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.

The spatial impact of visual distractors on saccade latency

Remote transient changes in the environment, such as the onset of visual distractors, impact on the exe- cution of target directed saccadic eye movements. Studies that have examined the latency of the saccade response have shown conflicting results. When there was an element of target selection, saccade latency increased as the distance between distractor and target increased. In contrast, when target selection is minimized by restricting the target to appear on one axis position, latency has been found to be slowest when the distractor is shown at fixation and reduces as it moves away from this position, rather than from the target. Here we report four experiments examining saccade latency as target and distractor posi- tions are varied. We find support for both a dependence of saccade latency on distractor distance from target and from fixation: saccade latency was longer when distractor is shown close to fixation and even longer still when shown in an opposite location (180°) to the target. We suggest that this is due to inhib- itory interactions between the distractor, fixation and the target interfering with fixation disengagement and target selection.

The impact of price promotions on producer strategies in markets with large product heterogeneity

Although current research indicates that increasing the number of options has negative effects on the cognitive ability of consumers, little understanding has been given to the consequences on producers and their strategic behavior. This article tests whether a large portfolio of products is beneficial to producers by observing UK consumer response to price promotions. The article shows that discounts induce mainly segment switching (74% of the total impact), with a limited effect on stockpiling (26%) and no impact on purchase incidence. Consequently, consumers prefer to “follow the discount” rather than purchase multiple units of the same wine. This result seems to explain the current structure of the market, and suggests that discounts may conflict with segment loyalty, a situation that disfavors producers, particularly in very populated segments. Results also casts doubts on the economic sustainability of competition based on an intense product differentiation in the wine sector.

Impact of duration thresholds on Atlantic tropical cyclone counts*

Records of Atlantic basin tropical cyclones (TCs) since the late nineteenth century indicate a very large upward trend in storm frequency. This increase in documented TCs has been previously interpreted as resulting from anthropogenic climate change. However, improvements in observing and recording practices provide an alternative interpretation for these changes: recent studies suggest that the number of potentially missed TCs is sufficient to explain a large part of the recorded increase in TC counts. This study explores the influence of another factor—TC duration—on observed changes in TC frequency, using a widely used Atlantic hurricane database (HURDAT). It is found that the occurrence of short-lived storms (duration of 2 days or less) in the database has increased dramatically, from less than one per year in the late nineteenth–early twentieth century to about five per year since about 2000, while medium- to long-lived storms have increased little, if at all. Thus, the previously documented increase in total TC frequency since the late nineteenth century in the database is primarily due to an increase in very short-lived TCs. The authors also undertake a sampling study based upon the distribution of ship observations, which provides quantitative estimates of the frequency of missed TCs, focusing just on the moderate to long-lived systems with durations exceeding 2 days in the raw HURDAT. Upon adding the estimated numbers of missed TCs, the time series of moderate to long-lived Atlantic TCs show substantial multidecadal variability, but neither time series exhibits a significant trend since the late nineteenth century, with a nominal decrease in the adjusted time series. Thus, to understand the source of the century-scale increase in Atlantic TC counts in HURDAT, one must explain the relatively monotonic increase in very short-duration storms since the late nineteenth century. While it is possible that the recorded increase in short-duration TCs represents a real climate signal, the authors consider that it is more plausible that the increase arises primarily from improvements in the quantity and quality of observations, along with enhanced interpretation techniques. These have allowed National Hurricane Center forecasters to better monitor and detect initial TC formation, and thus incorporate increasing numbers of very short-lived systems into the TC database.

The benefits of a compute cluster approach to high spatial resolution biodiversity richness modelling: projecting the impact of climate change on Mediterranean flora

High spatial resolution environmental data gives us a better understanding of the environmental factors affecting plant distributions at fine spatial scales. However, large environmental datasets dramatically increase compute times and output species model size stimulating the need for an alternative computing solution. Cluster computing offers such a solution, by allowing both multiple plant species Environmental Niche Models (ENMs) and individual tiles of high spatial resolution models to be computed concurrently on the same compute cluster. We apply our methodology to a case study of 4,209 species of Mediterranean flora (around 17% of species believed present in the biome). We demonstrate a 16 times speed-up of ENM computation time when 16 CPUs were used on the compute cluster. Our custom Java ‘Merge’ and ‘Downsize’ programs reduce ENM output files sizes by 94%. The median 0.98 test AUC score of species ENMs is aided by various species occurrence data filtering techniques. Finally, by calculating the percentage change of individual grid cell values, we map the projected percentages of plant species vulnerable to climate change in the Mediterranean region between 1950–2000 and 2020.

Impact of melt ponds on Arctic sea ice simulations from 1990 to 2007

The extent and thickness of the Arctic sea ice cover has decreased dramatically in the past few decades with minima in sea ice extent in September 2007 and 2011 and climate models did not predict this decline. One of the processes poorly represented in sea ice models is the formation and evolution of melt ponds. Melt ponds form on Arctic sea ice during the melting season and their presence affects the heat and mass balances of the ice cover, mainly by decreasing the value of the surface albedo by up to 20%. We have developed a melt pond model suitable for forecasting the presence of melt ponds based on sea ice conditions. This model has been incorporated into the Los Alamos CICE sea ice model, the sea ice component of several IPCC climate models. Simulations for the period 1990 to 2007 are in good agreement with observed ice concentration. In comparison to simulations without ponds, the September ice volume is nearly 40% lower. Sensitivity studies within the range of uncertainty reveal that, of the parameters pertinent to the present melt pond parameterization and for our prescribed atmospheric and oceanic forcing, variations of optical properties and the amount of snowfall have the strongest impact on sea ice extent and volume. We conclude that melt ponds will play an increasingly important role in the melting of the Arctic ice cover and their incorporation in the sea ice component of Global Circulation Models is essential for accurate future sea ice forecasts.

