The introduction, deployment and impact of assistant practitioners in diagnostic radiography in Scotland

This article describes the outcomes of an evaluation of the impact of introducing Assistant Practitioners (AP) roles into imaging departments in 13 of the 14 NHS Boards in Scotland. Between 2006 and 2009 some 34 individuals were trained as APs in diagnostic radiography with 33 subsequently taking up AP posts. In 2010 NHS Education for Scotland commissioned an evaluation of the impact brought about through introduction of the diagnostic imaging AP role in imaging departments. The research found that a minority of the managers had considered the workforce implications of introducing the new roles or the supervisory arrangements that would be required. In some sites implementation of the roles had resulted in the release of radiographers for additional training and higher level activities, but in others financial constraints had limited such initiatives. Managers believed that APs had helped maintain or improve service capacity and quality

Change leadership and change embeddedness in public organizations: Connecting macro-level reform to micro-level implementation

Governments initiate major public sector reforms for various reasons. Although change leadership appears crucial, its role in implementing reforms in public organisations receives scant attention. Insights from public administration and change management literature help to bridge the gap between these macro- and micro-level perspectives. Our multilevel study of two youth care organisations addressing public sector reform explores how leadership behaviour – and in interaction between top and middle managers – contributes to the concept of what we call change embeddedness among front-line employees. The use of leadership behaviours during the reform that are leader centric (shaping) appear to be associated with greater ambiguity and worse change embeddedness. However, leadership focused on engaging employees and boundary spanning with external organisations seems to support the embeddedness of the reform, especially when these behaviours are connected to a clear sense of purpose around the change

The management of change in public organisations: A literature review

This article presents a review of the recent literature on change management in public organisations and sets out to explore the extent to which this literature has responded to earlier critiques regarding the lack of (public) contextual factors. The review includes 133 articles published on this topic in the period from 2000 to 2010. The articles are analyzed based on the themes of the context, content, process, outcome and leadership of change. We identified whether the articles referred to different orders of change, as well as their employed methods and theory. Our findings concentrate on the lack of detail on change processes and outcomes and the gap between the common theories used to study change. We propose an agenda for the study of change management in public organisations that focuses on its complex nature by building theoretical bridges and performing more in-depth empirical and comparative studies on c

Stable Distributions in Stochastic Fragmentation

We investigate a class of stochastic fragmentation processes involving stable and unstable fragments. We solve analytically for the fragment length density and find that a generic algebraic divergence characterizes its small-size tail. Furthermore, the entire range of acceptable values of decay exponent consistent with the length conservation can be realized. We show that the stochastic fragmentation process is non-self-averaging as moments exhibit significant sample-to-sample fluctuations. Additionally, we find that the distributions of the moments and of extremal characteristics possess an infinite set of progressively weaker singularities.Comment: 11 pages, 5 figure

Body image distortion in fifth and sixth grade students may lead to stress, depression, and undesirable dieting behavior

The widespread pursuit of a thin physique may have a detrimental impact on the wellbeing of preadolescents. The influence of body image distortions on the lifestyles, dieting behaviors, and psychological factors was investigated in 631 fifth and sixth grade children in Kyeonggi-do, Korea. Children were classified into three weight groups (underweight, normal, and overweight) and three perception groups (underestimation, normal, and overestimation). Necessary information was obtained by questionnaire, and each subject's weight status was determined by the Röhrer index calculated from the annual measurement records, which were obtained from the school. According to their current weights, 57.4% of children were normal and 32.2% were overweight or obese, 16.6% of the children overestimated their body weight, and 55.2% had an undistorted body image. Overweight children had desirable lifestyles and dietary habits and presented reasonable weight control behaviors. Compared to those without distortion, the overestimated group had greater interest in weight control (P = 0.003) and dissatisfaction with their body weights (P = 0.011), presented unhealthy reasons to lose weight (P = 0.026), and had higher scores for "feeling sad when comparing own body with others" (P = 0.000) and for "easily getting annoyed and tired" (P = 0.037), even though they had similar obesity indices. More subjects from the overestimation group (P = 0.006) chose drama/movies as their favorite TV programs, suggesting a possible role for the media in body image distortion. These findings suggest that body image distortion can lead preadolescents to develop stress about obesity and unhealthy dieting practices, despite similar obesity indices to those without distorted body images. These results emphasize the importance of having an undistorted body image

Focused fluid seepage related to variations in accretionary wedge structure, Hikurangi margin, New Zealand

