The role of funding in the ‘performative decarbonisation’ of transport in England

oai:westminsterresearch.westminster.ac.uk:w7w7vThe scale of the decarbonisation challenge and the short timeframes over which action is required demand urgent action. This paper is set within the surface transport sector, now the largest sector of emissions with the slowest pace of change in many advanced liberal economies. It focuses on the strategies and actions of local government which is recognised to be a central player in catalysing change. Our evidence is derived from the actions of two UK local areas which claim to be at the forefront of the decarbonisation challenge. The paper focuses on the role of funding and financial mechanisms in addressing the climate crisis. In the face of an established pattern of austerity and hollowing out of local government we explore how deep transformation is being envisaged. We find a recursive set of issues which derive from a dependence on funding from outwith. This dependence means that despite comprehensive overarching strategies and goals the funding available is the core of the strategy. This means that the nature of the funds, such as the requirement for experimentation, innovation or private sector leverage, defines direction. In turn, and to maintain success in attracting funds, there is an emphasis on presenting ‘premium spaces of ambition’ with little evidence of attention to broader systemic change. This duality is openly recognised. This paper advances a wider point that greater emphasis should be placed on the ‘financialisation’ of climate policy and the reality rather than the rhetoric of change

Can the workload–injury relationship be moderated by improved strength, speed and repeated-sprint qualities?

Objectives: The aim of this study was to investigate potential moderators (i.e. lower body strength, repeated-sprint ability [RSA] and maximal velocity) of injury risk within a team-sport cohort. Design: Observational cohort study. Methods: Forty male amateur hurling players (age: 26.2 ± 4.4 year, height: 184.2 ± 7.1 cm, mass: 82.6 ± 4.7 kg) were recruited. During a two-year period, workload (session RPE × duration), injury and physical qualities were assessed. Specific physical qualities assessed were a three-repetition maximum Trapbar deadlift, 6 × 35-m repeated-sprint (RSA) and 5-, 10- and 20-m sprint time. All derived workload and physical quality measures were modelled against injury data using regression analysis. Odds ratios (OR) were reported against a reference group. Results: Moderate weekly loads between ≥1400 AU and ≤1900 AU were protective against injury during both the pre-season (OR: 0.44, 95% CI: 0.18–0.66) and in-season periods (OR: 0.59, 95% CI: 0.37–0.82) compared to a low load reference group (≤1200 AU). When strength was considered as a moderator of injury risk, stronger athletes were better able to tolerate the given workload at a reduced risk. Stronger athletes were also better able to tolerate larger week-to-week changes (>550–1000 AU) in workload than weaker athletes (OR = 2.54–4.52). Athletes who were slower over 5-m (OR: 3.11, 95% CI: 2.33–3.87), 10-m (OR: 3.45, 95% CI: 2.11–4.13) and 20-m (OR: 3.12, 95% CI: 2.11–4.13) were at increased risk of injury compared to faster athletes. When repeated-sprint total time (RSAt) was considered as a moderator of injury risk at a given workload (≥1750 AU), athletes with better RSAt were at reduced risk compared to those with poor RSAt (OR: 5.55, 95%: 3.98–7.94). Conclusions: These findings demonstrate that well-developed lower-body strength, RSA and speed are associated with better tolerance to higher workloads and reduced risk of injury in team-sport athletes. © 2018 Sports Medicine Australi

Relationship between quality of care and choice of clinical computing system: Retrospective analysis of family practice performance under the UK's quality and outcomes framework

OBJECTIVES: To investigate the relationship between performance on the UK Quality and Outcomes Framework pay-for-performance scheme and choice of clinical computer system. DESIGN: Retrospective longitudinal study. SETTING: Data for 2007–2008 to 2010–2011, extracted from the clinical computer systems of general practices in England. PARTICIPANTS: All English practices participating in the pay-for-performance scheme: average 8257 each year, covering over 99% of the English population registered with a general practice. MAIN OUTCOME MEASURES: Levels of achievement on 62 quality-of-care indicators, measured as: reported achievement (levels of care after excluding inappropriate patients); population achievement (levels of care for all patients with the relevant condition) and percentage of available quality points attained. Multilevel mixed effects multiple linear regression models were used to identify population, practice and clinical computing system predictors of achievement. RESULTS: Seven clinical computer systems were consistently active in the study period, collectively holding approximately 99% of the market share. Of all population and practice characteristics assessed, choice of clinical computing system was the strongest predictor of performance across all three outcome measures. Differences between systems were greatest for intermediate outcomes indicators (eg, control of cholesterol levels). CONCLUSIONS: Under the UK's pay-for-performance scheme, differences in practice performance were associated with the choice of clinical computing system. This raises the question of whether particular system characteristics facilitate higher quality of care, better data recording or both. Inconsistencies across systems need to be understood and addressed, and researchers need to be cautious when generalising findings from samples of providers using a single computing system

