Provider diversity in the NHS: impact on quality and innovation

The overall objective of the research project has been to assess the impact of provider diversity on quality and innovation in the NHS. The specific research aims were to identify the differences in performance between non-profit Third Sector organisations, for-profit private enterprises, and incumbent public sector institutions within the NHS as providers of health care services, as well as the factors that affect the entry and growth of new private and Third Sector providers. The study used both qualitative and quantitative methods based on case studies of four Local Health Economies (LHEs). Qualitative methods included documentary analysis and interviews with key informants and managers of both commissioning and provider organisations. To provide a focus to the study, two tracer conditions were followed: orthopaedic surgery and home health care for frail older people. In the case of hospital inpatient care, data on patient characteristics were also collected from the HES database. The analysis of this data provided preliminary estimates of the effects of provider type on quality, controlling for client characteristics and case mix. In addition, a survey of patient experience in diverse provider organisations was analysed to compare the different dimensions of quality of provision of acute services between incumbent NHS organisations and new independent sector treatment centres. The research has shown that, in respect of inpatient hospital services, diverse providers supply health services of at least as good quality as traditional NHS providers, and that there is ample opportunity to expand their scale and scope as providers of services commissioned by the NHS. The research used patient experience survey data to investigate whether hospital ownership affects the quality of services reported by NHS patients in areas other than clinical quality. The raw survey data appear to show that private hospitals provide higher quality services than the public hospitals. However, further empirical analysis leads to a more nuanced understanding of the performance differences. Firstly, the analysis shows that each sector offers greater quality in certain specialties. Secondly, the analysis shows that differences in the quality of patients’ reported experience are mainly attributable to patient characteristics, the selection of patients into each type of hospital, and the characteristics of individual hospitals, rather than to hospital ownership as such. Controlling for such differences, NHS patients are on average likely to experience a similar quality of care in a public or privately-run hospital. Nevertheless, for specific groups of patients and for specific types of treatments, especially the more straightforward ones, the private sector provides an improved patient experience compared to the public sector. Elsewhere, the NHS continues to provide a high quality service and outperforms the private sector in a range of services and for a range of clients.

Engaging in European spatial planning: a central and Eastern European perspective on the territorial cohesion debate

The following paper sets out to determine the differential extent of the engagement of Central and Eastern European (CEE) member states with the European spatial planning (ESP) debate over territorial cohesion. It focuses on the written statements submitted in response to the European Commission “Green Paper on Territorial Cohesion” consultation in 2009. The geographical distribution of the respondents is analysed, before CEE member states’ responses are examined in detail, to explore the diverse interpretations of the concept of “territorial cohesion” among CEE actors. While the data collection for this paper has been restricted empirically to the consultation process, it reflects its findings in consideration of member states’ engagement with the debate as it manifested before and after the Green Paper. The debate over the exact conceptual and operational “framing” of territorial cohesion, launched by the European Commission's Green Paper, constitutes one of the many arenas through which ESP currently evolves, together with the transnational initiatives developed in the framework of the European Territorial Cooperation objective, the European Observation Network for Territorial Development and Cohesion (ESPON) and the process that recently led to the publication of the Territorial Agenda of the European Union 2020. The paper concludes that the overall level of engagement of CEE actors in ESP is proportionally lower in comparison with that of their northwestern European counterparts. The increasing involvement of some CEE member states within the ESPON 2013 Programme, as well as the activities undertaken by the Hungarian and Polish EU Presidencies in 2011, suggests that this level of CEE engagement is growing albeit differentially.

Determinants of healthy eating: a cross-national study on motives and barriers

The paper investigates the impact of motives and barriers to healthy eating on individuals' healthy eating intention and behaviour using a cross-national design. Data were collected from the UK and the Czech Republic via a self-completion questionnaire. Findings highlight the significance of intrinsic motives and psychological barriers in predicting both intention and healthy eating behaviour for both UK and Czech consumers, albeit their weight as well as the variance captured by these factors differs across the two national cultures. Findings also indicate that physical barriers are in fact unimportant when it comes to adopting a healthy eating diet. These findings are discussed in the light of previous research, while their implications for policy makers and researchers are highlighted.

