Achieving provider engagement: providers' perceptions of implementing and delivering integrated care

The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda

‘You probably won’t notice any symptoms’ Blood pressure in pregnancy:discourses of contested expertise in an era of self-care and responsibilisation

Pregnancy is not a disease or illness, but requires clinical surveillance as life-threatening complications can develop. Preeclampsia, one such potentially serious complication, puts both mother and baby at risk. Self-monitoring blood pressure in the general population is well established, and its potential in pregnancy is currently being explored. In the context of self-monitoring, the information and guidance given to women regarding hypertension, and the literature they themselves seek out during pregnancy, are vital to perceptions of disease risk and subsequent responses to, and management of, any symptoms. Drawing on online, offline, official, and unofficial sources of information, discourses are examined to provide analysis of how self-responsibilization is reflected in contemporary information, advice, and guidance drawn from multiple sources. A paradox emerges between the paternalistic and lay discourses that seek to challenge and regain control. Findings are discussed in the context of Foucault’s governmentality and medical power

Regulation of CD44 binding to hyaluronan by glycosylation of variably spliced exons

The hyaluronan (HA)-binding function (lectin function) of the leukocyte homing receptor, CD44, is tightly regulated. Herein we address possible mechanisms that regulate CD44 isoform-specific HA binding. Binding studies with melanoma transfectants expressing CD44H, CD44E, or with soluble immunoglobulin fusions of CD44H and CD44E (CD44H-Rg, CD44E-Rg) showed that although both CD44 isoforms can bind HA, CD44H binds HA more efficiently than CD44E. Using CD44-Rg fusion proteins we show that the variably spliced exons in CD44E, V8-V10, specifically reduce the lectin function of CD44, while replacement of V8-V10 by an ICAM-1 immunoglobulin domain restores binding to a level comparable to that of CD44H. Conversely, CD44 bound HA very weakly when exons V8-V10 were replaced with a CD34 mucin domain, which is heavily modified by O-linked glycans. Production of CD44E-Rg or incubation of CD44E-expressing transfectants in the presence of an O-linked glycosylation inhibitor restored HA binding to CD44H-Rg and to cell surface CD44H levels, respectively. We conclude that differential splicing provides a regulatory mechanism for CD44 lectin function and that this effect is due in part to O-linked carbohydrate moieties which are added to the Ser/Thr rich regions encoded by the variably spliced CD44 exons. Alternative splicing resulting in changes in protein glycosylation provide a novel mechanism for the regulation of lectin activit

What’s Worth Talking About? Information Theory Reveals How Children Balance Informativeness and Ease of Production

Of all the things we could say, what determines what is worth saying? Greenfield’s principle of informativeness states that, right from the onset of language, humans selectively comment on whatever they find unexpected. We quantify this tendency using information theoretic measures, and test the counterintuitive prediction that children will produce words that are low frequency given the context because these will be most informative. Using corpora of child directed speech, we identified adjectives that varied in how informative (i.e., unexpected) they were given the noun they modified. Three-year-olds (N=31, replication N=13) heard an experimenter use these adjectives to describe pictures. The children’s task was then to describe the pictures to another person. As the information content of the experimenter’s adjective increased, so did children’s tendency to comment on the feature that adjective had encoded. Furthermore, our analyses suggest that children balance this informativeness with a competing drive to ease production

SPRWeb: preserving subjective responses to website colour schemes through automatic recolouring

Colours are an important part of user experiences on the Web. Colour schemes influence the aesthetics, first impressions and long-term engagement with websites. However, five percent of people perceive a subset of all colours because they have colour vision deficiency (CVD), resulting in an unequal and less-rich user experience on the Web. Traditionally, people with CVD have been supported by recolouring tools that improve colour differentiability, but do not consider the subjective properties of colour schemes while recolouring. To address this, we developed SPRWeb, a tool that recolours websites to preserve subjective responses and improve colour differentiability - thus enabling users with CVD to have similar online experiences. To develop SPRWeb, we extended existing models of non-CVD subjective responses to CVD, then used this extended model to steer the recolouring process. In a lab study, we found that SPRWeb did significantly better than a standard recolouring tool at preserving the temperature and naturalness of websites, while achieving similar weight and differentiability preservation. We also found that recolouring did not preserve activity, and hypothesize that visual complexity influences activity more than colour. SPRWeb is the first tool to automatically preserve the subjective and perceptual properties of website colour schemes thereby equalizing the colour-based web experience for people with CVD.Engineering and Applied Science

Challenges of Early Years leadership preparation: a comparison between early and experienced Early Years practitioners in England

Leadership has been under-researched in the Early Years (EY) sector of primary schools in England, especially in leading change for professional development. The aim of this paper is to theorise what the leadership culture for EY practitioners looks like, and how Initial Teacher Training providers and schools are preparing practitioners for leadership. Using case studies of EY practitioners in different stages of their career in primary schools, we offer an insight into their preparedness for leadership in EY, the implication being that leadership training requires an understanding and embedding of the EY culture and context. Interviews with both sample groups allowed for deeper insight into the lived world. Interviews were also conducted with the head teachers to gain an overview of the leadership preparation they provided. The main findings suggest that newer EY practitioners are better prepared for leadership from their university training in comparison to more experienced EY practitioners

Creativity and Autonomy in Swarm Intelligence Systems

This work introduces two swarm intelligence algorithms -- one mimicking the behaviour of one species of ants (\emph{Leptothorax acervorum}) foraging (a `Stochastic Diffusion Search', SDS) and the other algorithm mimicking the behaviour of birds flocking (a `Particle Swarm Optimiser', PSO) -- and outlines a novel integration strategy exploiting the local search properties of the PSO with global SDS behaviour. The resulting hybrid algorithm is used to sketch novel drawings of an input image, exploliting an artistic tension between the local behaviour of the `birds flocking' - as they seek to follow the input sketch - and the global behaviour of the `ants foraging' - as they seek to encourage the flock to explore novel regions of the canvas. The paper concludes by exploring the putative `creativity' of this hybrid swarm system in the philosophical light of the `rhizome' and Deleuze's well known `Orchid and Wasp' metaphor

Determination of rain age via γ rays from accreted radon progeny

金沢大学自然計測応用研究センター自然計測研究部門The relative γ ray activities from P 214 b and B 214 i condensed from precipitation are used to determine its "age," the average time the accreted activity has been removed from secular equilibrium. A verifiable assumption that radon progeny on/in the surface/volume of droplets mostly remains in secular equilibrium until they begin their descent, enables estimates of their transit times to ground of typically a few tens of minutes. This agrees well with the time expected for the activity on the surface of droplets to reach the ground from heights of a few kilometers. The half lives of γ activities from B 214 i and P 214 b, 19.7 and 26.9 min, respectively, are on the same scale as transit time to ground and close enough to each other to measure ratios of activities from secular equilibrium (1.00) to transient equilibrium (3.88) within a few hundreds of minutes. The ratio of γ count rates is independent of knowledge of either initial activity or any systematic errors and thus limited only by the uncertainty from counting statistics, which from condensates of 5-30 l of rain viewed with 2π solid angle by a 50% efficient, high-resolution Ge detector is only a few percent. These ratios fit extremely well to known theoretical curves, which cannot only be used to date rain but can also be extrapolated backward to determine radon progeny activities in rain prior to its descent, knowledge of which may facilitate further studies using radon progeny as tracers. © 2008 American Institute of Physics