Thermodynamics of the deposition of complex waxes and asphaltenes in crude oil

Peer reviewedPublisher PD

Beliefs about brain injury in Britain

Primary objective: Surveys have revealed that a high proportion of the public in the US and Canada hold misconceptions pertaining to the sequelae of brain injury. This study examined whether similar misconceptions are endorsed by adults in Britain. Research design: Survey. Methods and procedures: Three hundred and twenty-two participants completed a 17-item questionnaire containing true or false statements about general knowledge of brain injury, coma and consciousness, memory impairments and recovery. Main outcomes and results: Regardless of age, sex, level of education and familiarity with brain injury, participants held mistaken beliefs about consciousness, were inclined to under-estimate the extent of memory deficits and were unaware that patients are more vulnerable and less resistant to further injury. A large proportion of respondents indicated that their knowledge of brain injury had been derived from the popular media. Conclusions: Similar misconceptions to those reported in previous studies exist in Britain. Notably in this study these misconceptions were endorsed by a greater percentage of respondents. Greater public awareness is needed for decisions concerning funding and patient care. It is therefore important for healthcare professionals and public health campaigns to dispel myths about brain injury

Public services: are composite measures a robust reflection of performance in the public sector?

A composite indicator is an aggregated index comprising individual performance indicators. Composite indicators integrate a large amount of information in a format that is easily understood and are therefore a valuable tool for conveying a summary assessment of performance in priority areas. This research investigates the degree to which composite measures are an appropriate metric for evaluating performance in the public sector. Do they reflect accurately the performance of organisations? To what degree are they influenced by the uncertainty surrounding underlying indicators on which they are based? Are they robust and stable over time? The construction of composite measures creates specific methodological challenges that make such questions especially pertinent. We address these through a series of quantitative analyses of panel data relating to healthcare (Star ratings of NHS acute Trusts) and local government (Comprehensive Performance Assessment (CPA) ratings of authorities) in England where composites have been widely used. The creation of a composite comprises a number of important steps, each of which requires careful judgement. These include the specification of the choice of indicators, the transformation of measured performance on individual indicators, the specification of a set of weights on individual indicators, and combining the indicators using aggregation methods or decision rules. We use Monte Carlo simulations to examine the robustness of performance judgements to these different technical choices. We show the extent to which composites provide stable performance rankings of organisations over time and assess whether variations are due to genuine performance improvement or merely the result of random statistical variation. The analysis suggests that the judgements that have to be made in the construction of the composite can have a significant impact on the resulting score. Technical and analytical issues in the design of composite indicators have important policy implications. We highlight the issues which need to be considered in the construction of robust composite indicators so that they can be designed in ways which will minimise the potential for producing misleading performance information which may fail to deliver the expected improvements or even induce unwanted side-effects.performance measurement, performance indicators, composite indicators

Exploring the impact of public services on quality of life indicators

The fundamental aim of public services is to improve the quality of life of citizens. The main objective of this study was to investigate the influence of public service organisations (PSOs) on aspects of quality of life (broadly measured) of citizens at a local level. We assembled a rich database using 20 of the 45 quality of life measures developed by the Audit Commission. Those we selected covered broad areas of quality of life such as safety, housing, health, education, and transport and were available at ‘small area’ level. We used a range of advanced statistical methods to analyse the relationships between PSOs and quality of life measures at different hierarchical levels. The techniques were selected to be robust when making comparisons between levels and when looking at associations between quality of life measures. Our descriptive analyses (bivariate correlations, factor analysis and ANOVA) suggested overall some significant correlations between some of the quality of life variables. The SUR model results also indicated that the quality of life indicators are correlated, and therefore that we should look at these measures in a joint modelling approach such as MVML, as envisaged in the study objectives.

The Effect of Budgets on Doctor Behaviour: Evidence From A Natural Experiment

In many health care systems primary care physicians act as 'gatekeepers' to secondary care. We investigates the impact of the UK fundholding scheme under which general practices could elect to hold a budget to meet the costs of elective surgery for their patients. We use a differences in differences methodology on a large four year panel of English general practices before and after the abolition of fundholding. Fundholding incentives reduced fundholder elective admission rates by 3.3% and accounted for 57% of the difference between fundholder and nonfundholder elective admissions, with 43% a selection effect due to unobservable differences in practice characteristics. Fundholding had no effect on emergency admissions.Budgets; Health care; Fundholding; Admission rates

Bifurcation in electrostatic resistive drift wave turbulence

The Hasegawa-Wakatani equations, coupling plasma density and electrostatic potential through an approximation to the physics of parallel electron motions, are a simple model that describes resistive drift wave turbulence. We present numerical analyses of bifurcation phenomena in the model that provide new insights into the interactions between turbulence and zonal flows in the tokamak plasma edge region. The simulation results show a regime where, after an initial transient, drift wave turbulence is suppressed through zonal flow generation. As a parameter controlling the strength of the turbulence is tuned, this zonal flow dominated state is rapidly destroyed and a turbulence-dominated state re-emerges. The transition is explained in terms of the Kelvin-Helmholtz stability of zonal flows. This is the first observation of an upshift of turbulence onset in the resistive drift wave system, which is analogous to the well-known Dimits shift in turbulence driven by ion temperature gradients.Comment: 21 pages, 11 figure

