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The rise in interest rates globally in 2022–23 led to improved scheme funding for many defined-benefit pension schemes. Many schemes in the UK now find themselves closer to, or at, a fully funded position on a low-risk basis (annuity buyout or self-sufficiency). Finishing the journey while managing the risk of losses on that journey is highly desirable, but may be difficult to achieve in practice.
However many schemes are not yet sufficiently funded to buy out liabilities in full with an insurer. Others may not wish to, and many who can afford to do so are not yet able to for investment reasons (such as holding illiquid assets) or operational reasons (such as the time needed to resolve member data issues). For schemes that instead look to adopt self-sufficient ongoing management with low dependency on the sponsoring employer, this may be difficult to maintain in practice. In short, there remains a risk that benefits will not be secured in full, which with hindsight could have been avoided.
The addition of capital to pension scheme assets has long been deployed to enhance the security of member benefits e.g., capital from insurers in the case of a buyout or capital from sponsors in the form of contingent assets.
More recently, providers have developed a diverse set of arrangements that draw on external capital to aid trustees and corporates to meet scheme funding ambitions. Capital Backed Funding Arrangements (“CBFA”) are in this context an additional tool in the trustee toolkit for delivering funding strategies.
This paper focusses on the UK-defined benefit market but the dynamics are applicable to other jurisdictions, with CBFAs being developed for wider markets (e.g., Ireland).
In this paper we:
survey the current scheme funding landscape and consider the need in this environment for arrangements to support scheme funding journeys to deliver benefits in full
summarise the key features of arrangements in the market that may support these objectives
set out considerations for trustees and sponsoring companies when assessing these arrangements.
The aim of this paper is educational – to increase awareness of the key issues and potential solutions. Professional advice will always be required prior to any transaction. We welcome feedback from readers on further material that would be beneficial to support consideration of these arrangements.
In this paper, we investigate finite solvable tidy groups. We prove that a solvable group with order divisible by at least two primes is tidy if all of its Hall subgroups that are divisible by only two primes are tidy.
Let G be a p-group for some prime p. Recall that the Hughes subgroup of G is the subgroup generated by all of the elements of G with order not equal to p. In this paper, we prove that if the Hughes subgroup of G is cyclic, then G has exponent p or is cyclic or is dihedral. We also prove that if the Hughes subgroup of G is generalised quaternion, then G must be generalised quaternion. With these results in hand, we classify the tidy p-groups.
Background: Emerging evidence supports the use of billing data to identify stewardship targets in primary care. Standardizing an approach to antibiotic prescribing rate (APR) calculations could facilitate external benchmarking. Methods: Using methodology and an ICD-10 dictionary validated in urgent care clinics,1 we created an expanded ICD-10 dictionary to incorporate additional ICD-10 codes from primary care associated with antibiotic prescriptions (Fig. 1). We then compared antibiotic prescribing rates using the urgent care and expanded dictionaries. We included all primary care visits from 2019 to 2020 and extracted ICD-10 codes and antibiotic order data. Using the urgent care and expanded ICD-10 dictionary, we classified each encounter by prescribing tier based on whether antibiotics are almost always (tier 1), sometimes (tier 2), or almost never (tier 3) indicated. For encounters with ICD-10s in multiple tiers, we chose the lowest tier. For multiple ICD-10 codes within the same tier, we chose the first extracted ICD-10 code. We calculated antibiotic prescribing rates as the proportion of encounters associated with ≥ 1 antibacterial prescription. This quality improvement project was deemed non–human subjects research by the Stanford Panel on Human Subjects in Medical Research. Results: The urgent care dictionary has 1,400 ICD-10 codes. We added 1,439 ICD-10 codes derived from primary care encounters to create the expanded ICD-10 dictionary (8.5% tier 1, 9.1% tier 2, and 82.4% tier 3) (Fig. 1). We identified 177,531 encounters; 74% had ≥ 2 associated ICD-10 codes (Fig. 2). In total, 147,085 encounters (82.9%) were classified into a tier using the urgent care dictionary. An additional 22,039 encounters were classified with the expanded dictionary (Table 1). Most added encounters were tier 3 with low 0.7% APR (Tables 1 and 3). In total, 41,473 (28.2%) encounters were classified differently depending on the ICD-10 dictionary used, most commonly changing from tier 3 to tier 2 without an increase in overall tier 2 antibiotic prescribing rate (Tables 2 and 3). Overall antibiotic prescribing rates were similar when using either the urgent care or expanded ICD-10 dictionary (Table 2). Conclusions: The expanded ICD-10 dictionary allowed for classification of more encounters in primary care; however, it did not meaningfully change antibiotic prescribing rates. Antibiotic prescribing rates were likely diluted by classifying more encounters without identifying an associated increase in antibiotic prescribing. A more sophisticated classification system may help to accommodate the diversity and volume of ICD-10 codes used in primary care.
