Adams J, van der Waal Z, Rushton S, Rankin J. Associations between introduction and withdrawal of a financial incentive and timing of attendance for antenatal care and incidence of small for gestational age: natural experimental evaluation using interrupted time series methods.

1. An experiment, lasting 3 years, was carried out to investigate the control of hypomagnesaemia on a medium-heavy loam soil in Northern Ireland, using as criteria herbage analysis and analysis of blood sera of grazing dairy cows.2. Applications of calcined magnesite and magnesian limestone as soil treatments raised the magnesium contents of herbage slightly but not to levels judged to be safe. Low blood sorum magnesium levels were recorded for cows grazing this herbage although no cases of tetany occurred.3. Magnesium sulphate, appliedas a spray, temporarily raised the ‘apparent’ magnesium content of the herbage but was easily washed off by rain.4. Finely powdered calcined magnesite applied as a dust to the herbage immediately before grazing appeared to be a promising method of control under Northern Ireland conditions.

Background Within the current context of continued austerity and post-pandemic recovery, it remains important that Local Government services address the increasing needs of residents as cost-effectively as possible. Alliancing, whereby services work collaboratively focusing on the ‘whole-system’, has gained popularity as a tool with the potential to support collaborative whole systems approaches. This synthesis aims to identify how alliancing can be successfully operationalised in the commissioning of public health, wider National Health Service (NHS) and social care-related services. Methods A realist literature synthesis was undertaken in order to identify underlying generative mechanisms associated with alliancing, the contextual conditions surrounding the implementation and operationalisation of the alliancing approach mechanisms, and the outcomes produced as a result. An iterative approach was taken, using a recent systematic review of the effectiveness of Alliancing, online database searches, and grey literature searches. Results Three mechanistic components were identified within the data as being core to the successful implementation of alliances in public health and social care-related services within Local Government: (i) Achieving a system-level approach; (ii) placing local populations at the heart of the system; and (iii) creating a cultural shift. Programme theories were postulated within these components. Conclusions The alliancing approach offers an opportunity to achieve system-level change with the potential to benefit local populations. The realist synthesis approach taken within this study has provided insights into the necessary contextual and mechanistic factors of the Alliancing approach, above and beyond effectiveness outcomes typically collected through more conventional evaluation methodologies.