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Objectives We report on the experiences of peer support facilitators and study nurses who participated in a large trial of peer support for type 2 diabetes. The support was led by volunteer peer support facilitators, who were trained in overcoming barriers to diabetes care, motivational interviewing, listening skills and setting up and running group support sessions. There is currently a distinct lack of qualitative evidence on what works in peer support. Methods The peer support facilitators and study nurses completed open-answer questionnaire items on what worked well and less well, problems encountered and how they were resolved, group dynamics and suggestions for improvement. We also collected data from end-of-study meetings. Inductive thematic analysis was used to allow the emergent themes to be strongly based in the data. Findings: We find that process factors, peer support facilitator and peer characteristics, their relationships with each other and group dynamics are all fundamental for effective peer support. Sustaining and ending support also emerged as a key theme. Discussion Given the increasing interest in peer support, these findings will be useful to those interested in running groups in the future. Training programmes should help peer support facilitators develop confidence whilst emphasising that peer support ideally entails an equal, democratic dynamic. More attention is needed on to how to end groups appropriately.

Background The concept of “intersectionality” is increasingly employed within public health arenas, particularly in North America, and is often heralded as offering great potential to advance health inequalities research and action. Given persistently poor progress towards tackling health inequalities, and recent calls to reframe this agenda in the United Kingdom and Europe, the possible contribution of intersectionality deserves attention. Yet, no existing research has examined professional stakeholder understandings and perspectives on applying intersectionality to this field. Methods In this paper we seek to address that gap, drawing upon a consultation survey and face-to-face workshop (n = 23) undertaken in the United Kingdom. The survey included both researchers (n = 53) and policy and practice professionals (n = 20) with varied roles and levels of engagement in research and evaluation. Topics included familiarity with the term and concept “intersectionality”, relevance to health inequalities work, and issues shaping its uptake. Respondents were also asked to comment on two specific policy suggestions: intersectionally targeting and tailoring interventions, and evaluating the intersectional effects of policies. The workshop aims were to share examples of applying intersectionality within health inequalities research and practice; understand the views of research and practice colleagues on potential contributions and challenges; and identify potential ways to promote intersectional approaches. Results Findings indicated a generally positive response to the concept and a cautiously optimistic assessment that intersectional approaches could be valuable. However, opinions were mixed and various challenges were raised, especially around whether intersectionality research is necessarily critical and transformative and, accordingly, how it should be operationalized methodologically. Nonetheless, there was general agreement that intersectionality is concerned with diverse inequalities and the systems of power that shape them. Conclusions We position intersectionality within the wider context of health inequalities policy and practice, suggesting potential ways forward for the approach in the context of the United Kingdom. The views of policy and practice professionals suggest that intersectionality has far to travel to help counter individualistic narratives and to encourage an approach that is sensitive to subgroup inequalities and the processes that generate them. Examples of promising practice, albeit mostly in North America, suggest that it is possible for intersectionality to gain traction.

Abstract. Multilevel models have recently been used to empirically investigate the idea that social characteristics are intersectional such as age, sex, ethnicity, and socioeconomic position interact with each other to drive outcomes. Some argue this approach solves the multiple-testing problem found in standard dummy-variable (fixed-effects) regression, because intersectional effects are automatically shrunk toward their mean. The hope is intersections appearing statistically significant by chance in a fixed-effects regression will not appear so in a multilevel model. However, this requires assumptions that are likely to be broken. We use simulations to show the effect of breaking these assumptions: when there are true main effects/interactions, unmodeled in the fixed part of the model. We show, while the multilevel approach outperforms the fixed-effects approach, shrinkage is less than is desired, and some intersectional effects are likely to appear erroneously statistically significant by chance. We conclude with advice to make this promising method work robustly.

ObjectivesPrevious research has shown that poor physical and mental health are important risk factors for early work exit. We examined potential differences in this association in older workers (50+) across educational levels.MethodsCoordinated analyses were carried out in longitudinal data sets from four European countries: the Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Ageing), England (English Longitudinal Study of Ageing) and Germany (German Ageing Survey). The effect of poor self-rated health (SRH), functional limitations and depression on different types of early work exit (early retirement, economic inactivity, disability and unemployment) was examined using Cox regression analysis. We examined educational differences in these effects by testing interaction terms.ResultsPoor physical and mental health were more common among the lower educated. Poor SRH, functional limitations, and depression were all associated with a higher risk of early work exit. These health effects were strongest for the disability exit routes (poor SRH: HRs 5.77 to 8.14; functional limitations: HRs 6.65 to 10.42; depression: HRs 3.30 to 5.56). In the Netherlands (functional limitations) and England (functional limitations and SRH), effects were stronger in the lower educated.ConclusionsThe prevalence of health problems, that is, poor SRH, functional limitations and depression, was higher in the lower educated workers. All three health indicators increase the risk of early work exit. In some countries, health effects on early exit were stronger in the lower educated. Thus, lower educated older workers are an important target group for health policy and intervention.