1. Stenehjem E, et al. Clin Infect Dis 2020;70:1781–1787.
Patient and public involvement (PPI) plays a crucial role in ensuring research is carried out in conjunction with the people that it will impact upon. In this article, we present our experiences and reflections from working collaboratively with patients and public through the lifetime of an National Institute for Health Research (NIHR) programme grant; the Chronic Headache Education and Self-management Study (CHESS) which took place between 2015 and 2020.
PPI over the course of CHESS:
We worked closely with three leading UK migraine charities and a lay advisory group throughout the programme. We followed NIHR standards and used the Guidance for Reporting Involvement of Patients and the Public checklist. We consulted our PPI contacts using a variety of methods depending on the phase of the study and the nature of the request. This included emails, discussions, and face-to-face contact.
PPI members contributed throughout the study in the programme development, in the grant application, ethics documentation, and trial oversight. During the feasibility study; in supporting the development of a classification interview for chronic headache by participating in a headache classification conference, assessing the relevance, and acceptability of patient-reported outcome measures by helping to analyse cognitive interview data, and testing the smartphone application making suggestions on how best to present the summary of data collected for participants. Due to PPI contribution, the content and duration of the study intervention were adapted and a Delphi study with consensus meeting developed a core outcome set for migraine studies.
Conclusions:
The involvement of the public and patients in CHESS has allowed us to shape its overall design, intervention development, and establish a core outcome set for future migraine studies. We have reflected on many learning points for the future application of PPI.
The Variables and Slow Transients Survey (VAST) on the Australian Square Kilometre Array Pathfinder (ASKAP) is designed to detect highly variable and transient radio sources on timescales from 5 s to
$\sim\!5$
yr. In this paper, we present the survey description, observation strategy and initial results from the VAST Phase I Pilot Survey. This pilot survey consists of
$\sim\!162$
h of observations conducted at a central frequency of 888 MHz between 2019 August and 2020 August, with a typical rms sensitivity of
$0.24\ \mathrm{mJy\ beam}^{-1}$
and angular resolution of
$12-20$
arcseconds. There are 113 fields, each of which was observed for 12 min integration time, with between 5 and 13 repeats, with cadences between 1 day and 8 months. The total area of the pilot survey footprint is 5 131 square degrees, covering six distinct regions of the sky. An initial search of two of these regions, totalling 1 646 square degrees, revealed 28 highly variable and/or transient sources. Seven of these are known pulsars, including the millisecond pulsar J2039–5617. Another seven are stars, four of which have no previously reported radio detection (SCR J0533–4257, LEHPM 2-783, UCAC3 89–412162 and 2MASS J22414436–6119311). Of the remaining 14 sources, two are active galactic nuclei, six are associated with galaxies and the other six have no multi-wavelength counterparts and are yet to be identified.
Recovering the agency, skill and innovation of archaeological field assistants from historical encounters is essential to interrogating processes of knowledge production, but is often hampered by access to appropriate archival sources and methods. We detail a field project from early twentieth-century Basutoland (modern-day Lesotho) that is unique both for its aim to salvage details of rock-art production as a dying craft and for its archive chronicling the project's intellectual journey from experiment to draft manuscripts to published work over more than three decades. We argue that critical historiographic attention to this archive offers a guide for examining the intimate dynamics of fieldwork and the effects of these micropolitics on the archaeological canon. We demonstrate how sustained attention to long processes of knowledge production can pinpoint multiple instances in which the usability of field assistants’ scientific knowledge is qualified, validated, or rejected, and in this case how an African assistant is transformed into an ethnographic interlocutor. For rock-art studies especially, this represents a need for interrogating the epistemic cultures—not just the content—of foundational historical data.
Morgan and Parker proved that if G is a group with
${\textbf{Z}(G)} = 1$
, then the connected components of the commuting graph of G have diameter at most
$10$
. Parker proved that if, in addition, G is solvable, then the commuting graph of G is disconnected if and only if G is a Frobenius group or a
$2$
-Frobenius group, and if the commuting graph of G is connected, then its diameter is at most
$8$
. We prove that the hypothesis
$Z (G) = 1$
in these results can be replaced with
$G' \cap {\textbf{Z}(G)} = 1$
. We also prove that if G is solvable and
$G/{\textbf{Z}(G)}$
is either a Frobenius group or a
$2$
-Frobenius group, then the commuting graph of G is disconnected.