The effects on waiting times of expanding provider choice:evidence from a policy experiment

Long waiting times for inpatient treatment in the UK National Health Service have long been a source of great popular and political concern, and therefore a target for policy initiatives. One such is the London Patient Choice Project, under which patients at risk of breaching inpatient waiting time targets were offered the choice of an alternative hospital with a guaranteed shorter wait. This paper uses a difference in difference econometric methodology to infer the impact of the choice project on ophthalmology waiting times. In line with our theoretical predictions, it finds that the project led to lower average waiting times in the London region and a convergence in waiting times amongst London hospitals.

Perceived barriers and facilitators to female condoms among UK based healthcare professionals

Objectives: The female condom (FC) is an effective strategy against sexually transmitted infections (STIs) in susceptible women and men who have sex with men. FCs are the only female-initiated dual protection method that protects against both STIs and unintended pregnancy. As healthcare professionals (HCPs) are a key element in the promotion of contraceptive use, it is important to examine attitudes toward FCs among this group. Study participants: 15 male and female HCPs aged between 22-57 years recruited from sexual and reproductive health settings located in Brighton, London, and Glasgow. Sampling method: purposive sampling with targeted advertisements (newsletters and bulletins). Study design: face-to-face and telephone interviews with sexual health HCPs. Main outcome measure: potential barriers and facilitators to FCs in the UK. Data were analysed thematically to identify common views and perspectives. Results: FCs were thought to be unacceptable to most women due to stigma, design, negative visual appeal, insertion difficulties and lack of familiarity. The perceived unavailability and higher cost of FCs, in comparison to male condoms, are major barriers to their use. Conclusions: HCPs are reluctant to promote FCs, often due to the perceived social stigma surrounding FCs. Further education and promotion are needed to increase acceptability and correct usage. Future research needs to explore strategies to increase the acceptability of FCs among women, men who have sex with men and HCPs

The privilege of induction avoidance and calcineurin inhibitors withdrawal in 2 haplotype HLA matched white kidney transplantation

BACKGROUND: White recipients of 2-haplotype HLA-matched living kidney transplants are perceived to be of low immunologic risk. Little is known about the safety of induction avoidance and calcineurin inhibitor withdrawal in these patients. METHODS: We reviewed our experience at a single center and compared it to Organ Procurement and Transplantation Network (OPTN) registry data and only included 2-haplotype HLA-matched white living kidney transplants recipients between 2000 and 2013. RESULTS: There were 56 recipients in a single center (where no induction was given) and 2976 recipients in the OPTN. Among the OPTN recipients, 1285 received no induction, 903 basiliximab, 608 thymoglobulin, and 180 alemtuzumab. First-year acute rejection rates were similar after induction-free transplantation among the center and induced groups nationally. Compared with induction-free transplantation in the national data, there was no decrease in graft failure risk over 13 years with use of basiliximab (adjusted hazard ratio [aHR], 0.86; confidence interval [CI], 0.68-1.08), Thymoglobulin (aHR, 0.92; CI, 0.7-1.21) or alemtuzumab (aHR, 1.18; CI, 0.72-1.93). Among induction-free recipients at the center, calcineurin inhibitor withdrawal at 1 year (n = 27) did not significantly impact graft failure risk (HR,1.62; CI, 0.38-6.89). CONCLUSIONS: This study may serve as a foundation for further studies to provide personalized, tailored, immunosuppression for this very low-risk population of kidney transplant patients

Copolymers of glutamic acid and tyrosine are potent inhibitors of oocyte casein kinase II

AbstractPolypeptides rich in glutamic acid are strong inhibitors purified from isolated nuclei of Xenopus laevis oocytes of casein kinase II. The presence of tyrosine in these peptides greatly enhances their inhibitory capacity. Using casein as a substrate, copolyglu:tyr (4:1) has an I50 value of 20 nM, 250 fold lower than that of polyglutamic acid which is 5 μM. A similar large difference is observed when a synthetic peptide is used as substrate. The inhibition of copolyglu:tyr is competitive with casein and can be completely reversed by high ionic strength. The relative inhibitory capacity of the polypeptides tested, in descending order, is copolyglu:tyr (4:1) > copolyglu:tyr (1:1) > polyglu > copolyglu:phe (4:1) > copolyglu:ala ( > copolyglu:leu (4:1). The high affinity for tyrosine-containing acid peptides is shared by rat liver and yeast casein kinase II so that it seems to be a general property of these enzymes