Impact of Pay for Performance on Prescribing of Long-Acting Reversible Contraception in Primary Care: An Interrupted Time Series Study

Background

The aim of this study was to evaluate the impact of Quality and Outcomes Framework (QOF), a major pay-for-performance programme in the United Kingdom, on prescribing of long-acting reversible contraceptives (LARC) in primary care.

Methods

Negative binomial interrupted time series analysis using practice level prescribing data from April 2007 to March 2012. The main outcome measure was the prescribing rate of long-acting reversible contraceptives (LARC), including hormonal and non hormonal intrauterine devices and systems (IUDs and IUSs), injectable contraceptives and hormonal implants.

Results

Prescribing rates of Long-Acting Reversible Contraception (LARC) were stable before the introduction of contraceptive targets to the QOF and increased afterwards by 4% annually (rate ratios  = 1.04, 95% CI = 1.03, 1.06). The increase in LARC prescribing was mainly driven by increases in injectables (increased by 6% annually), which was the most commonly prescribed LARC method. Of other types of LARC, the QOF indicator was associated with a step increase of 20% in implant prescribing (RR =  1.20, 95% CI =  1.09, 1.32). This change is equivalent to an additional 110 thousand women being prescribed with LARC had QOF points not been introduced.

Conclusions

Pay for performance incentives for contraceptive counselling in primary care with women seeking contraceptive advice has increased uptake of LARC methods.     

Novel microbial nitrogen removal processes

The present-day wastewater treatment practices can be significantly improved through the introduction of new microbial treatment technologies. Recently, several new processes for nitrogen removal have been developed. These new nitrogen removal technologies provide practicable options for treating nitrogen-laden wastewaters. The new processes are based on partial nitrification of ammonium to nitrite combined with anaerobic ammonium oxidation. These processes include the single reactor system for high ammonia removal over nitrite (SHARON) process, which involves part conversion of ammonium to nitrite; the anaerobic ammonium oxidation (ANAMMOX) process, which involves anaerobic ammonium oxidation; and the completely autographic nitrogen removal over nitrite (CANON) process, which involves nitrogen removal within one reactor under oxygen-limited conditions. These new processes target the removal of nitrogen from wastewaters containing significant quantities of ammonium.     

Development of a spore-based formulation of microbial pesticides for control of rice sheath blight

An effective formulated biopesticide for controlling sheath blight in rice was developed using three microbial antagonists (Bacillus megaterium, Bacillus subtilis and Aspergillus niger) isolated from the rice sheath. The efficiency of spore-based formulations of the above microbial antagonists was investigated and their effectiveness in controlling sheath blight was demonstrated. Application of talc-based formulations of individual antagonists and mixtures of the three antagonists as spray treatments or soil applications were effective in reducing the incidence by up to 45% at 27 days after inoculation of the pathogen of sheath blight and increased rice yield. The use of spores of a fungal antagonist (A. niger), in comparison to commonly used bacterial antagonists, is a novel feature of the present study. Optimum sporulation conditions of the antagonists for preparation of spore-based formulations and their commercially desirable features such as the ability to maintain spore viability in storage were also determined. Culturing in the synthetic replacement sporulation medium (SRSM-2) for 72 hours was the most effective for sporulation of the two bacterial antagonists while culturing in potato dextrose broth (PDB) for 7 days was the most effective for sporulation of the fungal antagonist. It was demonstrated that talc-based formulations of all antagonists, either in refrigerated storage (4°C) or at room temperature (28±2°C), were able to maintain greater spore viability over a longer period (>6 months) than spore suspensions. In view of the relatively shorter life spans of formulations based on vegetative cells, spore-based formulations have a distinct advantage in achieving longer-lasting control, especially under harsh field conditions.     

The adenovirus L4 100-kilodalton protein is necessary for efficient translation of viral late mRNA species.

When screening a number of adenovirus type 5 (Ad5) temperature-sensitive mutants for defects in viral gene expression, we observed that H5ts1-infected 293 cells accumulated reduced levels of newly synthesized viral late proteins. Pulse-labeling and pulse-chase experiments were used to establish that the late proteins synthesized in H5ts1-infected cells under nonpermissive conditions were as stable as those made in Ad5-infected cells. H5ts1-infected cells contained normal levels of viral late mRNAs. Because these observations implied that translation of viral mRNA species was defective in mutant virus-infected cells, the association of viral late mRNAs with polyribosomes was examined during the late phase of infection at a nonpermissive temperature. In Ad5-infected cells, the majority of the viral L2, L3, L4, pIX, and IVa2 late mRNA species were polyribosome bound. By contrast, these same mRNA species were recovered from H5ts1-infected cells in fractions nearer the top of polyribosome gradients, suggesting that initiation of translation was impaired. During the late phase of infection, neither the polyribosome association nor the translation of most viral early mRNA species was affected by the H5ts1 mutation. This lesion, mapped by marker rescue to the L4 100-kilodalton (kDa) nonstructural protein, has been identified as a single base pair substitution that replaces Ser-466 of the Ad5 100-kDa protein with Pro. A set of temperature-independent revertants of H5ts1 was isolated and characterized. Either true reversion of the H5ts1 mutation or second-site mutation of Pro-466 of the H5ts1 100-kDa protein to Thre, Leu, or His restored both temperature-independent growth and the efficient synthesis of viral late proteins. We therefore conclude that the Ad5 L4 100-kDa protein is necessary for efficient initiation of translation of viral late mRNA species during the late phase of infection.     