The patient experience of radiotherapy magnetic resonance (MR) simulation is unknown. This study aims to evaluate the patient experience of MR simulation in comparison to computed tomography (CT) simulation, identifying the quality of patient experience and pathway changes which could improve patient experience outcomes.
Materials and Methods:
MR simulation was acquired for 46 anal and rectal cancer patients. Patient experience questionnaires were provided directly after MR simulation. Questionnaire responses were assessed after 33 patients (cohort one). Changes to the scanning pathway were identified and implemented. The impact of changes was assessed by cohort two (13 patients).
Results:
Response rates were 85% (cohort one) and 54% (cohort two). 75% of cohort one respondents found the magnetic resonance imaging (MRI) experience to be better or similar to their CT experience. Implemented changes included routine use of blankets, earplugs and headphones, music and feet-first positioning and further MRI protocol optimisation. All cohort two respondents found the MRI experience to be better or similar to the CT experience.
Findings:
MR simulation can be a comfortable and positive experience that is comparable to that of standard radiotherapy CT simulation. Special attention is required due to the fundamental differences between CT and MRI scanning.
A common feature in Answer Set Programming is the use of a second negation, stronger than default negation and sometimes called explicit, strong or classical negation. This explicit negation is normally used in front of atoms, rather than allowing its use as a regular operator. In this paper we consider the arbitrary combination of explicit negation with nested expressions, as those defined by Lifschitz, Tang and Turner. We extend the concept of reduct for this new syntax and then prove that it can be captured by an extension of Equilibrium Logic with this second negation. We study some properties of this variant and compare to the already known combination of Equilibrium Logic with Nelson’s strong negation.
Prehospital physicians balance the need to stabilize patients prior to transport, minimizing the delay to transport patients to the appropriate level of care. Literature has focused on which interventions should be performed in the prehospital environment, with airway management, specifically prehospital intubation (PHI), being a commonly discussed topic. However, few studies have sought additional factors which influence scene time or quantify the impact of mission characteristics or therapeutic interventions on scene time.
Hypothesis/Problem:
The goal of this study was to identify specific interventions, patient demographics, or mission characteristics that increase scene time and quantify their impact on scene time.
Methods:
A retrospective, database model-building study was performed using the prehospital mission database of South Australian Ambulance Service (SAAS; Adelaide, South Australia) MedSTAR retrieval service from January 1, 2015 through August 31, 2016. Mission variables, including patient age, weight, gender, retrieval platform, physician type, PHI, arterial line placement, central line placement, and finger thoracostomy, were assessed for predictors of scene time.
Results:
A total of 506 missions were included in this study. Average prehospital scene time was 34 (SD = 21) minutes. Four mission variables significantly increased scene time: patient age, rotary wing transport, PHI, and arterial line placement increased scene time by 0.09 (SD = 0.08) minutes, 13.6 (SD = 3.2) minutes, 11.6 (SD = 3.8) minutes, and 34.4 (SD = 8.4) minutes, respectively.
Conclusion:
This study identifies two mission characteristics, patient age and rotary wing transport, and two interventions, PHI and arterial line placement, which significantly increase scene time. Elderly patients are medically complex and more severely injured than younger patients, thus, may require more time to stabilize on-scene. Inherent in rotary wing operations is the time to prepare for the flight, which is shorter during ground transport. The time required to safely execute a PHI is similar to that in the literature and has remained constant over the past two years; arterial line placement took longer than envisioned. The SAAS MedSTAR has changed its clinical practice guidelines for prehospital interventions based on this study’s results. Retrieval services should similarly assess the necessity and efficiency of interventions to optimize scene time, knowing that the time required to safely execute an intervention may reach a minimum duration. Defining the scene time enables mission planning, team training, and audit review with the aim of improved patient care.
This study was conducted to evaluate the cost-effectiveness of sunitinib versus interferon-alfa for the treatment of advanced and/or metastatic renal cell carcinoma (RCC) in Singapore.
Methods
A partitioned survival model with three health states (progression-free, progressive disease, and death) was developed from a healthcare payer perspective over a 10-year time horizon. Survival curves from the pivotal trial of sunitinib versus interferon-alfa were extrapolated beyond the trial period to estimate the underlying progression-free survival and overall survival parametric distributions. Health state utilities were derived from the literature and direct costs were sourced from local public healthcare institutions. The sunitinib dose in the model reflected local prescribing practices whereby a combination of 50 mg (28 percent) and 37.5 mg (72 percent) strengths are used.
