Extent of regretted sexual intercourse among young teenagers in Scotland: a cross sectional survey

No abstract available

Transforming the NHS through transforming ourselves

Abstract Background: Leadership development impacts on quality of care and workplace cultures for staff. Clinical Leadership embracing transformational and other collective leadership approaches are key enablers to developing effective workplace cultures at the micro-systems level. Following the development of a shared purpose and values framework, an internal, inter-professional clinical leadership programme was set up to grow a critical community of transformational leaders across one NHS organisation in England. This programme had previously been unsuccessful in engaging medical doctors. Aims and Objectives: This paper shares how a dedicated practice development based clinical leadership programme set out to support medical doctors across one organisation with their leadership journey, equipping them to become both transformational and collective leaders and facilitators with the skills to begin to develop and sustain effective workplace cultures, that are person centred, safe and effective. Methods: Practice development methodology with its collaborative, inclusive and participative approach for developing person centred cultures combined with clinical leadership strategies, formed the basis of the programme which emphasised the use of active and action learning drawing on the workplace as the main resource for learning, development and improvement. Self-assessment and co-creation of insights about clinical leadership together with collaborative analysis of evaluation data led to the syntheses of insights through the use of reflection and action planning. Findings/Results: Findings are presented at two levels: 1) Five individual authentic reflections by authors to illustrate their leadership journeys which also demonstrate how a range of tools were used and their impact from reflections. Insights and learning include recognition of the benefits of peer support and networking; development of a disciplined approach to learning and self-management; 2) A collaborative reflection and critique that embraced the feeling of a sense of team ethos and community cohesion, for the first time in a safe environment; as well as, a sense of collective shared purpose and values. Conclusions: We conclude that the programme helped to identify the impact of leadership on workplace cultures and to begin to embed ways of working that are collaborative, inclusive, participative and celebratory. This unique approach by one organisation to leadership development has enabled a journey of self-transformation for medical clinical leaders to commence. Practical implications arising from our learning: • An internal model grows clinical leadership capacity across the organisation through peer support and networking and collective leadership. • Investing in a safe confidential space for clinical leads and other staff groups is a strategy for leadership development practice. • There is need to develop more skilled critical companions to support leadership, improvement and development activities • Clinical leadership development, informed by practice development methodology, demonstrates potential for enabling transformative and collective leadership for achieving person-centred cultures in the workplace. Keywords: Clinical leadership, collective leadership, critical companionship, micro-systems, transformational leadership, workplace cultur

Earthquake-Resistant Fiber Reinforced Concrete Coupling Beams Without Diagonal Bars

Results from large-scale tests on fibre-reinforced concrete coupling beams subjected to large displacement reversals are reported. The main goal of using fibre reinforcement was to eliminate the need for diagonal bars and reduce the amount of confinement reinforcement required for adequate seismic performance. Experimental results indicate that the use of 30 mm long, 0.38 mm diameter hooked steel fibres with a 2300 MPa minimum tensile strength and in a volume fraction of 1.5% allows elimination of diagonal bars in coupling beams with span-todepth ratios greater than or equal to 2.2. Further, no special confinement reinforcement is required except at the ends of the coupling beams. The fibre-reinforced concrete coupling beam design was implemented in a high-rise building in the city of Seattle, WA, USA. A brief description of the coupling beam design used for this building, and construction process followed in the field, is provided

Spatial variation in direct and indirect contact rates at the wildlife-livestock interface for informing disease management

Little is known about disease transmission relevant contact rates at the wildlife-livestock interface and the factors shaping them. Indirect contact via shared resources is thought to be important but remains unquantified in most systems, making it challenging to evaluate the impact of livestock management practices on contact networks. Free-ranging wild pigs (Sus scrofa) in North America are an invasive, socially-structured species with an expanding distribution that pose a threat to livestock health given their potential to transmit numerous livestock diseases, such as pseudorabies, brucellosis, trichinellosis, and echinococcosis, among many others. Our objective in this study was to quantify the spatial variations in direct and indirect contact rates among wild pigs and cattle on a commercial cow-calf operation in Florida, USA. Using GPS data from 20 wild pigs and 11 cattle and a continuous-time movement model, we extracted three types of spatial contacts between wild pigs and cattle, including direct contact, indirect contact in the pastoral environment (unknown naturally occurring resources), and indirect contact via anthropogenic cattle resources (feed supplements and water supply troughs). We examined the effects of sex, spatial proximity, and cattle supplement availability on contact rates at the species level and characterized wild pig usage of cattle supplements. Our results suggested daily pig-cattle direct contacts occurred only occasionally, while a significant number of pig-cattle indirect contacts occurred via natural resources distributed heterogeneously across the landscape. At cattle supplements, more indirect contacts occurred at liquid molasses than water troughs or molasses-mineral block tubs due to higher visitation rates by wild pigs. Our results can be directly used for parameterizing epidemiological models to inform risk assessment and optimal control strategies for controlling transmission of shared diseases

