On leadership development in the national health service Scotland

The National Health Service (NHS), which delivers healthcare to all in the UK, is undergoing profound change, from the role of the primary-care providers, the general practitioners, to the specialist hospital managers. There is a drive that ranges from greater care in the community to more effective use of highly specialist resources in hospitals. This is linked to the restructuring of the management in the NHS, requiring a new breed of leaders to achieve organisational change, and to attain development and growth. To develop the new cadre of managers, an exciting Programme is being established for Leadership and Organisational Development. This paper reflects on the background to the change in the NHS, and provides an account of the Leadership Development Programme that is being implemented in the NHS Scotland

Partner bereavement and risk of chronic urticaria, alopecia areata and vitiligo:cohort studies in the UK and Denmark

The pathogeneses of skin diseases are not fully understood. Psychological stress has been proposed to be associated with skin diseases, but the epidemiological evidence is limited [1, 2]. We have recently reported the associations between partner bereavement (an extreme life stressor) and psoriasis, atopic eczema and melanoma [3, 4]. In this study, we further investigated whether partner bereavement was associated with urticaria, alopecia areata, or vitiligo

Incidence of acute complications of herpes zoster among immunocompetent adults in England:a matched cohort study using routine health data

BACKGROUND: Herpes zoster can cause rare but serious complications; the frequency of these complications has not been well described. OBJECTIVES: To quantify the risks of acute non-postherpetic neuralgia (PHN) zoster complications, to inform vaccination policy. METHODS: We conducted a cohort study among unvaccinated immunocompetent adults with incident zoster, and age-, sex- and practice-matched control adults without zoster, using routinely collected health data from the UK Clinical Practice Research Datalink (years 2001 to 2018). Crude attributable risks of complications were estimated as the difference between Kaplan-Meier-estimated 3-month cumulative incidences in patients with zoster vs. controls. We used Cox models to obtain hazard ratios for our primary outcomes in patients with and without zoster. Primary outcomes were ocular, neurological, cutaneous, visceral and zoster-specific complications. We also assessed whether antivirals during acute zoster protected against the complications. RESULTS: In total 178 964 incident cases of zoster and 1 799 380 controls were included. The absolute risks of zoster-specific complications within 3 months of zoster diagnosis were 0·37% [95% confidence interval (CI) 0·34-0·39] for Ramsay Hunt syndrome, 0·01% (95% CI 0·0-0·01) for disseminated zoster, 0·04% (95% CI 0·03-0·05) for zoster death and 0·97% (95% CI 0·92-1·00) for zoster hospitalization. For other complications, attributable risks were 0·48% (95% CI 0·44-0·51) for neurological complications, 1·33% (95% CI 1·28-1·39) for ocular complications, 0·29% (95% CI 0·26-0·32) for cutaneous complications and 0·78% (95% CI 0·73-0·84) for visceral complications. Attributable risks were higher among patients > 50 years old. Patients with zoster had raised risks of all primary outcomes relative to controls. Antiviral prescription was associated with reduced risk of neurological complications (hazard ratio 0·61, 95% CI 0·53-0·70). CONCLUSIONS: Non-PHN complications of zoster were relatively common, which may affect cost-effectiveness calculations for zoster vaccination. Clinicians should be aware that zoster can lead to various complications, besides PHN

Eruptions of Magnetic Ropes in Two Homologous Solar Events on 2002 June 1 and 2: a Key to Understanding of an Enigmatic Flare

The goal of this paper is to understand the drivers, configurations, and scenarios of two similar eruptive events, which occurred in the same solar active region 9973 on 2002 June 1 and 2. The June 2 event was previously studied by Sui, Holman, and Dennis (2006, 2008), who concluded that it was challenging for popular flare models. Using multi-spectral data, we analyze a combination of the two events. Each of the events exhibited an evolving cusp-like feature. We have revealed that these apparent ``cusps'' were most likely mimicked by twisted magnetic flux ropes, but unlikely to be related to the inverted Y-like magnetic configuration in the standard flare model. The ropes originated inside a funnel-like magnetic domain whose base was bounded by an EUV ring structure, and the top was associated with a coronal null point. The ropes appear to be the major drivers for the events, but their rise was not triggered by reconnection in the coronal null point. We propose a scenario and a three-dimensional scheme for these events in which the filament eruptions and flares were caused by interaction of the ropes.Comment: 22 pages, 11 figure