Chronic diseases and their inequalities amongst older adults are a significant public health challenge. Prevention and treatment of chronic diseases will benefit from insight into which population groups show greatest risk. Biomarkers are indicators of the biological mechanisms underlying health and disease. We analysed disparities in a common set of biomarkers at the population level using English national data (n = 16,437). Blood-based biomarkers were HbA1c, total cholesterol and C-reactive protein. Non-blood biomarkers were systolic blood pressure, resting heart rate and body mass index. We employed an intersectionality perspective which is concerned with how socioeconomic, gender and ethnic disparities combine to lead to varied health outcomes. We find granular intersectional disparities, which vary by biomarker, with total cholesterol and HbA1c showing the greatest intersectional variation. These disparities were additive rather than multiplicative. Each intersectional subgroup has its own profile of biomarkers. Whilst the majority of variation in biomarkers is at the individual rather than intersectional level (i.e. intersections exhibit high heterogeneity), the average differences are potentially associated with important clinical outcomes. An intersectional perspective helps to shed light on how socio-demographic factors combine to result in differential risk for disease or potential for healthy ageing.

The UK health system must take urgent action to better understand and meet the health needs of migrants and ethnic minority people, say Sarah Salway and colleagues

Since the early 1990s, the European service sector has been growing and employment in this sector has risen. Within the service sector the Health and Care Sector (HCS) plays a dominant role – as part of the social protection system but also in economic terms. Against this background, the HCS has particular relevance: it is not only the ageing of society that is responsible for a rising demand of care workers, but also changing family and household structures as more persons are living alone and depend on professional or informal care (Schulz & Radvanský 2014: Schulmann, Reichert & Leichsenring 2019).

Aims\ud \ud Cerebrovascular disease is one of more typical reasons for hospitalisation and re-hospitalisation in people with type 2 diabetes. We aimed to derive and externally validate two risk prediction algorithms for cerebrovascular hospitalisation and re-hospitalisation.\ud \ud \ud \ud Methods\ud \ud Two independent cohorts were used to derive and externally validate the two risk scores. The development cohort comprises 4704 patients with type 2 diabetes registered in 18 general practices across Cambridgeshire. The validation cohort includes 1121 type 2 patients from a post-trial cohort data. Outcomes were cerebrovascular hospitalisation within two years and cerebrovascular re-hospitalisation within ninety days of the previous cerebrovascular hospitalisation. Logistic regression was applied to derive the two risk scores for cerebrovascular hospitalisation and re-hospitalisation from development cohort, which were externally validated in the validation cohort.\ud \ud \ud \ud Results\ud \ud The incidence of cerebrovascular hospitalisation and re-hospitalisation was 3.76% and 1.46% in the development cohort, and 4.99% and 1.87% in the external validation cohort. Age, gender, body mass index, blood pressures, and lipid profiles were included in the final model. Model discrimination was similar in both cohorts, with all C-statistics > 0.70, and very good calibration of observed and predicted individual risks.\ud \ud \ud \ud Conclusion\ud \ud Two new risk scores that quantify individual risks of cerebrovascular hospitalisation and re-hospitalisation have been well derived and externally validated. Both scores are on the basis of a few of clinical measurements that are commonly available for patients with type 2 diabetes in primary care settings and could work as tools to identify individuals at high risk of cerebrovascular hospitalisation and re-hospitalisation.

