Effect of a quality improvement programme on leadership, innovation and use of quality improvement methods in general practice

Introduction Market mechanisms and pay-for-performance have failed to deliver continuing improvements in UK clinical care. Leadership and innovation are currently seen as essential to maintain and improve clinical quality but little is known about the relationship between these and the extent to which quality improvement (QI) methods are used in general practice. This study aimed to investigate the effect of quality improvement training on leadership behaviour, culture of innovation and adoption of QI methods in general practice. Method Self-administered postal questionnaires were sent to general practitioner quality leads in one UK county at the beginning (2007) and the end (2010) of a QI programme. The questionnaire consisted of background demographic information, a 12-item scale to assess leadership behaviour, a seven-dimension self-rating scale for innovation culture and questions on current use of quality improvement techniques and the effect of this on practice. We analysed change between the two surveys and the effect of participation in QI training. Results Sixty-three completed questionnaires (62%) were returned in 2007 and 47 (46%) in 2010; 32 practices completed both surveys. Although leadership behaviours were not commonly expressed, many practices reported a positive culture of innovation with significant positive correlation between leadership and innovation (r = 0.57; P < 0.001); apart from clinical audit and significant event analysis, QI methods were not reported as having been adopted by most participating practices. Percentage leadership score changed little over three years (increase 4.0 points, 95%CI -8.9 to 16.9) with little difference between participating and non-participating practices (7.6, -6.4 to 21.6) and no evidence of differential change (-1.5, -17.0 to 14.0). Percentage innovation culture scores showed a similar pattern (time -4.1 points, -15.1 to 6.9, group -1.6, -12.7 to 9.4, differential change 5.3, -7.8 to 18.5). Conclusions Leadership behaviours were infrequently reported, and despite describing a culture of innovation there was low uptake of QI methods beyond clinical and significant event audit even after practices participated in a QI programme. There is evidence that practices may need greater support to enhance leadership competences and develop quality improvement skills to stimulate innovation if improvements in health care are to accelerate

Rotorcraft aeroelastic stability

Theoretical and experimental developments in the aeroelastic and aeromechanical stability of helicopters and tilt-rotor aircraft are addressed. Included are the underlying nonlinear structural mechanics of slender rotating beams, necessary for accurate modeling of elastic cantilever rotor blades, and the development of dynamic inflow, an unsteady aerodynamic theory for low-frequency aeroelastic stability applications. Analytical treatment of isolated rotor stability in hover and forward flight, coupled rotor-fuselage stability in hover and forward flight, and analysis of tilt-rotor dynamic stability are considered. Results of parametric investigations of system behavior are presented, and correlation between theoretical results and experimental data from small and large scale wind tunnel and flight testing are discussed

Survey of Army/NASA rotorcraft aeroelastic stability research

Theoretical and experimental developments in the aeroelastic and aeromechanical stability of helicopters and tilt-rotor aircraft are addressed. Included are the underlying nonlinear structural mechanics of slender rotating beams, necessary for accurate modeling of elastic cantilever rotor blades, and the development of dynamic inflow, an unsteady aerodynamic theory for low frequency aeroelastic stability applications. Analytical treatment of isolated rotor stability in hover and forward flight, coupled rotor-fuselage stability are considered. Results of parametric investigations of system behavior are presented, and correlations between theoretical results and experimental data from small- and large-scale wind tunnel and flight testing are discussed

Large-scale compression of genomic sequence databases with the Burrows-Wheeler transform

Motivation The Burrows-Wheeler transform (BWT) is the foundation of many algorithms for compression and indexing of text data, but the cost of computing the BWT of very large string collections has prevented these techniques from being widely applied to the large sets of sequences often encountered as the outcome of DNA sequencing experiments. In previous work, we presented a novel algorithm that allows the BWT of human genome scale data to be computed on very moderate hardware, thus enabling us to investigate the BWT as a tool for the compression of such datasets. Results We first used simulated reads to explore the relationship between the level of compression and the error rate, the length of the reads and the level of sampling of the underlying genome and compare choices of second-stage compression algorithm. We demonstrate that compression may be greatly improved by a particular reordering of the sequences in the collection and give a novel `implicit sorting' strategy that enables these benefits to be realised without the overhead of sorting the reads. With these techniques, a 45x coverage of real human genome sequence data compresses losslessly to under 0.5 bits per base, allowing the 135.3Gbp of sequence to fit into only 8.2Gbytes of space (trimming a small proportion of low-quality bases from the reads improves the compression still further). This is more than 4 times smaller than the size achieved by a standard BWT-based compressor (bzip2) on the untrimmed reads, but an important further advantage of our approach is that it facilitates the building of compressed full text indexes such as the FM-index on large-scale DNA sequence collections.Comment: Version here is as submitted to Bioinformatics and is same as the previously archived version. This submission registers the fact that the advanced access version is now available at http://bioinformatics.oxfordjournals.org/content/early/2012/05/02/bioinformatics.bts173.abstract . Bioinformatics should be considered as the original place of publication of this article, please cite accordingl

The relationship between written knowledge of the alphabet and spelling ability at the fourth grade level

Profound differences in theory are never invented; they grow out of conflicting elements in a genuine problem. The problem of spelling is not new; it has existed since the first crude attempts at written communication. From the earliest symbol to the complex alphabets used in spelling today, the written word has been the method by which mankind has expressed himself and recorded his discoveries