Results
The base-case analysis comparing sunitinib versus interferon-alfa resulted in an incremental cost effectiveness ratio (ICER) of SGD191,061 (USD139,757) per quality-adjusted life-year gained. Sensitivity analysis demonstrated that the ICER was most sensitive to variations in the utility value assumed for the progression-free health state and the price of sunitinib.
Conclusions
In the absence of any price reduction, sunitinib had an exceedingly high ICER and was not considered a cost-effective use of healthcare resources in Singapore's context for the first-line treatment of advanced RCC. The findings from our evaluation will be useful to inform local healthcare decision making and resource allocations for tyrosine kinase inhibitors when appraised alongside comparative clinical effectiveness data and payer affordability considerations.
Proglacial environments are ideal for studying the development of soils through the changes of rocks exposed by glacier retreat to weathering and microbial processes. Carbon (C) and nitrogen (N) contents as well as soil pH and soil elemental compositions are thought to be dominant factors structuring the bacterial, archaeal and fungal communities in the early stages of soil ecosystem formation. However, the functional linkages between C and N contents, soil composition and microbial community structures remain poorly understood. Here, we describe a multivariate analysis of geochemical properties and associated microbial community structures between a moraine and a glaciofluvial outwash in the proglacial area of a High Arctic glacier (Longyearbreen, Svalbard). Our results reveal distinct differences in developmental stages and heterogeneity between the moraine and the glaciofluvial outwash. We observed significant relationships between C and N contents, δ13Corg and δ15N isotopic ratios, weathering and microbial abundance and community structures. We suggest that the observed differences in microbial and geochemical parameters between the moraine and the glaciofluvial outwash are primarily a result of geomorphological variations of the proglacial terrain.
In this paper, we propose a variant of Answer Set Programming (ASP) with evaluable functions that extends their application to sets of objects, something that allows a fully logical treatment of aggregates. Formally, we start from the syntax of First Order Logic with equality and the semantics of Quantified Equilibrium Logic with evaluable functions (${\rm QEL}^=_{\cal F}$). Then, we proceed to incorporate a new kind of logical term, intensional set (a construct commonly used to denote the set of objects characterised by a given formula), and to extend ${\rm QEL}^=_{\cal F}$ semantics for this new type of expression. In our extended approach, intensional sets can be arbitrarily used as predicate or function arguments or even nested inside other intensional sets, just as regular first-order logical terms. As a result, aggregates can be naturally formed by the application of some evaluable function (count, sum, maximum, etc) to a set of objects expressed as an intensional set. This approach has several advantages. First, while other semantics for aggregates depend on some syntactic transformation (either via a reduct or a formula translation), the ${\rm QEL}^=_{\cal F}$ interpretation treats them as regular evaluable functions, providing a compositional semantics and avoiding any kind of syntactic restriction. Second, aggregates can be explicitly defined now within the logical language by the simple addition of formulas that fix their meaning in terms of multiple applications of some (commutative and associative) binary operation. For instance, we can use recursive rules to define sum in terms of integer addition. Last, but not least, we prove that the semantics we obtain for aggregates coincides with the one defined by Gelfond and Zhang for the ${\cal A}\mathit{log}$ language, when we restrict to that syntactic fragment.
Current understanding of climate change impacts, adaptation and vulnerability among Inuit in the Arctic is relatively static, rooted in the community and time that case studies were conducted. This paper captures the dynamism of Inuit–climate relationships by applying a longitudinal approach to assessing vulnerability to climate change among Inuit in Ulukhaktok, Northwest Territories, Canada. Data were collected in 2005 and 2016 following a consistent methodology and analytical framework. Findings from the studies are analysed comparatively together with longitudinal datasets. The data reveal that many of the climatic changes recorded in 2005 that adversely affected hunting activities have been observed to be persisting or progressing, such as decreasing sea ice thickness and extent, and stronger and more consistent summer winds. Inuit are responding by altering travel routes and equipment, taking greater pre-trip precautions, and concentrating their efforts on more efficient and accessible hunts. Increasing living and subsistence costs and time-constraints, changes in the generation and transmission of environmental knowledge and land skills, and the concentration of country food sharing networks were identified as key constraints to adaptation. The findings indicate that the connections between subsistence activities and the wage economy are central to understanding how Inuit experience and respond to climate change.
Rock art worldwide has proved extremely difficult to date directly. Here, the first radiocarbon dates for rock paintings in Botswana and Lesotho are presented, along with additional dates for Later Stone Age rock art in South Africa. The samples selected for dating were identified as carbon-blacks from short-lived organic materials, meaning that the sampled pigments and the paintings that they were used to produce must be of similar age. The results reveal that southern African hunter-gatherers were creating paintings on rockshelter walls as long ago as 5723–4420 cal BP in south-eastern Botswana: the oldest such evidence yet found in southern Africa.
