Exploring the use of strategic frameworks in dental practice

This paper explores the use of strategic frameworks in NHS and private dental practice. It reviews the policy context of dentistry and suggests the challenges in this context will require dental practices to prioritise understanding and engagement with a strategic approach. A strategic approach will be required in order to enhance and improve performance. Two specific strategic frameworks will be explored in terms of their relevance to NHS and private dental practic

Self Management and Telehealth: Lessons Learnt from the Evaluation of a Dorset Telehealth Program

Dorset Clinical Commissioning Group

Tornado And Severe Weather Climatology And Predictability By Enso Phase In The North Central U.S.: A Compositing Study

Climatological factors, including the phase of the El Niño-Southern Oscillation (ENSO), are known predictors for parameters such as seasonal temperature and precipitation and tropical cyclone activity. ENSO phase also has a relationship to severe weather activity and may have utility in predicting anomalies in severe weather climatology, including the number of significant tornadoes and the number of tornado days. While not useful in daily severe weather operations and forecasting, determining the relationship between ENSO phase and severe weather climatology anomalies can aid preparedness for potentially active seasons among operational meteorologists, emergency managers, the media, and others with a role in preparing spotters and citizens for severe weather seasons

Prenatal factors contribute to the emergence of kwoshiorkor or marasmus in severe undernutrition: evidence for the predictive adaptation model

Severe acute malnutrition in childhood manifests as oedematous (kwashiorkor, marasmic kwashiorkor) and non-oedematous (marasmus) syndromes with very different prognoses. Kwashiorkor differs from marasmus in the patterns of protein, amino acid and lipid metabolism when patients are acutely ill as well as after rehabilitation to ideal weight for height. Metabolic patterns among marasmic patients define them as metabolically thrifty, while kwashiorkor patients function as metabolically profligate. Such differences might underlie syndromic presentation and prognosis. However, no fundamental explanation exists for these differences in metabolism, nor clinical pictures, given similar exposures to undernutrition. We hypothesized that different developmental trajectories underlie these clinical-metabolic phenotypes: if so this would be strong evidence in support of predictive adaptation model of developmental plasticity

TESTS FOR CORROSION MADE WITH STEEL MATERIALS SUBJECTED TO VARIOUS CONDITIONS FOR PROTRACTED PERIODS

This paper, as the title indicates, presents the results of tests that were made for corrosion by means of steel materials subjected to various conditions for long periods of time. The ages of the test-pieces ranged from 15 to 20 years, and the treatment, as well as the conditions to which the steel were subjected, also varied widely.in range. The corrosion of steel placed in concrete, which is particularly important, was tested with concrete of various mixtures as well as with protecting concrete of different thicknesses.附図９

Synoptic-Scale Convective Environment Climatology by ENSO Phase in the North Central United States

The El Niño-Southern Oscillation (ENSO) is known to affect synoptic patterns across the continental United States, particularly by its impact on the upper tropospheric jet stream position. Global circulation patterns influence synoptic weather patterns by impacting the location of mid-tropospheric ridge and trough locations and thus areas favorable for temperature and precipitation anomalies, which in turn influence regional severe weather activity. Though it is one of several factors associated with the potential for severe weather, the synoptic environment plays a key role in severe weather potential by providing favorable ingredients for the development of severe convection (e.g. Miller 1967). While ENSO is one of many factors that influence global circulations, and by distillation may have a less distinguishable influence on the synoptic pattern, coherent signals can be uncovered in the synoptic environment, based on ENSO phase, that would influence the potential for severe convection in the north central United States. Seasonal predictions of severe weather potential are not much aid for daily operations, but they can be used by emergency managers, the media, and forecasters to increase preparedness for seasons that have the potential for above normal convective activity

Needs and problems related to sociodemographic factors of informal caregiving of people with heart failure: A mixed methods study in three European countries

Aims: To explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics. Design: A qualitative focused mixed methods design was used. Methods: In total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven-phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed. Results: Three clusters of caregivers were identified: spouses, adult children and non-family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health. Conclusions: Informal caregiving emerged as a complex process influenced by various sociodemographic factors. Gender, relationship type and economic status are the important factors to be considered planning to develop approaches to address the needs of caregivers serving people with heart failure. Impact: A comprehensive understanding of the nature of informal caregiving of individuals with heart failure, the complexity of the real-world sociodemographic and cultural factors is warranted. The use of the EMDA method gave us the possibility of processing large masses of qualitative data through rapid, complex calculations. In detail, AATD allowed us to study in deep the significant fuzziness of what caregivers expressed and to analyse the content of the entire interviews and to produce global knowledge by using multi-dimensional statistical methods to grasp the fundamental sense of the interviews, beyond the simple words. Three clusters were identified in the samples, including spouses, adult children and non-family members. This study demonstrated that some sociodemographic characteristics could lead to everyday needs. Therefore, these demographic characteristics should be considered in developing targeted interventions. The research was conducted in Europe, but the technique shown can be replicated everywhere. The findings not only impact nursing but can be extended to all those stakeholders who concur with a public health educational mission. Patient or Public Contribution: Carers were involved in this study after the discharge of their loved ones or at the time of the outpatient visit. They were involved after they had been observed in their dynamics of involvement in caring of the familiars or friends with heart failure

Limitations of fasting indices in the measurement of insulin sensitivity in Afro-Caribbean adults

In young Afro-Caribbean adults, HOMA-IR compared poorly with other measures of insulin sensitivity. It remains important to determine whether similar findings occur in a more insulin resistant population. However, HOMA-IR correlated with clinical measures of insulin sensitivity (i.e. adiposity), so it may still be useful in epidemiological studies

New development: strategic user orientation in public services delivery—the missing link in the strategic trinity?

This paper explores the application of strategic planning and management to Public Service Organisations (PSOs). It argues that the impact of these approaches has been limited by the absence of an underlying strategic orientation that would provide a value-base upon which to embed these approaches within PSOs. It argues further for such an orientation to privelege the need for public services to add value to the lives of citizens and service users and not to focus solely upon internal measures of efficiency and performance

Place matters: but does local leadership?

The arrival of New Labour into Government witnessed the prominent re-emergence of place onto the policy agenda. This heralded a range of area-based-initiatives designed to both tackle neighbourhood forms of deprivation and to re-establish a sense of identity and connection between individuals and their local community. In terms of place-making, effective and inclusive participation, representation and leadership were all identified as prerequisites for the creation of sustainable communities . But how important is local leadership and strategic vision within local public service organisations in achieving the desired place-making outcomes? This paper examines the extent to which local leadership and strategic vision represents a significant factor in promoting higher levels of satisfaction, belonging, cohesion and participation across single tier councils in England. The ensuing empirical evidence raises significant questions not only about the importance of local leadership in place-making, but also the environmental and organizational factors that shape local places