The impact of NTFP sales on rural households’ cash income in India’s dry deciduous forest

In recent years, researchers and policy makers have recognized that nontimber forest products (NTFPs) extracted from forests by rural people can make a significant contribution to their well-being and to the local economy. This study presents and discusses data that describe the contribution of NTFPs to cash income in the dry deciduous forests of Orissa and Jharkhand, India. In its focus on cash income, this study sheds light on how the sale of NTFPs and products that use NTFPs as inputs contribute to the rural economy. From analysis of a unique data set that was collected over the course of a year, the study finds that the contribution of NTFPs to cash income varies across ecological settings, seasons, income level, and caste. Such variation should inform where and when to apply NTFP forest access and management policies.

Impact of stratospheric ozone on Southern Hemisphere circulation change: A multimodel assessment

The impact of stratospheric ozone on the tropospheric general circulation of the Southern Hemisphere (SH) is examined with a set of chemistry‐climate models participating in the Stratospheric Processes and their Role in Climate (SPARC)/Chemistry‐Climate Model Validation project phase 2 (CCMVal‐2). Model integrations of both the past and future climates reveal the crucial role of stratospheric ozone in driving SH circulation change: stronger ozone depletion in late spring generally leads to greater poleward displacement and intensification of the tropospheric midlatitude jet, and greater expansion of the SH Hadley cell in the summer. These circulation changes are systematic as poleward displacement of the jet is typically accompanied by intensification of the jet and expansion of the Hadley cell. Overall results are compared with coupled models participating in the Intergovernmental Panel on Climate Change Fourth Assessment Report (IPCC AR4), and possible mechanisms are discussed. While the tropospheric circulation response appears quasi‐linearly related to stratospheric ozone changes, the quantitative response to a given forcing varies considerably from one model to another. This scatter partly results from differences in model climatology. It is shown that poleward intensification of the westerly jet is generally stronger in models whose climatological jet is biased toward lower latitudes. This result is discussed in the context of quasi‐geostrophic zonal mean dynamics.

Impact of global warming on the Asian winter monsoon in a coupled GCM

The Asian winter monsoon (AWM) response to the global warming was investigated through a long-term integration of the transient greenhouse warming with the ECHAM4/OPYC3 CGCM. The physics of the response was studied through analyses of the impact of the global warming on the variations of the ocean and land contrast near the ground in the Asian and western Pacific region and the east Asian trough and jet stream in the middle and upper troposphere. Forcing of transient eddy activity on the zonal circulation over the Asian and western Pacific region was also analyzed. It is found that in the global warming scenario the winter northeasterlies along the Pacific coast of the Eurasian continent weaken systematically and significantly, and intensity of the AWM reduces evidently, but the AWM variances on the interannual and interdecadal scales are not affected much by the global warming. It is suggested that the global warming makes the climate over the most part of Asia to be milder with enhanced moisture in winter. In the global warming scenario the contrasts of the sea level pressure and the near-surface temperature between the Asian continent and the Pacific Ocean become significantly smaller, northward and eastward shifts and weakening of the east Asian trough and jet stream in the middle and upper troposphere are found. As a consequence, the cold air in the AWM originating from the east Asian trough and high latitudes is less powerful. In addition, feedback of the transient activity also makes a considerable contribution to the higher-latitude shift of the jet stream over the North Pacific in the global warming scenario.

Impact of serving method on the consumption of nutritional supplement drinks: randomised trial in older adults with cognitive impairment

Aim: To analyse the influence of serving method on compliance and consumption of nutritional supplement drinks in older adults with cognitive impairment. Background: Oral nutritional supplement drinks have positive benefits on increasing nutritional status within undernourished elderly people leading to weight gain. However, consumption of these drinks is low and therefore limits their effectiveness. Design: This study was a non blind randomised control trial where participants either consumed nutritional supplement drinks in a glass/beaker or consumed them through a straw inserted directly into the container. Method: Participants with longstanding cognitive impairment were recruited from nursing homes (n=31) and hospitals (n=14). Participants were randomised to serving method. Nursing and care staff were instructed to give the supplement drinks three times per day on alternate days over a week by the allocated serving method. The researcher weighed the amount of supplement drink remaining after consumption. Data were collected over 12 months in 2011-2012. Results: 45 people participated in this study mean age 86.7 (SD 7.5 ) years. After randomisation there was no significant difference between the baseline characteristics of the two groups. Participants randomised to consume nutritional drinks from a glass / beaker drank significantly more than those who consumed them via a straw inserted directly into the container. However, supplements allocated to be given in a glass/beaker were more frequently omitted. Conclusion: Nutritional supplement drinks should be given to people with dementia who are able to feed themselves in a glass or a beaker if staffing resources allow (NIHR CSP ref 31101).