Hydrogeological processes influence the morphology, mechanical behavior, and evolution of subduction margins. Fluid supply, release, migration, and drainage control fluid pressure and collectively govern the stress state, which varies between accretionary and nonaccretionary systems. We compiled over a decade of published and unpublished acoustic data sets and seafloor observations to analyze the distribution of focused fluid expulsion along the Hikurangi margin, New Zealand. The spatial coverage and quality of our data are exceptional for subduction margins globally. We found that focused fluid seepage is widespread and varies south to north with changes in subduction setting, including: wedge morphology, convergence rate, seafloor roughness, and sediment thickness on the incoming Pacific plate. Overall, focused seepage manifests most commonly above the deforming backstop, is common on thrust ridges, and is largely absent from the frontal wedge despite ubiquitous hydrate occurrences. Focused seepage distribution may reflect spatial differences in shallow permeability architecture, while diffusive fluid flow and seepage at scales below detection limits are also likely. From the spatial coincidence of fluids with major thrust faults that disrupt gas hydrate stability, we surmise that focused seepage distribution may also reflect deeper drainage of the forearc, with implications for pore-pressure regime, fault mechanics, and critical wedge stability and morphology. Because a range of subduction styles is represented by 800 km of along-strike variability, our results may have implications for understanding subduction fluid flow and seepage globally

SW-ARRAY: a dynamic programming solution for the identification of copy-number changes in genomic DNA using array comparative genome hybridization data

Comparative genome hybridization (CGH) to DNA microarrays (array CGH) is a technique capable of detecting deletions and duplications in genomes at high resolution. However, array CGH studies of the human genome noting false negative and false positive results using large insert clones as probes have raised important concerns regarding the suitability of this approach for clinical diagnostic applications. Here, we adapt the Smith–Waterman dynamic-programming algorithm to provide a sensitive and robust analytic approach (SW-ARRAY) for detecting copy-number changes in array CGH data. In a blind series of hybridizations to arrays consisting of the entire tiling path for the terminal 2 Mb of human chromosome 16p, the method identified all monosomies between 267 and 1567 kb with a high degree of statistical significance and accurately located the boundaries of deletions in the range 267–1052 kb. The approach is unique in offering both a nonparametric segmentation procedure and a nonparametric test of significance. It is scalable and well-suited to high resolution whole genome array CGH studies that use array probes derived from large insert clones as well as PCR products and oligonucleotides

Cannabis sativa and the endogenous cannabinoid system: therapeutic potential for appetite regulation

The herb Cannabis sativa (C. sativa) has been used in China and on the Indian subcontinent for thousands of years as a medicine. However, since it was brought to the UK and then the rest of the western world in the late 19th century, its use has been a source of controversy. Indeed, its psychotropic side effects are well reported but only relatively recently has scientific endeavour begun to find valuable uses for either the whole plant or its individual components. Here, we discuss evidence describing the endocannabinoid system, its endogenous and exogenous ligands and their varied effects on feeding cycles and meal patterns. Furthermore we also critically consider the mounting evidence which suggests non‐tetrahydrocannabinol phytocannabinoids play a vital role in C. sativa‐induced feeding pattern changes. Indeed, given the wide range of phytocannabinoids present in C. sativa and their equally wide range of intra‐, inter‐ and extra‐cellular mechanisms of action, we demonstrate that non‐Δ9tetrahydrocannabinol phytocannabinoids retain an important and, as yet, untapped clinical potential

A Taxonomy and Results from a Comprehensive Review of 28 Maternal Health Voucher Programmes

It is increasingly clear that Millennium Development Goal 4 and 5 will not be achieved in many low- and middle-income countries with the weakest gains among the poor. Recognizing that there are large inequalities in reproductive health outcomes, the post-2015 agenda on universal health coverage will likely generate strategies that target resources where maternal and newborn deaths are the highest. In 2012, the United States Agency for International Development convened an Evidence Summit to review the knowledge and gaps on the utilization of financial incentives to enhance the quality and uptake of maternal healthcare. The goal was to provide donors and governments of the low- and middle-income countries with evidenceinformed recommendations on practice, policy, and strategies regarding the use of financial incentives, including vouchers, to enhance the demand and supply of maternal health services. The findings in this paper are intended to guide governments interested in maternal health voucher programmes with recommendations for sustainable implementation and impact. The Evidence Summit undertook a systematic review of five financing strategies. This paper presents the methods and findings for vouchers, building on a taxonomy to catalogue knowledge about voucher programme design and functionality. More than 120 characteristics under five major categories were identified: programme principles (objectives and financing); governance and management; benefits package and beneficiary targeting; providers (contracting and service pricing); and implementation arrangements (marketing, claims processing, and monitoring and evaluation). Among the 28 identified maternal health voucher programmes, common characteristics included: a stated objective to increase the use of services among the means-tested poor; contracted-out programme management; contracting either exclusively private facilities or a mix of public and private providers; prioritizing community-based distribution of vouchers; and tracking individual claims for performance purposes. Maternal voucher programmes differed on whether contracted providers were given training on clinical or administrative issues; whether some form of service verification was undertaken at facility or communitylevel; and the relative size of programme management costs in the overall programme budget. Evidence suggests voucher programmes can serve populations with national-level impact. Reaching scale depends on whether the voucher programme can: (i) keep management costs low, (ii) induce a large demand-side response among the bottom two quintiles, and (iii) achieve a quality of care that translates a greater number of facility-based deliveries into a reduction in maternal morbidity and mortality