An evolutionary innovation perspective on the selection of low and zero carbon technologies in new housing

The Code for Sustainable Homes (the Code) will require new homes in the United Kingdom to be ‘zero carbon’ from 2016. Drawing upon an evolutionary innovation perspective, this paper contributes to a gap in the literature by investigating which low and zero carbon technologies are actually being used by house builders, rather than the prevailing emphasis on the potentiality of these technologies. Using the results from a questionnaire three empirical contributions are made. First, house builders are selecting a narrow range of technologies. Second, these choices are made to minimise the disruption to their standard design and production templates (SDPTs). Finally, the coalescence around a small group of technologies is expected to intensify with solar-based technologies predicted to become more important. This paper challenges the dominant technical rationality in the literature that technical efficiency and cost benefits are the primary drivers for technology selection. These drivers play an important role but one which is mediated by the logic of maintaining the SDPTs of the house builders. This emphasises the need for construction diffusion of innovation theory to be problematized and developed within the context of business and market regimes constrained and reproduced by resilient technological trajectories.

Plant natriuretic peptide active site determination and effects on cGMP and cell volume regulation

Natriuretic peptides (NP) were first identified in animals where they play a role in the regulation of salt and water balance. This regulation is partly mediated by intracellular changes in cyclic GMP (cGMP). NP immunoanalogues occur in many plants and have been isolated, with two NP encoding genes characterised in Arabidopsis thaliana L. (AtPNP-A and AtPNP-B). Part of AtPNP-A contains the region with homology to human atrial (A)NP. We report here on the effects of recombinant AtPNP-A and smaller synthetic peptides within the ANP-homologous region with a view to identifying the biologically active domain of the molecule. Furthermore, we investigated interactions between AtPNP-A and the hormone, abscisic acid (ABA). ABA does not significantly affect Arabidopsis mesophyll protoplast volume regulation, whereas AtPNP-A and synthetic peptides promote water uptake into the protoplasts causing swelling. This effect is promoted by the membrane permeable cGMP analogue, 8-Br-cGMP, and inhibited by guanylate cyclase inhibitors indicating that increases in cGMP are an essential component of the plant natriuretic peptides (PNP) signalling cascade. ABA does not induce cGMP transients and does not affect AtPNP-A dependent cGMP increases, hence the two regulators differ in their second messenger signatures. Interestingly, AtPNP-A significantly delays and reduces the extent of ABA stimulated stomatal closure that is also based on cell volume regulation. We conclude that a complex interplay between observed PNP effects (stomatal opening and protoplast swelling) and ABA is likely to be cell type specific.

An innovation framework based on best practice exemplars from the Australian School Innovation in Science, Technology and Mathematics (ASISTM) project

This report describes research into 16 ASISTM projects selected to be broadly representative of exemplars in innovation. Case studies of each project were constructed from interviews with a range of key participants, and used to develop and refine an innovation framework that is used to make sense of and describe the key features of each project. The major issue binding these projects was found to be that of student interest and engagement, and this was pursued through involving students in contemporary science, technology and mathematics (STM) practices in authentic settings. The findings point to an enriched set of purposes of STM education implicit in these projects, a set of pedagogical practices that are varied and consistent with contemporary educational thinking, and a varied array of 'actors' recruited to these projects.

Gender differences in personal, social and environmental influences on active travel to and from school for Australian adolescents

Active travel (walking or cycling for transport) is an important contributor to adolescents overall physical activity (PA). This study examines associations between personal, social and environmental variables and active travel to and from school using data from a large observational study to examine active travel in 2961 year 6 and 8 students (48.7% male), aged 10–14 years (M = 11.4, SD = 0.8 yrs) from 231 schools. Participants completed an on-line survey and all reported living within 2 km of school. Data collected included mode of travel to and from school, self-reported health, and PA variables. Social environmental variables included having playgrounds, parks or gyms close by, feeling safe to walk alone, barriers to walking in the neighbourhood (e.g. traffic, no footpaths), peer and family support for PA, existence of sports teams/scout groups, community disorder and perceived neighbourhood safety. Results showed that while more girls (44.3%) than boys (37.4%) walked to school, lower proportions rode bikes (8.3% vs 22.4%) and hence fewer were active travellers overall. Logistic regression models, adjusted for age, location and socio-economic status were conducted for active travel to/from school, separately for boys and girls. Predictors for boys and girls being ‘active travellers’ to/from school included recreational facilities close to home, higher perceived safety of the neighbourhood and higher community disorder. For boys, social support from friends, scout groups available and higher enjoyment of physical activity was also important. These findings suggest areas for future research and may be used to guide strategies to increase active travel to and from school.