Social quality focusses on the nature of 'the social', arguing that people are realised as social beings through interacting with a range of collectives, both from the formal world of systems and the informal lifeworld. Four conditional factors are necessary for this to occur, which at the same time are assumed to influence health and well-being: socio-economic security, social cohesion, social inclusion and social empowerment. In this paper we test the utility of social quality in explaining self-rated health as a response to arguments that the social determinants of health (SDH) framework often lacks a theoretical basis. We use multilevel models to analyse national English and Welsh data (the Citizenship Survey) to test for both individual- and neighbour-level affects. Our key findings are that (1) neighbourhood contextual (cross-level) effects are present with respect to collective action, personal trust, cross-cutting ties, income sufficiency, and income security; (2) measures of national, community and personal identity as indicators of social cohesion show clear associations with health alongside more common measures such as trust; (3) the security aspects of socioeconomic determinants are especially important (housing security, income sufficiency, and income security); (4) social rights, including institutional rights but especially civil rights have effects of particularly large magnitude. Social quality offers a theoretically-driven perspective on the SDH which has important policy implications and suggests a number of promising avenues for future research.

BackgroundEducational inequalities in health have been widely reported. A low educational level is associated with more adverse working conditions. Working conditions, in turn, are associated with health and there is evidence that this association remains after work exit. Because many countries are raising the statutory retirement age, lower educated workers have to spend more years working under adverse conditions. Therefore, educational health inequalities may increase in the future. This study examined (1) whether there were educational differences over time in health after work exit and (2) whether work characteristics mediate these educational inequalities in health.MethodsData from five prospective cohort studies were used: The Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Aging), England (English Longitudinal Study of Ageing), Germany (German Aging Study), and Finland (Finnish Longitudinal Study on Municipal Employees). In each dataset we used Generalized Estimating Equations to examine the relationship between education and self-rated health after work exit with a maximum follow-up of 15 years and possible mediation of work characteristics, including physical demands, psychosocial demands, autonomy, and variation in activities.ResultsThe low educated reported significantly poorer health after work exit than the higher educated. Lower educated workers had a higher risk of high physical demands and a lower risk of high psychosocial demands, high variation in tasks, and high autonomy at work, compared to higher educated workers. These work characteristics were found to be mediators of the relationship between education and health after work exit, consistent across countries.ConclusionEducational inequalities in health are still present after work exit. If workers are to spend an extended part of their lives at work due to an increase in the statutory retirement age, these health inequalities may increase. Improving working conditions will likely reduce these inequalities in health.

Background The health and social care sector (HCS) is currently facing multiple challenges across Europe: against the background of ageing societies, more people are in need of care. Simultaneously, several countries report a lack of skilled personnel. Due to its structural characteristics, including a high share of part-time workers, an ageing workforce, and challenging working conditions, the HCS requires measures and strategies to deal with these challenges. Methods This qualitative study analyses if and how organisations in three countries (Germany, Finland, and the UK) report similar challenges and how they support longer working careers in the HCS. Therefore, we conducted multiple case studies in care organisations. Altogether 54 semi-structured interviews with employees and representatives of management were carried out and analysed thematically. Results Analysis of the interviews revealed that there are similar challenges reported across the countries. Multiple organisational measures and strategies to improve the work ability and working life participation of (ageing) workers were identified. We identified similar challenges across our cases but different strategies in responding to them. With respect to the organisational measures, our results showed that the studied organisations did not implement any age-specific management strategies but realised different reactive and proactive human relation measures aiming at maintaining and improving employees’ work ability (i.e., health, competence and motivation) and longer working careers. Conclusions Organisations within the HCS tend to focus on the recruitment of younger workers and/or migrant workers to address the current lack of skilled personnel. The idea of explicitly focusing on ageing workers and the concept of age management as a possible solution seems to lack awareness and/or popularity among organisations in the sector. The concept of age management offers a broad range of measures, which could be beneficial for both, employees and employers/organisations. Employees could benefit from a better occupational well-being and more meaningful careers, while employers could benefit from more committed employees with enhanced productivity, work ability and possibly a longer career.

While the nature of gambling practices is contested, a strong evidence\ud base demonstrates that gambling can become a serious disorder and have\ud a range of detrimental effects for individuals, communities and societies.\ud Over the last decade, football in the UK has become visibly entwined with\ud gambling marketing. To explore this apparent trend, we tracked shirt\ud sponsors in both the English and Scottish Premier Leagues since 1992 and\ud found a pronounced increase in the presence of sponsorship by gambling\ud companies. This increase occurred at the same time the Gambling Act 2005,\ud which liberalized rules, was introduced. We argue that current levels of\ud gambling sponsorship in UK football, and the global visibility it provides to\ud gambling brands, is a public health concern that needs to be debated and\ud addressed. We recommend that legislators revisit the relationship between\ud football in the UK and the sponsorship it receives from the gambling industry.