The Wicked Machinery of Government: Malta and the Problems of Continuity under the New Model Administration

This is a study focused on the early years of British rule in Malta (1800-1813). It explores the application to the island of the “new model” of colonial government, one based on direct rule from London mediated by the continuation of existing laws and institutions. Systemic deficiencies are identified. These tended to undermine the effectiveness of direct British rule. This study also reveals, in the context of legal and constitutional continuity, unresolved tensions between modernity and tradition. The political stability of the island was damaged and the possibility of continued British possession was threatened

The history and evolution of the clinical effectiveness of haemophilia type a treatment: a systematic review.

First evidence of cases of haemophilia dates from ancient Egypt, but it was when Queen Victoria from England in the 19th century transmitted this illness to her descendants, when it became known as the "royal disease". Last decades of the 20th century account for major discoveries that improved the life expectancy and quality of life of these patients. The history and evolution of haemophilia healthcare counts ups and downs. The introduction of prophylactic schemes during the 1970s have proved to be more effective that the classic on-demand replacement of clotting factors, nevertheless many patients managed with frequent plasma transfusions or derived products became infected with the Human Immunodeficiency Virus (HIV) and Hepatitis C virus during the 1980s and 1990s. Recombinant factor VIII inception has decreased the risk of blood borne infections and restored back longer life expectancies. Main concerns for haemophilia healthcare are shifting from the pure clinical aspects to the economic considerations of long-term replacement therapy. Nowadays researchers' attention has been placed on the future costs and cost-effectiveness of costly long-term treatment. Equity considerations are relevant as well, and alternative options for less affluent countries are under the scope of further research. The aim of this review was to assess the evidence of different treatment options for haemophilia type A over the past four decades, focusing on the most important technological advances that have influenced the natural course of this "royal disease"

Transgressing the moral economy: Wheelerism and management of the nationalised coal industry in Scotland

This article illuminates the links between managerial style and political economy in post-1945 Britain, and explores the origins of the 1984–1985 miners' strike, by examining in longer historical context the abrasive attitudes and policies of Albert Wheeler, Scottish Area Director of the National Coal Board (NCB). Wheeler built on an earlier emphasis on production and economic criteria, and his micro-management reflected pre-existing centralising tendencies in the industries. But he was innovative in one crucial aspect, transgressing the moral economy of the Scottish coalfield, which emphasised the value of economic security and changes by joint industrial agreement

The need to promote behaviour change at the cultural level: one factor explaining the limited impact of the MEMA kwa Vijana adolescent sexual health intervention in rural Tanzania. A process evaluation

Background - Few of the many behavioral sexual health interventions in Africa have been rigorously evaluated. Where biological outcomes have been measured, improvements have rarely been found. One of the most rigorous trials was of the multi-component MEMA kwa Vijana adolescent sexual health programme, which showed improvements in knowledge and reported attitudes and behaviour, but none in biological outcomes. This paper attempts to explain these outcomes by reviewing the process evaluation findings, particularly in terms of contextual factors. Methods - A large-scale, primarily qualitative process evaluation based mainly on participant observation identified the principal contextual barriers and facilitators of behavioural change. Results - The contextual barriers involved four interrelated socio-structural factors: culture (i.e. shared practices and systems of belief), economic circumstances, social status, and gender. At an individual level they appeared to operate through the constructs of the theories underlying MEMA kwa Vijana - Social Cognitive Theory and the Theory of Reasoned Action – but the intervention was unable to substantially modify these individual-level constructs, apart from knowledge. Conclusion - The process evaluation suggests that one important reason for this failure is that the intervention did not operate sufficiently at a structural level, particularly in regard to culture. Recently most structural interventions have focused on gender or/and economics. Complementing these with a cultural approach could address the belief systems that justify and perpetuate gender and economic inequalities, as well as other barriers to behaviour change

Why is there no queer international theory?

Over the last decade, Queer Studies have become Global Queer Studies, generating significant insights into key international political processes. Yet, the transformation from Queer to Global Queer has left the discipline of International Relations largely unaffected, which begs the question: if Queer Studies has gone global, why has the discipline of International Relations not gone somewhat queer? Or, to put it in Martin Wight’s provocative terms, why is there no Queer International Theory? This article claims that the presumed non-existence of Queer International Theory is an effect of how the discipline of International Relations combines homologization, figuration, and gentrification to code various types of theory as failures in order to manage the conduct of international theorizing in all its forms. This means there are generalizable lessons to be drawn from how the discipline categorizes Queer International Theory out of existence to bring a specific understanding of International Relations into existence