Healthy ageing: farming into the twilight

Policy directives in agriculture have long been concerned with encouraging low producing farmers to retire - with limited success. From a healthy ageing perspective, the choice to remain on the farm into advancing years could appear a desirable policy outcome. Yet as farmers age, many with little prospect of inter-generational succession, there is growing concern that some farm families are beginning to experience extraordinary isolation, reduced health and quality of life, and increasing vulnerability with seemingly no choice but to stay on the farm and soldier on. The John Richards Initiative in Aged Care in Rural Australia hosted a forum on ‘ageing farmers', where the issues of healthy ageing and the barriers to retirement were discussed from three different perspectives - the demographic and economic drivers of structural ageing in the farm sector, the cultural and identity issues underlying retirement choices of farmers and the health and well-being implications of ageing on-farm. This article brings these diverse and interdisciplinary viewpoints together to explore the challenges and options for ageing farmers, where the question may be shifting from concerns about ‘who will run the farm' to ‘who will be there to take care of me'?

Influence of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: outcomes of the Supermarket Healthy Eating for Life randomized controlled trial

BACKGROUND: Fiscal strategies are increasingly considered upstream nutrition promotion measures. However, few trials have investigated the effectiveness or cost effectiveness of pricing manipulations on diet in real-world settings. OBJECTIVE: We assessed the effects on fruit, vegetable, and beverage purchasing and consumption of a 20% price-reduction intervention, a tailored skills-based behavior-change intervention, and a combined intervention compared with a control condition. DESIGN: The Supermarket Healthy Eating for Life trial was a randomized controlled trial conducted over 3 mo [baseline (time 1) to postintervention (time 2) with a 6-mo follow-up (time 3)]. Female primary household shoppers in Melbourne, Australia, were randomly assigned to a 1) skill-building (n = 160), 2) price-reduction (n = 161), 3) combined skill-building and price-reduction (n = 160), or 4) control (n = 161) group. Supermarket transaction data and surveys were used to measure the following study outcomes: fruit, vegetable, and beverage purchases and self-reported fruit and vegetable consumption at each time point. RESULTS: At 3 mo (time 2), price reduction-alone participants purchased more total vegetables and frozen vegetables than did controls. Price reduction-alone and price reduction-plus-skill-building participants purchased more fruit than did controls. Relative to controls, in the price-reduction group, total vegetable consumption increased by 233 g/wk (3.1 servings or 15% more than at baseline), and fruit purchases increased by 364 g/wk (2.4 servings; 35% more than at baseline). Increases were not maintained 6 mo postintervention (time 3). Price reduction-alone participants showed a tendency for a slight increase in fruit consumption at time 2 (P = 0.09) that was maintained at time 3 (P = 0.014). No intervention improved purchases of bottled water or low-calorie beverages. CONCLUSIONS: A 20% price reduction in fruit and vegetables resulted in increased purchasing per household of 35% for fruit and 15% for vegetables over the price-reduction period. These findings show that price modifications can directly increase produce purchases. The Supermarket Healthy Eating for Life trial was registered at Current Controlled Trials Registration as ISRCTN39432901.

Effect of soluble fiber on hypertriglyceridemia and immune profile in HIV-positive individuals undergoing highly active antiretroviral therapy

The advent of highly active antiretroviral therapy (HAART), since 1996, represented a profound impact on the natural history of HIV-infection by promoting important and sustainable viral replication suppression and increasing survival and quality of life among seropositive patients. Nonetheless, antiretroviral therapy has been observed to be accompanied by metabolic alterations such as dyslipidemia, especially hypertriglyceridemia, insulin resistance, hyperglycemia and lipodystrophy (body fat redistribution). Epidemiological studies have demonstrated a correlation between high triglyceride (TG) levels and higher incidence of coronary artery disease (CAD). Some investigators suggest dietary intervention as part of hyperlipidemia treatment, including an increase in soluble fiber intake (10-25g/day). Whereas some studies have demonstrated that both cholesterol and serum triglyceride levels decrease with the use of food fiber, others have shown just a serum triglyceride decrease, and others failed to observe any alteration in lipid metabolism. The purpose of this study was to assess the effect of soluble fiber (R) (partially hydrolyzed guar gum) supplementation on hypertriglyceridemia and immune profile in HIVpositive individuals on HAART. Nineteen HIV-positive individuals with hypertriglyceridemia (serum levels >= 150 to < 500mg/dl) were studied. of these individuals, 63.16% were males and 36.84% females, with mean age of 43.52 +/- 9.22 years. These individuals had been on the same HAART regimen for at least six months, had no change in therapy during the study and received 20g/day of soluble fiber for four months at pre-established times. Clinical-nutritional, biochemical (total proteins, albumin, globulin, total cholesterol, LDL-c, HDL-c, TG, TG/HDL-c and LDLc/HDL-c), hematimetric (hemoglobin, hematocrit and total lymphocytes), and immunologic (lymphocytes T CD4(+), T CD8(+); T CD4(+)/CD8(+) ratio, viral load, TNF-alpha and IL-6) parameters were assessed in all patients at three time points (M0: pretreatment, M1: 30 days, and M2: four months after intervention). Significance level was set at 5% for all data statistically analyzed. Serum TG and TG/HDL-c ratio reduction was observed at all time points, but statistical significance was found just at M0 and M2. The remaining biochemical, hematimetric and immunologic parameters (lymphocytes T CD4(+), T CD8(+); T CD4(+)/ CD8(+) ratio, and viral load) showed no significant difference at all times. Regarding serum cytokines, TNF-alpha and IL-6 significantly decreased between M0 and M2, and only IL-6 reduced between M1 and M2. The data collected show that dietary and anthropometric parameters remained unchanged excluding potential confounding factors related with the effect of fiber supplementation on serum TG, TNF-alpha and IL-6. Thus, soluble fiber (R) contributed to an important reduction in hypertriglyceridemia and in the serum levels of the proinflammatory cytokines TNF-alpha and IL-6 in HIV-seropositive individuals on HAART. In addition, soluble fiber (R) might have minimized the process of atherosclerosis in these individuals, given that elevated serum levels of TG, TNF-alpha and IL-6 have been associated with the development of these lesions.