Objectives People with type 2 diabetes and increased systolic blood pressure (SBP) are at high risk of cardiovascular disease (CVD). In this study, we aimed to investigate the association between CVD-related hospital payments and SBP and tested whether this association is influenced by diabetes peer support. Methods Two cohorts comprising people with type 2 diabetes were included in the study. The first cohort comprised 4,704 patients with type 2 diabetes assessed between 2008 and 2009 from 18 general practices in Cambridgeshire and followed up to 2009–2011. The second cohort comprised 1,121 patients with type 2 diabetes from post-trial follow-up data, recruited between 2011 and 2012 and followed up to 2015. SBP was measured at baseline. Inpatient payments for CVD hospitalization within 2 years since baseline was the main outcome. The impact of 1:1, group or combined diabetes peer support and usual care were investigated in the second cohort. Adjusted mean CVD inpatient payments per person were estimated using a 2-part model after adjusting for baseline characteristics. Results A “hockey-stick” relationship between baseline SBP and estimated CVD inpatient payment was identified in both cohorts, with a threshold at 133 to 141 mmHg, suggesting increased payments for patients with SBP below and above the threshold. The combined peer-support intervention altered the aforementioned association, with no increased payment with SBP above the threshold, and payment slightly decreased with SBP beyond the threshold. Conclusions SBP maintained between 133 and 141 mmHg is associated with the lowest CVD disease management costs for patients with type 2 diabetes. Combined peer-support intervention could significantly decrease CVD-related hospital payments.

This study examined whether the association between work characteristics and health remains after work exit and whether individual factors mediate this association. Longitudinal datasets from three countries were used: Netherlands (LASA), Denmark (DLSA) and England (ELSA). The association between pre-retirement work characteristics (physical demands, psychosocial demands, variation in activities and autonomy) and post-retirement self-rated health (SRH) was examined longitudinally, including individual factors (physical activity, smoking, alcohol use, BMI and depressive symptoms) as possible mediators. Work characteristics were neither associated with post-retirement health nor with individual factors. Among the individual factors, higher physical activity and higher alcohol use were associated with better post-retirement SRH, and a higher BMI and more depressive symptoms, to poorer post-retirement SRH. These associations were found in both low and high SEP. Targeting work characteristics will not likely reduce social inequalities in post-retirement health. Improving individual factors will benefit the health of all.

ObjectivesIncreasing life expectancy has led governments to implement reforms aimed at delaying retirement. Chronic conditions are an important barrier to this given their association with pain, functional limitations, depression and ultimately lower life expectancy. Chronic diseases are gendered in terms of these characteristics, as well as their population prevalence. I examined the extent to which gender moderates the extent to which different chronic conditions lead to disability employment exit, the proportion of exits they account for and key mediators in this process.MethodsData from waves 1 to 8 of the English Longitudinal Study of Ageing were analysed. I followed employees aged 50–70 years until they experienced disability employment exit, or were censored. I analysed the influence of chronic conditions, functional limitations, pain, depressive symptoms and subjective life expectancy using discrete time survival analysis. All analyses were carried out separately by gender if a significant interaction was found. The mediation analysis was carried out using the Karlson/Holm/Breen method.ResultsNo significant gender interactions were found for the risk of chronic conditions on disability employment exit. Lung disease (OR 4.1; 95% CI 2.8 to 5.9), cancer (OR 2.9; 95% CI 2.1 to 4.0) and arthritis (OR 2.6; 95% CI 2.1 to 3.3) were the strongest determinants. Depressive symptoms (OR 3.2; 95% CI 2.5 to 4.1) were also a strong determinant, and along with arthritis, explained a greater proportion of women than men’s exits given differences in prevalence. Pain and various types of functional limitations were important mediators of exit as well as determinants in their own right.ConclusionThe results suggest that gender differences in the prevalence of different chronic conditions result in differences in the proportion of disability employment exits they account for in the population. Targeted and tailored interventions, for example, in the workplace might take this into account.