Varietal Difference in the Ability to Flower in Response to Poor Nutrition and its Correlation with Chlorogenic Acid Accumulation in Pharbitis nil

Strain Kidachi of Pharbitis nil scarcely flowered in responseto poor nutrition (culture in tap water) under continuous light,although strain Violet flowered easily. In parallel to the floweringresponse, the chlorogenic acid (CGA) content in the cotyledonsdid not increase during the culture in tap water in Kidachi,although it rapidly increased in Violet. The F¹ hybrids betweenthese two strains and their F² progeny flowered in responseto poor nutrition, although F¹ showed a lower and F² a muchlower flowering response than the parent Violet. These floweringresponses were closely correlated with the accumulation of CGAin the cotyledons. ¹Present address: Botany Department, Institute of Agriculture,Yezin, Burma. (Received November 20, 1987; Accepted March 13, 1988)     

Reversible conversion from Ca(2)+-ATPase activity to Mg(2)+- and Mn(2)+-ATPase activities of coupling factor purified from acetone powder of Rhodospirillum rubrum chromatophores.

It is known that the coupling factor purified from the acetone powder of chromatophores from Rhodospirillum rubrum shows ATPase activity in the presence of Ca(2)+, but not in the presence of Mg(2)+ or Mn(2)+. The present study deals with conditions, under which the Ca(2)+-ATPase activity is reversibly converted into Mg(2)+- and Mn(2)+-ATPase activites with the purified coupling factor. 1. Of the pH indicators tested, 6 kinds coverted the Ca(2)+-ATPase activity into Mg(2)+- and Mn(2)+-ATPase activities in the order, ethyl orange greater than tropaeolin 000 greater than or equal to metanil yellow greater than tropaeolin 00 greater than ethyl red greater than or equal to bromthymol blue. 2. Of the detergents tested, those other than Triton X-100 and Brij 58 caused the conversion described above; dodecylsulfonate was most effective, whereas dodecylpyridinium chloride was moderately effective. 3. 2,4-Dinitrophenol stimulated approximately two-fold the Ca(2)+-ATPase activity, but not the Mg(2)+- or Mn(2)+-ATPase activity at all. However, in the presence of dodecylpyridinium chloride, the pH indicator remarkably stimulated the Mg(2)+- and Mn(2)+-ATPase activities, accompanied with a partial inhibition of the Ca(2)+-ATPase activity. Methyl red and ethyl red showed similar effects. 4. All the nucleoside triphosphates tested can serve as the substrate. ATP was most effective for the Ca(2)+-ATPase activity, whereas dATP was most effective for the Mg(2)+- and Mn(2)+-ATPase activities induced by ethyl orange. 5. In the presence of ethyl orange, the ATPase activity was induced by various divalent cations in the following order of effectiveness, Mg(2)+ greater than Zn(2)+ greater than CO(2)+ greater than Mn(2)+ greater than Ni(2)+. 6. The mechanism of the reversible conversion from the Ca(2)+-ATPase activity to the Mg(2)+- and Mn(2)+-ATPase activities by pH indicators and detergents is discussed.     

Isolation and characterization of a new cellulosome-producing Clostridium thermocellum strain

The anaerobic thermophilic bacterium, Clostridium thermocellum, is a potent cellulolytic microorganism that produces large extracellular multienzyme complexes called cellulosomes. To isolate C. thermocellum organisms that possess effective cellulose-degrading ability, new thermophilic cellulolytic strains were screened from more than 800 samples obtained mainly from agriculture residues in Thailand using microcrystalline cellulose as a carbon source. A new strain, C. thermocellum S14, having high cellulose-degrading ability was isolated from bagasse paper sludge. Cellulosomes prepared from S14 demonstrated faster degradation of microcrystalline cellulose, and 3.4- and 5.6-fold greater Avicelase activity than those from C. thermocellum ATCC27405 and JW20 (ATCC31449), respectively. Scanning electron microscopic analysis showed that S14 had unique cell surface features with few protuberances in contrast to the type strains. In addition, the cellulosome of S14 was resistant to inhibition by cellobiose that is a major end product of cellulose hydrolysis. Saccharification tests conducted using rice straw soaked with sodium hydroxide indicated the cellulosome of S14 released approximately 1.5-fold more total sugars compared to that of ATCC27405. This newly isolated S14 strain has the potential as an enzyme resource for effective lignocellulose degradation.     

A new primate from the Eocene Pondaung Formation of Myanmar and the monophyly of Burmese amphipithecids

The family Amphipithecidae is one of the two fossil primate taxa from Asia that appear to be early members of the anthropoid clade. Ganlea megacanina, gen. et sp. nov., is a new amphipithecid from the late middle Eocene Pondaung Formation of central Myanmar. The holotype of Ganlea is distinctive in having a relatively enormous lower canine showing heavy apical wear, indicating an important functional role of the lower canine in food preparation and ingestion. A phylogenetic analysis of amphipithecid relationships suggests that Ganlea is the sister taxon of Myanmarpithecus, a relatively small-bodied taxon that has often, but not always, been included in Amphipithecidae. Pondaungia is the sister taxon of the Ganlea + Myanmarpithecus clade. All three Pondaung amphipithecid genera are monophyletic with respect to Siamopithecus, which is the most basal amphipithecid currently known. The inclusion of Myanmarpithecus in Amphipithecidae diminishes the likelihood that amphipithecids are specially related to adapiform primates. Extremely heavy apical wear has been documented on the lower canines of all three genera of Burmese amphipithecids. This distinctive wear pattern suggests that Burmese amphipithecids were an endemic radiation of hard object feeders that may have been ecological analogues of living New World pitheciin monkeys.