The effect of the ocean water immersion and UV ageing on the dynamic mechanical properties of the PPS/glass fiber composites

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of disinfection and accelerated ageing on dimensional stability and detail reproduction of a facial silicone with nanoparticles

The aim of the present study was to evaluate the effect of disinfection and accelerated ageing on the dimensional stability and detail reproduction of a facial silicone with different types of nanoparticle. A total of 60 specimens were fabricated with Silastic MDX 4-4210 silicone and they were divided into three groups: colourless and pigmented with nanoparticles (make-up powder and ceramic powder). Half of the specimens of each group were disinfected with Efferdent tablets and half with neutral soap for 60 days. Afterwards, all specimens were subjected to accelerated ageing. Both dimensional stability and detail reproduction tests were performed after specimen fabrication (initial period), after chemical disinfection, and after accelerated ageing periods (252, 504 and 1008 hours). The dimensional stability test was conducted using AutoCAD software, while detail reproduction was analysed using a stereoscope magnifying glass. Dimensional stability values were statistically evaluated by analysis of variance (ANOVA) followed by Tukey's test (p < 0.01). Detail reproduction results were compared using a score. Chemical disinfection and also accelerated ageing affected the dimensional stability of the facial silicone with statistically significant results. The silicone's detail reproduction was not affected by these two factors regardless of nanoparticle type, disinfection and accelerated ageing. © 2012 Informa UK, Ltd.

Effects of active smoking on airway and systemic inflammation profiles in patients with chronic obstructive pulmonary disease

Background: The markers that characterize local and systemic inflammation in chronic obstructive pulmonary disease (COPD) remain unclear, as do their correlations with smoking status and presence of disease. The aim of this study was to assess markers of inflammation in the peripheral blood and airways of current smokers without COPD, of current smokers with COPD and of ex-smokers with COPD. METHODS: In this study, 17 current smokers with COPD (mean age: 58.2 ± 9.6 years; mean forced expiratory volume in 1 second [FEV1]: 56.1 ± 15.9%), 35 ex-smokers with COPD (mean age: 66.3 ± 7.3 years; mean FEV1: 47.9 ± 17.2%) and 20 current smokers without COPD (mean age: 49.1 ± 6.2 years; mean FEV1: 106.5 ± 15.8%) were evaluated. Spirometry findings, body composition and serum/induced sputum concentrations of tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-8 and IL-10, together with serum C-reactive protein (CRP) levels, were assessed. RESULTS: Serum TNF-α concentration was higher in all current smokers than in ex-smokers with COPD. In current smokers without COPD, serum CRP level was lower than in ex-smokers with COPD and significantly lower than in current smokers with COPD. Sputum TNF-α concentration was higher in current and ex-smokers with COPD than in current smokers without COPD. Multiple regression analyses showed that serum TNF-α was associated with active smoking, and serum CRP and sputum TNF-α were associated with COPD diagnosis. CONCLUSIONS: Smoking is associated with higher systemic inflammation in patients with COPD. Current findings also support the hypothesis that smoking and COPD have different effects on the regulation of airway and systemic inflammatory processes. © 2013 Lippincott Williams and Wilkins.