Total cholesterol to high density lipoprotein cholesterol ratio (TC/HDL) is an important prognostic factor for cardiovascular disease (CVD). This study used restricted cubic spline modelling to investigate the dose-response associations between TC/HDL and both CVD hospitalisation and CVD re-hospitalisation in two independent prospective cohorts. The East Cambridgeshire and Fenland (ECF) cohort includes 4,704 patients with type 2 diabetes from 18 general practices in Cambridgeshire. The RAndomised controlled trial of Peer Support In type 2 Diabetes (RAPSID) cohort comprises 1,121 patients with type 2 diabetes with post-trial follow-up data. TC/HDL and other demographic and clinical measurements were measured at baseline. Outcomes were CVD hospitalisation over 2 years, and CVD re-hospitalisation after 90 days of the prior CVD hospitalisation. Modelling showed nonlinear relationships between TC/HDL and risks of CVD hospitalisation and re-hospitalisation consistently in both cohorts (all P < 0.001 for linear tests). The lowest risks of CVD hospitalisation and re-hospitalisation were consistently found for TC/HDL at 2.8 (95% confidence interval: 2.6 to 3.0) in both cohorts and both overall and by gender. This is lower than the current lipid control target, 4.0 of TC/HDL. Reducing the TC/HDL target to 2.8 would include a further 33-44% patients with TC/HDL in the 2.8-4.0 range. Studies are required to assess the effectiveness and cost effectiveness of the earlier introduction of, and more intensive, lipid lowering treatment needed to achieve this new lower TC/HDL target.

As a response to the ageing population, the United Kingdom (UK) government, like many others, has increased the State Pension Age. This has involved equalising women's State Pension Age with men's, raising it from 60 to 65, with further increases already underway. It has been argued that a key issue with how this change has been implemented is the lack of notice the government gave to the women affected, impacting on their ability to plan for retirement. So far, there has been very little research exploring inequalities in awareness of these developments and, in particular, considering whether women of particular socio-economic backgrounds are less likely to know about the changes. This has implications for potentially further widening inequalities in old age. In this paper we analyse data from the English Longitudinal Study of Ageing. We consider the role of cognitive ability in mediating the relationship between socio-economic background and awareness, given recent debates on deficiencies in financial literacy. We find that socio-economic inequalities exist, especially with respect to labour force status, occupation and education. We also find that cognitive ability, especially numeracy, mediates a sizeable proportion of the relationship. These findings have important implications in terms of implementing future policy changes and awareness campaigns to help mitigate the possibility that they will further entrench inequalities in older age.

Aim\ud \ud To investigate the impact of a low‐cost diabetes peer‐support intervention, aimed at reducing inpatient and outpatient care utilization and healthcare payments, by conducting a cohort study that followed up a randomized controlled trial.\ud \ud \ud \ud Methods\ud \ud A total of 1121 adults with Type 2 diabetes were recruited through general practices in Cambridgeshire and Hertfordshire, UK, and were followed up for 3.25 financial years after 8–12 months of one‐to‐one, group or combined diabetes peer support and usual care. Use of, and payments for inpatient and outpatient services were fully recorded in the follow‐up. Adjusted mean inpatient and outpatient payments per person were estimated using a two‐part model after adjusting for baseline characteristics.\ud \ud \ud \ud Results\ud \ud The mean age of the recruited adults was 65.6±11.4 years, 60.4% were male, and 16.8% were insulin‐treated. Compared with the control group, less healthcare utilization (especially non‐elective inpatient care and outpatient consultations) was observed in each of the intervention groups, particularly the combined intervention group. Over the course of 3.25 financial years, significant reductions of 41% (£909.20 per head) were observed for overall inpatient payments (P

Do people change their cultural preferences in social interactions where social class is particularly salient? It remains unclear whether cultural preferences vary across interactions or whether they are stable over time. We argue that individuals may alter their cultural preferences over time and that this will be influenced by both the specifics of a particular social interaction and the ‘cultural politics of class’ in which that interaction is embedded. Using a lab-based split-ballot experiment in a research university in the East of England (n = 300), we examine preferences towards music genres depending on whether respondents are assigned to one of three experimental conditions: (1) a vignette describing someone who is working class, (2) a vignette describing someone who is middle class or (3) no vignette. Those born in the UK alter the strength of their preferences towards highbrow music genres when social class is made more salient. When the salience of class is increased it also activates particular cultural stereotypes and these stereotypes influence the strength of respondents’ preferences towards highbrow music genres. This mechanism suggests that individuals use cultural stereotypes in social interaction to position themselves and others in the social hierarchy through cultural preferences.