First Results from the DRIFT-IIa Dark Matter Detector

Data from the DRIFT-IIa directional dark matter experiment are presented, collected during a near continuous 6 month running period. A detailed calibration analysis comparing data from gamma-ray, x-ray and neutron sources to a GEANT4 Monte Carlo simulations reveals an efficiency for detection of neutron induced recoils of 94+/-2(stat.)+/-5(sys.)%. Software-based cuts, designed to remove non-nuclear recoil events, are shown to reject 60Co gamma-rays with a rejection factor of better than 8x10-6 for all energies above threshold. An unexpected event population has been discovered and is shown here to be due to the alpha-decay of 222Rn daughter nuclei that have attached to the central cathode. A limit on the flux of neutrons in the Boulby Underground Laboratory is derived from analysis of unshielded and shielded data.Comment: 43 pages, 14 figures, submitted to Astroparticle Physic

Track Reconstruction and Performance of DRIFT Directional Dark Matter Detectors using Alpha Particles

First results are presented from an analysis of data from the DRIFT-IIa and DRIFT-IIb directional dark matter detectors at Boulby Mine in which alpha particle tracks were reconstructed and used to characterise detector performance--an important step towards optimising directional technology. The drift velocity in DRIFT-IIa was [59.3 +/- 0.2 (stat) +/- 7.5 (sys)] m/s based on an analysis of naturally-occurring alpha-emitting background. The drift velocity in DRIFT-IIb was [57 +/- 1 (stat) +/- 3 (sys)] m/s determined by the analysis of alpha particle tracks from a Po-210 source. 3D range reconstruction and energy spectra were used to identify alpha particles from the decay of Rn-222, Po-218, Rn-220 and Po-216. This study found that (22 +/- 2)% of Po-218 progeny (from Rn-222 decay) are produced with no net charge in 40 Torr CS2. For Po-216 progeny (from Rn-220 decay) the uncharged fraction is (100 +0 -35)%.Comment: 27 pages, 12 figures, 5 tables. Submitted to Nuclear Instruments and Methods in Physics Research, Section A. Subj-class: Instrumentation and Detector

Elliptical galaxy nuclei activity powered by infalling globular clusters

Globular cluster systems evolve, in galaxies, due to internal and external dynamics and tidal phenomena. One of the causes of evolution, dynamical friction, is responsible for the orbital decay of massive clusters into the innermost galactic regions. It is found that these clusters are effective source of matter to feed a central galactic black hole such to make it grow and shine as an AGN.Comment: 8 pages, 2 eps figures, in press in the Proc. of the Meeting Baryons in Cosmic Structures, Monte Porzio (Italy), oct. 20-21 2003, ASP Conf. Ser., eds. E. Giallongo, G. De Zotti, N. Menc

Measurement of the Range Component Directional Signature in a DRIFT-II Detector using 252Cf Neutrons

The DRIFT collaboration utilizes low pressure gaseous detectors to search for WIMP dark matter with directional signatures. A 252Cf neutron source was placed on each of the principal axes of a DRIFT detector in order to test its ability to measure directional signatures from the three components of very low energy (~keV/amu) recoil ranges. A high trigger threshold and the event selection procedure ensured that only sulfur recoils were analyzed. Sulfur recoils produced in the CS2 target gas by the 252Cf source closely match those expected from massive WIMP induced sulfur recoils. For each orientation of the source a directional signal from the range components was observed, indicating that the detector is directional along all 3 axes. An analysis of these results yields an optimal orientation for DRIFT detectors when searching for a directional signature from WIMPs. Additional energy dependent information is provided to aid in understanding this effect.Comment: 14 pages, 1 Table, 8 Figure

Reviews and syntheses: Changing ecosystem influences on soil thermal regimes in northern high-latitude permafrost regions

Soils in Arctic and boreal ecosystems store twice as much carbon as the atmosphere, a portion of which may be released as high-latitude soils warm. Some of the uncertainty in the timing and magnitude of the permafrost–climate feedback stems from complex interactions between ecosystem properties and soil thermal dynamics. Terrestrial ecosystems fundamentally regulate the response of permafrost to climate change by influencing surface energy partitioning and the thermal properties of soil itself. Here we review how Arctic and boreal ecosystem processes influence thermal dynamics in permafrost soil and how these linkages may evolve in response to climate change. While many of the ecosystem characteristics and processes affecting soil thermal dynamics have been examined individually (e.g., vegetation, soil moisture, and soil structure), interactions among these processes are less understood. Changes in ecosystem type and vegetation characteristics will alter spatial patterns of interactions between climate and permafrost. In addition to shrub expansion, other vegetation responses to changes in climate and rapidly changing disturbance regimes will affect ecosystem surface energy partitioning in ways that are important for permafrost. Lastly, changes in vegetation and ecosystem distribution will lead to regional and global biophysical and biogeochemical climate feedbacks that may compound or offset local impacts on permafrost soils. Consequently, accurate prediction of the permafrost carbon climate feedback will require detailed understanding of changes in terrestrial ecosystem distribution and function, which depend on the net effects of multiple feedback processes operating across scales in space and time