Excess mortality in England and Wales during the first wave of the COVID-19 pandemic

Background Deaths during the COVID-19 pandemic result directly from infection and exacerbation of other diseases and indirectly from deferment of care for other conditions, and are socially and geographically patterned. We quantified excess mortality in regions of England and Wales during the pandemic, for all causes and for non-COVID-19-associated deaths. Methods Weekly mortality data for 1 January 2010 to 1 May 2020 for England and Wales were obtained from the Office of National Statistics. Mean-dispersion negative binomial regressions were used to model death counts based on pre-pandemic trends and exponentiated linear predictions were subtracted from: (i) all-cause deaths and (ii) all-cause deaths minus COVID-19 related deaths for the pandemic period (week starting 7 March, to week ending 8 May). Findings Between7Marchand8May2020,therewere 47 243 (95% CI: 46 671 to 47 815) excess deaths in England and Wales, of which 9948 (95% CI: 9376 to 10 520) were not associated with COVID-19. Overall excess mortality rates varied from 49 per 100 000 (95% CI: 49 to 50) in the South West to 102 per 100 000 (95% CI: 102 to 103) in London. Non-COVID-19 associated excess mortality rates ranged from −1 per 100 000 (95% CI: −1 to 0) in Wales (ie, mortality rates were no higher than expected) to 26 per 100 000 (95% CI: 25 to 26) in the West Midlands. Interpretation The COVID-19 pandemic has had markedly different impacts on the regions of England and Wales, both for deaths directly attributable to COVID-19 infection and for deaths resulting from the national public health response

Impact of the English Directly Enhanced Service (DES) for Learning Disability

Final Report to the Department of Healt

Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study.

OBJECTIVE: To estimate the impact of a national primary care pay for performance scheme, the Quality and Outcomes Framework in England, on emergency hospital admissions for ambulatory care sensitive conditions (ACSCs). DESIGN: Controlled longitudinal study. SETTING: English National Health Service between 1998/99 and 2010/11. PARTICIPANTS: Populations registered with each of 6975 family practices in England. MAIN OUTCOME MEASURES: Year specific differences between trend adjusted emergency hospital admission rates for incentivised ACSCs before and after the introduction of the Quality and Outcomes Framework scheme and two comparators: non-incentivised ACSCs and non-ACSCs. RESULTS: Incentivised ACSC admissions showed a relative reduction of 2.7% (95% confidence interval 1.6% to 3.8%) in the first year of the Quality and Outcomes Framework compared with ACSCs that were not incentivised. This increased to a relative reduction of 8.0% (6.9% to 9.1%) in 2010/11. Compared with conditions that are not regarded as being influenced by the quality of ambulatory care (non-ACSCs), incentivised ACSCs also showed a relative reduction in rates of emergency admissions of 2.8% (2.0% to 3.6%) in the first year increasing to 10.9% (10.1% to 11.7%) by 2010/11. CONCLUSIONS: The introduction of a major national pay for performance scheme for primary care in England was associated with a decrease in emergency admissions for incentivised conditions compared with conditions that were not incentivised. Contemporaneous health service changes seem unlikely to have caused the sharp change in the trajectory of incentivised ACSC admissions immediately after the introduction of the Quality and Outcomes Framework. The decrease seems larger than would be expected from the changes in the process measures that were incentivised, suggesting that the pay for performance scheme may have had impacts on quality of care beyond the directly incentivised activities

Withdrawing performance indicators: retrospective analysis of general practice performance under UK Quality and Outcomes Framework