In recent years, health behaviour interventions have received a great deal of attention in both research and policy as a means of encouraging people to lead healthier lives. The emphasis of such interventions has varied over time, in terms of level of intervention (e.g. individual vs community) and drawing on different disciplinary perspectives. Recently, a number of critiques have focused on how health behaviour interventions sometimes sideline issues of social context, framing health as a matter of individual choice and, by implication, a personal responsibility. Part of this criticism is that health behaviour interventions often do not draw on alternative social science understandings of the structured and contextual aspects of behaviour and health. Yet to our knowledge, no study has attempted to empirically assess the extent to which, and in what ways, the health behaviour intervention field has paid attention to social context. In this article, we undertake this task using bibliometric techniques in order to map out the health behaviour intervention field. We find that the number of health behaviour interventions has grown rapidly in recent years, especially since around 2006, and that references to social science disciplines and concepts that foreground issues of social context are rare and, relatively speaking, constitute less of the field post 2006. More quantifiable concepts are used most, and those more close to the complexities of social context are mentioned least. The document co-citation analysis suggests that pre 2006, documents referring to social context were relatively diffuse in the network of key citations, but post 2006 this influence had largely diminished. The journal co-citation analysis shows less disciplinary overlap post 2006. At present, health behaviour interventions are continuing to focus on individualised approaches drawn from behavioural psychology and behavioural economics. Our findings lend empirical support to a number of recent papers that suggest more interdisciplinary collaboration is needed to advance the field.

The relationship between social class and mental illness stigma has received little attention in recent years. At the same time, the concept of mental health literacy has become an increasingly popular way of framing knowledge and understanding of mental health issues. British Social Attitudes survey data present an opportunity to unpack the relationships between these concepts and social class, an important task given continuing mental health inequalities. Regression analyses were undertaken which centred on depression and schizophrenia vignettes, with an asthma vignette used for comparison. The National Statistics Socio-economic Classification, education and income were used as indicators of class. A number of interesting findings emerged. Overall, class variables showed a stronger relationship with mental health literacy than stigma. The relationship was gendered such that women with higher levels of education, especially those with a degree, had the lowest levels of stigma and highest levels of mental health literacy. Interestingly, class showed more of an association with stigma for the asthma vignette than it did for both the depression and schizophrenia vignettes, suggesting that mental illness stigma needs to be contextualised alongside physical illness stigma. Education emerged as the key indicator of class, followed by the National Statistics Socio-economic Classification, with income effects being marginal. These findings have implications for targeting health promotion campaigns and increasing service use in order to reduce mental health inequalities.

Summary Accurate estimates of daily crop evapotranspiration (ET) are needed for efficient irrigation management, especially in arid and semi-arid regions where crop water demand exceeds rainfall. Daily grass or alfalfa reference ET values and crop coefficients are widely used to estimate crop water demand. Inaccurate reference ET estimates can hence have a tremendous impact on irrigation costs and the demands on U.S. freshwater resources, particularly within the Ogallala aquifer region. ET networks calculate reference ET using local meteorological data. With gaps in spatial coverage of existing networks and the agriculture-based Texas High Plains ET (TXHPET) network in jeopardy due to lack of funding, there is an immediate need for alternative sources capable of filling data gaps without high maintenance and field-based support costs. Non-agricultural weather stations located throughout the Texas High Plains are providing publicly accessible meteorological data. However, there are concerns that the data may not be suitable for estimating reference ET due to factors such as weather station siting, fetch requirements, data formats, parameters recorded, and quality control issues. The goal of the research reported in this paper is to assess the use of alternative data sources for reference ET computation. Towards this objective, we trained Gaussian process models, an instance of kernel-based machine learning algorithms, on data collected from weather stations to estimate reference ET values and augment the TXHPET database. Results show that Gaussian process models provide much greater accuracy than baseline least square regression models.

A number of connectionist models (inspired by biological neural networks) have been designed to simulate human data in bilingual word reading tasks. These models have in common a reliance on neuron-like nodes that are connected by a distributed pattern of synapse-like connections. When some nodes become active due to linguistic input, this activation pattern spreads throughout the network and eventually activates other nodes that correspond to word recognition states and/or motor responses. Various models differ with one another on certain architectural details. Some models use localist representations, where a single node represents each word, while others use distributed representations, where each word is represented by a pattern of activation across many nodes. Some models focus on how the connection strengths are developed via a learning algorithm, while others focus more on real-time processing dynamics. By fitting existing human data, and then making explicit predictions for future experiments, these different models steadily advance our understanding of how bilinguals comprehend written words.