The Numeniini is a tribe of 13 wader species (Scolopacidae, Charadriiformes) of which seven are Near Threatened or globally threatened, including two Critically Endangered. To help inform conservation management and policy responses, we present the results of an expert assessment of the threats that members of this taxonomic group face across migratory flyways. Most threats are increasing in intensity, particularly in non-breeding areas, where habitat loss resulting from residential and commercial development, aquaculture, mining, transport, disturbance, problematic invasive species, pollution and climate change were regarded as having the greatest detrimental impact. Fewer threats (mining, disturbance, problematic native species and climate change) were identified as widely affecting breeding areas. Numeniini populations face the greatest number of non-breeding threats in the East Asian-Australasian Flyway, especially those associated with coastal reclamation; related threats were also identified across the Central and Atlantic Americas, and East Atlantic flyways. Threats on the breeding grounds were greatest in Central and Atlantic Americas, East Atlantic and West Asian flyways. Three priority actions were associated with monitoring and research: to monitor breeding population trends (which for species breeding in remote areas may best be achieved through surveys at key non-breeding sites), to deploy tracking technologies to identify migratory connectivity, and to monitor land-cover change across breeding and non-breeding areas. Two priority actions were focused on conservation and policy responses: to identify and effectively protect key non-breeding sites across all flyways (particularly in the East Asian- Australasian Flyway), and to implement successful conservation interventions at a sufficient scale across human-dominated landscapes for species’ recovery to be achieved. If implemented urgently, these measures in combination have the potential to alter the current population declines of many Numeniini species and provide a template for the conservation of other groups of threatened species.
Democratic therapeutic community (DTC) treatment has been used for many years in an effort to help people with personality disorder. High-quality evidence from randomised controlled trials (RCTs) is absent.
Aims
To test whether DTC treatment reduces use of in-patient services and improves the mental health of people with personality disorder.
Method
An RCT of 70 people meeting DSM-IV criteria for personality disorder (trial registration: ISRCTN57363317). The intervention was DTC and the control condition was crisis planning plus treatment as usual (TAU). The primary outcome was days of in-patient psychiatric treatment. Secondary outcomes were social function, mental health status, self-harm and aggression, attendance at emergency departments and primary care, and satisfaction with care. All outcomes were measured at 12 and 24 months after randomisation.
Results
Number of in-patient days at follow-up was low among all participants and there was no difference between groups. At 24 months, self- and other directed aggression and satisfaction with care were significantly improved in the DTC compared with the TAU group.
Conclusions
DTC is more effective than TAU in improving outcomes in personality disorder. Further studies are required to confirm this conclusion.
The Kulshan caldera formed at ∼1.15 Ma on the present-day site of Mt. Baker, Washington State, northwest USA and erupted a compositionally zoned (dacite-rhyolite) magma and a correlative eruptive, the Lake Tapps tephra. This tephra has previously been described, but only from the Puget Lowland of NW Washington. Here an occurrence of a Kulshan caldera correlative tephra is described from the Quaternary Palouse loess at the Washtucna site (WA-3). Site WA-3 is located in east-central Washington, ∼340 km southeast of the Kulshan caldera and ∼300 km east-southeast of the Lake Tapps occurrence in the Puget Lowland. Major- and trace element chemistry and location of the deposit at Washtucna within reversed polarity sediments indicates that it is not correlative with the Mesa Falls, Rockland, Bishop Ash, Lava Creek B or Huckleberry Ridge tephras. Instead the Washtucna deposit is related to the Lake Tapps tephra by fractional crystallisation, but is chemically distinct, a consequence of its eruption from a compositionally zoned magma chamber. The correlation of the Washtucna occurrence to the Kulshan caldera-forming eruption indicates that it had an eruptive volume exceeding 100 km3, and that its tephra could provide a valuable early-Pleistocene chronostratigraphic marker in the Pacific Northwest.
There is a well-developed view of artifacts according to which their nature depends on the intentions of their authors or creators. However, in the modern world of artifact design and creation, typically not one but many agents are involved in the process of making an artifact. In this paper, I show how the intentional view can be maintained even for ‘collective’ artifacts having multiple authors. My approach is to combine some basic concepts that have been proposed in the study of collective intentionality with a suitable model of artifact creation that takes account of the multiple agents and processes that arise in design, engineering and manufacturing a new or existing product. In this way, we can explain how an artifactual kind can be understood via a form of collective intentionality. For the design sciences, notions such as we-intentionality and group agency can help to model different types of cooperation and, in particular, to reconcile individualism with strong forms of collectivity at a group level.