Objectives To investigate the effect of withdrawing incentives on recorded quality of care, in the context of the UK Quality and Outcomes Framework pay for performance scheme. Design Retrospective longitudinal study. Setting Data for 644 general practices, from 2004/05 to 2011/12, extracted from the Clinical Practice Research Datalink. Participants All patients registered with any of the practices over the study period—13 772 992 in total. Intervention Removal of financial incentives for aspects of care for patients with asthma, coronary heart disease, diabetes, stroke, and psychosis. Main outcome measures Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium treatment monitoring (psychosis), removed in April 2006; blood pressure monitoring (coronary heart disease, diabetes, stroke), cholesterol concentration monitoring (coronary heart disease, diabetes), and blood glucose monitoring (diabetes), removed in April 2011. Multilevel mixed effects multiple linear regression models were used to quantify the effect of incentive withdrawal. Results Mean levels of performance were generally stable after the removal of the incentives, in both the short and long term. For the two indicators removed in April 2006, levels in 2011/12 were very close to 2005/06 levels, although a small but statistically significant drop was estimated for influenza immunisation. For five of the six indicators withdrawn from April 2011, no significant effect on performance was seen following removal and differences between predicted and observed scores were small. Performance on related outcome indicators retained in the scheme (such as blood pressure control) was generally unaffected. Conclusions Following the removal of incentives, levels of performance across a range of clinical activities generally remained stable. This indicates that health benefits from incentive schemes can potentially be increased by periodically replacing existing indicators with new indicators relating to alternative aspects of care. However, all aspects of care investigated remained indirectly or partly incentivised in other indicators, and further work is needed to assess the generalisability of the findings when incentives are fully withdrawn

Characterization of zebrafish polymerase iii promoters for the expression of short hairpin RNA interference molecules

RNA interference (RNAi) is a powerful, sequence specific, and long-lasting method of gene knockdown, and can be elicited by the expression of short-hairpin RNA (shRNA) molecules driven via polymerase III type 3 promoters from a DNA vector or transgene. To further develop RNAi as a tool in zebrafish, we have characterized the zebrafish U6 and H1 snRNA promoters and compared the efficiency of each of the promoters to express an shRNA and silence a reporter gene, relative to previously characterized U6 promoters from pufferfish, chicken, and mouse. Our results show that the zebrafish polymerase III promoters were capable of effective gene silencing in the zebrafish ZF4 cell line, but were ineffective in mammalian Vero cells. In contrast, mouse and chicken promoters were active in Vero but not ZF4 cells, highlighting the importance of homologous promoters to achieve effective silencing

Spatial distribution of clinical computer systems in primary care in England in 2016 and implications for primary care electronic medical record databases: a cross-sectional population study.

OBJECTIVES: UK primary care databases (PCDs) are used by researchers worldwide to inform clinical practice. These databases have been primarily tied to single clinical computer systems, but little is known about the adoption of these systems by primary care practices or their geographical representativeness. We explore the spatial distribution of clinical computing systems and discuss the implications for the longevity and regional representativeness of these resources. DESIGN: Cross-sectional study. SETTING: English primary care clinical computer systems. PARTICIPANTS: 7526 general practices in August 2016. METHODS: Spatial mapping of family practices in England in 2016 by clinical computer system at two geographical levels, the lower Clinical Commissioning Group (CCG, 209 units) and the higher National Health Service regions (14 units). Data for practices included numbers of doctors, nurses and patients, and area deprivation. RESULTS: Of 7526 practices, Egton Medical Information Systems (EMIS) was used in 4199 (56%), SystmOne in 2552 (34%) and Vision in 636 (9%). Great regional variability was observed for all systems, with EMIS having a stronger presence in the West of England, London and the South; SystmOne in the East and some regions in the South; and Vision in London, the South, Greater Manchester and Birmingham. CONCLUSIONS: PCDs based on single clinical computer systems are geographically clustered in England. For example, Clinical Practice Research Datalink and The Health Improvement Network, the most popular primary care databases in terms of research outputs, are based on the Vision clinical computer system, used by <10% of practices and heavily concentrated in three major conurbations and the South. Researchers need to be aware of the analytical challenges posed by clustering, and barriers to accessing alternative PCDs need to be removed