Approximately US $1.3 billion is spent each year on insecticide applications in major row crops. Despite this significant economic importance, there are currently no widely established decision-support tools available to assess suitability of spray application conditions or of the predicted quality or performance of a given commercial insecticide applications. We conducted a field study, involving 14 commercial spray applications with either fixed wing airplane (N=8) or ground rig (N=6), and we used environmental variables as regression fits to obtained spray deposition (coverage in percentage). We showed that (1) ground rig applications provided higher spray deposition than aerial applications, (2) spray deposition was lowest in the bottom portion of the canopy, (3) increase in plant height reduced spray deposition, (4) wind speed increased spray deposition, and (5) higher ambient temperatures and dew point increased spray deposition. Potato psyllid, Bactericera cockerelli (Sulc) (Hemiptera: Triozidae), mortality increased asymptotically to approximately 60% in response to abamectin spray depositions exceeding around 20%, whereas mortality of psyllid adults reached an asymptotic response approximately 40% when lambda-cyhalothrin/thiamethoxam spray deposition exceeded 30%. A spray deposition support tool was developed (http://pilcc.tamu.edu/) that may be used to make decisions regarding (1) when is the best time of day to conduct spray applications and (2) selecting which insecticide to spray based on expected spray deposition. The main conclusion from this analysis is that optimization of insecticide spray deposition should be considered a fundamental pillar of successful integrated pest management programs to increase efficiency of sprays (and therefore reduce production costs) and to reduce risk of resistance development in target pest populations.

It is widely recognized that image-based remote sensing can provide spatially and temporally distributed information on soil and crop characteristics including tillage and evapotranspiration (ET) from plot to regional scales. ET is an important component of the water balance and the major consumptive use of irrigation water and precipitation on cropland. Numerous ET models have been developed in the last three decades to make use of visible, near‐infrared (NIR), shortwave infrared (SWIR), and most importantly, thermal data acquired by sensors on airborne and satellite platforms. However, there are numerous challenges related to spatial and temporal resolutions of remotely sensed data. These include the need for a comprehensive database for model development, enhancement, and testing; availability of cloud-free images; high quality weather data; accurate estimation and partitioning of evaporation and transpiration; and user-friendly platforms for distributing ET maps for irrigation scheduling and groundwater management purposes in arid and semiarid regions such as the Texas High Plains. In the last decade (2005-2015), researchers at the USDA-ARS Conservation and Production Research Laboratory, home of four large monolithic weighing lysimeters, in collaboration with Texas AM measurements of turbulent fluxes with eddy covariance and Bowen ratio systems, sensible heat flux induced light intensity scintillations, net radiation and soil heat fluxes, crop growth parameters, and ET by mass balance. This has allowed the development, enhancement, and testing of numerous remote sensing ET models; development of a framework to generate daily time series ET maps; and development of ET mapping and reference ET software. In this paper, we discuss these accomplishments and the status of ongoing research projects in detail. Keywords. Energy Balance Models, Evapotranspiration, Irrigation Management, Hydrologic models

Health-related behaviours are a concern for contemporary health policy and practice given their association with a range of illness outcomes. Many of the policies and interventions aimed at changing health-related behaviours assume that people are more or less free to choose their behaviour and how they experience health. Within sociology and anthropology, these behaviours are viewed not as acts of choice but as actions and practices situated within a larger sociocultural context. In this paper, we outline three theoretical perspectives useful in understanding behaviours that may influence one's health in this wider context: theories of social practice, social networks and interactionism. We argue that by better understanding how health-related behaviours are performed in people's everyday lives, more suitable interventions and clinical management can be developed.

Talking treatments are underused in England by working-class people: their higher rates of common mental disorders compared with their middle-class counterparts are not matched by an increased use of these treatments. Given that, overall, talking treatments are effective in tackling depression and anxiety, understanding their underuse is important. Based upon semi-structured interview data I argue that a framework centred on individuals' cultural dispositions towards treatment can help with this task. Following Bourdieu, such dispositions can be traced to social structural conditioning factors, together comprising the habitus. Four key dispositions emerge from the data: verbalisation and introspection, impetus for emotional health, relation to medical authority and practical orientation to the future. In turn, these dispositions are rooted in the material, health, occupational and educational characteristics of working-class circumstances. Tracing these circumstances offers suggestions for increasing the use of this service.

