ka event

Pressure Induced Topological Phase Transitions in Membranes

Some highly unusual features of a lipid-water liquid crystal are revealed by high pressure x-ray diffraction, light scattering and dilatometric studies of the lamellar (bilayer $L_{\alpha}$) to nonlamellar inverse hexagonal ($H_{II}$) phase transition. (i) The size of the unit cell of the $H_{II}$ phase increases with increasing pressure. (ii) The transition volume, $\Delta V_{bh}$, decreases and appears to vanish as the pressure is increased. (iii) The intensity of scattered light increases as $\Delta V_{bh}$ decreases. Data are presented which suggest that this increase is due to the formation of an intermediate cubic phase, as predicted by recent theoretical suggestions of the underlying universal phase sequence.Comment: 12 pages, typed using REVTEX 2.

Testing umbrella species and food-web properties of large carnivores in the Rocky Mountains

Despite criticisms, the umbrella species concept remains a fundamental conservation tool for protecting biodiversity in the face of global change, yet it is rarely tested. Food web theory provides a tool to test both umbrella-species' suitability and their ecological function, which we investigate in a large-mammal food web. Using data from 698 camera trap locations in the Canadian Rockies, we develop hierarchical occupancy models to predict the co-occurrence of 16 large mammal species. We draw upon previous diet studies in the Canadian Rockies to describe the meta food-web (meta-web) for these species. Next, we filtered the meta-web using predicted occupancy to estimate realized food webs at each camera location. We tested the umbrella species concept using predicted occupancy across all 698 camera sites. We then tested for carnivore effects using realized food webs on 5 food-web properties: species richness, links, connectance, nestedness and modularity using generalized linear models while accounting for landscape covariates known to affect food web dynamics. Our multispecies occupancy models reflected factors previously demonstrated to affect large mammal occurrence. Our results also demonstrated that grizzly bear (Ursus horribilis), a generalist carnivore, was the best umbrella carivore species, and explained species richness the best. When considering food web properties, however, wolves (Canis lupus) and cougars (Felis concolor) served as better umbrellas that also captured food web properties such as connectance, links and nestedness that better reflect ecological interactions. Our results support the role of large carnivores as umbrella and ecologically interactive species in conservation planning