Tackling disinvestment in health care services. The views of resource allocators in the English NHS.

PURPOSE: The aims of this paper are to explore the experiences of budget holders within the English National Health Service (NHS), in their attempts to implement programmes of disinvestment, and to consider factors which influence the success (or otherwise) of this activity. DESIGN/METHODOLOGY/APPROACH: Between 24 January and 15 March 2011 semi-structured, telephone interviews were conducted with representatives of 12 Primary Care Trusts in England. Interviews focussed on: understanding of the term "disinvestment"; current activities, and perceived determinants of successful disinvestment decision making and implementation. Data were organised into themes according to standard qualitative data coding practices. FINDINGS: Findings indicate that experiences of disinvestment are varied and that organisations are currently adopting a range of approaches. There are a number of apparently influential determinants of disinvestment which relate to both health system features and organisational characteristics. According to the experiences of the interviewees, many of the easier disinvestment options have now been taken and more ambitious plans, which require wider engagement and more thorough project management, will be required in the future. RESEARCH LIMITATIONS/IMPLICATIONS: Findings from the research suggest that issues around understanding and usage of disinvestment terminology should be addressed and that a more in-depth and ethnographic research agenda will be of most value in moving forward both the theory and practice of disinvestment. ORIGINALITY/VALUE: This research suggests that, in the English NHS at least, there is a disjuncture between common usage of the term "disinvestment" and the way that it has previously been understood by the wider research community. In addition to this, the research also highlights a broader range of potential determinants of disinvestment than are considered in the extant literature.

Four shareworthy SEPR scenario ideas.

In this communication article, we share our scenario ideas at the request of the journal editor. These are (1) a scenario for building sustainable suburbs; (2) a counterfactual scenario for coping with the super wicked COVID problem; (3) envisioning alternative futures of cultural ecosystem services supplies in Southwestern Ghana; and (4) a path toward writing successful scenarios. The ideas will be fully developed in due course into scholarly articles for the journal.

Involving citizens in disinvestment decisions: what do health professionals think? Findings from a multi-method study in the English NHS.

Public involvement in disinvestment decision making in health care is widely advocated, and in some cases legally mandated. However, attempts to involve the public in other areas of health policy have been accused of tokenism and manipulation. This paper presents research into the views of local health care leaders in the English National Health Service (NHS) with regards to the involvement of citizens and local communities in disinvestment decision making. The research includes a Q study and follow-up interviews with a sample of health care clinicians and managers in senior roles in the English NHS. It finds that whilst initial responses suggest high levels of support for public involvement, further probing of attitudes and experiences shows higher levels of ambivalence and risk aversion and a far more cautious overall stance. This study has implications for the future of disinvestment activities and public involvement in health care systems faced with increased resource constraint. Recommendations are made for future research and practice.

Identification and characterization of 4-aryl-3,4-dihydropyrimidin-2(1H)-ones as inhibitors of the fatty acid transporter FATP4.

Several potent, cell permeable 4-aryl-dihydropyrimidinones have been identified as inhibitors of FATP4. Lipophilic ester substituents at the 5-position and substitution at the para-position (optimal groups being -NO(2) and CF(3)) of the 4-aryl group led to active compounds. In two cases racemates were resolved and the S enantiomers shown to have higher potencies.

Identification of aminopiperidine benzamides as MCHr1 antagonists.

The identification of a novel series of benzamide-containing MCHr1 antagonists is described. Compound 22 displayed moderate efficacy in a diet induced obesity mice model.

Targeted deletion of fatty acid transport protein-4 results in early embryonic lethality.

Fatty acid transport protein-4 (FATP4) is the major FATP in the small intestine. We previously demonstrated, using in vitro antisense experiments, that FATP4 is required for fatty acid uptake into intestinal epithelial cells. To further examine the physiological role of FATP4, mice carrying a targeted deletion of FATP4 were generated. Deletion of one allele of FATP4 resulted in 48% reduction of FATP4 protein levels and a 40% reduction of fatty acid uptake by isolated enterocytes. However, loss of one FATP4 allele did not cause any detectable effects on fat absorption on either a normal or a high fat diet. Deletion of both FATP4 alleles resulted in embryonic lethality as crosses between heterozygous FATP4 parents resulted in no homozygous offspring; furthermore, no homozygous embryos were detected as early as day 9.5 of gestation. Early embryonic lethality has been observed with deletion of other genes involved in lipid absorption in the small intestine, namely microsomal triglyceride transfer protein and apolipoprotein B, and has been attributed to a requirement for fat absorption early in embryonic development across the visceral endoderm. In mice, the extraembryonic endoderm supplies nutrients to the embryo prior to development of a chorioallantoic placenta. In wild-type mice we found that FATP4 protein is highly expressed by the epithelial cells of the visceral endoderm and localized to the brush-border membrane of extraembryonic endodermal cells. This localization is consistent with a role for FATP4 in fat absorption in early embryogenesis and suggests a novel requirement for FATP4 function during development.