Background Diabetes peer support, where one person with diabetes helps others, may improve diabetes management. The objective of this study was to perform a cost analysis of peer support strategies used in RAndomized controlled trial of Peer Support in type 2 Diabetes. Methods We performed a 2×2 factorial randomized cluster controlled trial in England. People with type 2 diabetes were invited to participate as either ‘peer’ or ‘peer support facilitator’ (PSF) through postal invitation predominantly from general practice. Clusters, based on local communities, were each randomly assigned to one arm of group, 1:1, both group and 1:1 or control interventions. The intervention was delivered over 8–12 months by trained PSFs, supported by monthly meetings with a diabetes nurse. Out-of-pocket expenses/service utilization were self-reported at baseline, midpoint and on trial completion. Intervention costs were collated. Non-hospital costs used National Health Service (NHS) reference costs. Hospital payments were obtained from one local commissioning group and mean payments calculated. The analysis employed a societal perspective. Costs were evaluated at the conclusion of the trial. Results Participants (n=1299) were recruited across 130 clusters. The four arms were well balanced and matched (60% male, mean diabetes duration 9.5 years, mean glycated haemoglobin (HbA1c) 7.4+/-1.3%, 17% insulin treated). Implementation costs at 2013 rates were £13.84/participant/annum, participant out-of-pocket expenses for any intervention were £11.41/participant/annum and the NHS-incurred costs were reduced by £138.38/participant/annum. Savings for the 1:1, group and any intervention were £233.65, £90.52 and £113.13/participant/annum, respectively. Conclusions We conclude that both 1:1 and group diabetes peer support over 8–12 months are cost saving in this setting, although much of the benefit is largely derived by differences in self-reported healthcare utilization. Long-term benefits should be investigated. Trial registration number ISRCTN66963621

When humans perform a response task or timing task repeatedly, fluctuations in measures of timing from one action to the next exhibit long-range correlations known as 1/f noise. The origins of 1/f noise in timing have been debated for over twenty years, with one common explanation serving as a default: Humans are composed of physiological processes throughout the brain and body that operate over a wide range of timescales, and these processes combine to be expressed as a general source of 1/f noise. To test this explanation, the present study investigated the coupling versus independence of 1/f noise in timing deviations, key-press durations, pupil dilations, and heartbeat intervals while tapping to an audiovisual metronome. All four dependent measures exhibited clear 1/f noise, regardless of whether tapping was synchronized or syncopated. 1/f spectra for timing deviations were found to match those for key-press durations on an individual basis, and 1/f spectra for pupil dilations matched those in heartbeat intervals. Results indicate a complex, multiscale relationship among 1/f noises arising from common sources, such as those arising from timing functions versus those arising from autonomic nervous system functions. Results also provide further evidence against the default hypothesis that 1/f noise in human timing is just the additive combination of processes throughout the brain and body. Our findings are better accommodated by theories of complexity matching that begin to formalize multiscale coordination as a foundation of human behavior.

Background Diabetes peer support, where one person with diabetes helps guide and support others, has been proposed as a way to improve diabetes management. We have tested whether different diabetes peer support strategies can improve metabolic and/or psychological outcomes. Methods People with type 2 diabetes (n = 1,299) were invited to participate as either 'peer' or 'peer support facilitator' (PSF) in a 2x2 factorial randomised cluster controlled trial across rural communities (130 clusters) in England. Peer support was delivered over 8-12 months by trained PSFs, supported by monthly meetings with a diabetes educator. Primary end point was HbA1c. Secondary outcomes included quality of life, diabetes distress, blood pressure, waist, total cholesterol and weight. Outcome assessors and investigators were masked to arm allocation. Main factors were 1:1 or group intervention. Analysis was by intention-to-treat adjusting for baseline. Results The 4 arms were well matched (Group n = 330, 1:1(individual) n = 325, combined n = 322, control n = 322); 1035 (79·7%) completed the mid-point postal questionnaire and 1064 (81·9%) had a final HbA1c. A limitation was that although 92.6% PSFs and peers were in telephone contact, only 61.4% of intervention participants attended a face to face session. Mean baseline HbA1c was 57 mmol/mol (7·4%), with no significant change across arms. Follow up systolic blood pressure was 2·3 mm Hg (0.6 to 4.0) lower among those allocated group peer-support and 3·0 mm Hg (1.1 to 5.0) lower if the group support was attended at least once. There was no impact on other outcomes by intention to treat or significant differences between arms in self-reported adherence or medication. Conclusions Group diabetes peer support over 8-12 months was associated with a small improvement in blood pressure but no other significant outcomes. Long term benefits should be investigated. Trial registration ISRCTN.com ISRCTN6696362166963621.