Leadership of healthcare commissioning networks in England : a mixed-methods study on clinical commissioning groups

Objective: To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation. Design: Mixed-method, multisite and case study research. Setting: Six clinical commissioning groups and local clusters in the East of England area, covering in total 208 GPs and 1 662 000 population. Methods: Semistructured interviews with 56 lead GPs, practice managers and staff from the local health authorities (primary care trusts, PCT) as well as various healthcare professionals; 21 observations of clinical commissioning group (CCG) board and executive meetings; electronic survey of 58 CCG board members (these included GPs, practice managers, PCT employees, nurses and patient representatives) and subsequent social network analysis. Main outcome measures: Collaborative relationships between CCG board members and stakeholders from their healthcare network; clarifying the role of GPs as network leaders; strengths and areas for development of CCGs. Results: Drawing upon innovation network theory provides unique insights of the CCG leaders’ activities in establishing best practices and introducing new clinical pathways. In this context we identified three network leadership roles: managing knowledge flows, managing network coherence and managing network stability. Knowledge sharing and effective collaboration among GPs enable network stability and the alignment of CCG objectives with those of the wider health system (network coherence). Even though activities varied between commissioning groups, collaborative initiatives were common. However, there was significant variation among CCGs around the level of engagement with providers, patients and local authorities. Locality (sub) groups played an important role because they linked commissioning decisions with patient needs and brought the leaders closer to frontline stakeholders. Conclusions: With the new commissioning arrangements, the leaders should seek to move away from dyadic and transactional relationships to a network structure, thereby emphasising on the emerging relational focus of their roles. Managing knowledge mobility, healthcare network coherence and network stability are the three clinical leadership processes that CCG leaders need to consider in coordinating their network and facilitating the development of good clinical commissioning decisions, best practices and innovative services. To successfully manage these processes, CCG leaders need to leverage the relational capabilities of their network as well as their clinical expertise to establish appropriate collaborations that may improve the healthcare services in England. Lack of local GP engagement adds uncertainty to the system and increases the risk of commissioning decisions being irrelevant and inefficient from patient and provider perspectives

High-pulse energy supercontinuum laser for high-resolution spectroscopic photoacoustic imaging of lipids in the 1650-1850 nm region

We propose a cost-effective high-pulse energy supercontinuum (SC) source based on a telecom range diode laser-based amplifier and a few meters of standard single-mode optical fiber, with a pulse energy density as high as ∼25 nJ/nm in the 1650-1850 nm regime (factor >3 times higher than any SC source ever used in this wavelength range). We demonstrate how such an SC source combined with a tunable filter allows high-resolution spectroscopic photoacoustic imaging and the spectroscopy of lipids in the first overtone transition band of C-H bonds (1650-1850 nm). We show the successful discrimination of two different lipids (cholesterol and lipid in adipose tissue) and the photoacoustic cross-sectional scan of lipid-rich adipose tissue at three different locations. The proposed high-pulse energy SC laser paves a new direction towards compact, broadband and cost-effective source for spectroscopic photoacoustic imaging

A Population of Dust-rich Quasars at z ~ 1.5

We report Herschel SPIRE (250, 350, and 500 μm) detections of 32 quasars with redshifts 0.5 ≤z < 3.6 from the Herschel Multi-tiered Extragalactic Survey (HerMES). These sources are from a MIPS 24 μm flux-limited sample of 326 quasars in the Lockman Hole Field. The extensive multi-wavelength data available in the field permit construction of the rest-frame spectral energy distributions (SEDs) from ultraviolet to the mid-infrared for all sources, and to the far-infrared (FIR) for the 32 objects. Most quasars with Herschel FIR detections show dust temperatures in the range of 25-60 K, with a mean of 34 K. The FIR luminosities range from 10^(11.3) to 10^(13.5) L_☉, qualifying most of their hosts as ultra- or hyper-luminous infrared galaxies. These FIR-detected quasars may represent a dust-rich population, but with lower redshifts and fainter luminosities than quasars observed at ~1 mm. However, their FIR properties cannot be predicted from shorter wavelengths (0.3-20 μm, rest frame), and the bolometric luminosities derived using the 5100 Å index may be underestimated for these FIR-detected quasars. Regardless of redshift, we observed a decline in the relative strength of FIR luminosities for quasars with higher near-infrared luminosities

Floristic composition and diversity of epiphytes in Farante Forest, Sodo Zuria District, Wolaita Zone, Southern Ethiopia

Although epiphytes play a significant role in the functioning of forest ecosystems, their ecological importance has often given less attention. The objective of this study was to assess the floristic composition and diversity of epiphytes in the Farante Forest. A total of sixty (25m x 25m) plots/quadrates were systematically laid. They were laid on the line transacts that were established in the Farante forest for vegetation for data collection. Phorophytes’ vertical structure, diameter at breast height, bark texture, abundance of epiphytes and phorophytes, and elevation of each plot were collected as data. Voucher specimens of both epiphytes and phorophytes were collected for identification in the national herbarium of Ethiopia. Twenty-six (26) vascular epiphytes belonging to 22 genera and 10 families were recorded in Farante Forest. Polypodiaceae was the most abundant family. Acacia abyssinica, Ficus vasta, and Olea europaea subsp. cuspidata harbored the highest species richness of epiphytes. The relative distribution of epiphytes on the vertical structure of the phorophyte indicated 37% on the trunk, 36% on the canopy, and 27% on the base. The relative distribution of epiphytes on the texture of the phorophyte indicates 63% on a rough texture and 37% on a smooth texture. A significant (p = 0.002) and positive correlation (r = 0.96) were observed in the abundance of epiphytes and the size of the DBH of phorophytes. The diversity and evenness of epiphytes were 3.01 and 0.924, respectively, in the forest. The finding, therefore, confirmed the dominance of a few epiphytes harbored by a few host species, the highest epiphyte composition in the trunk zone, and the rough bark of phorophytes

Effects of Long-Versus Short-Term Exposure to the Mediterranean Diet on Skin Microvascular Function and Quality of Life of Healthy Adults in Greece and the UK

The beneficial effects of the Mediterranean diet (MD) adherence in reducing cardiovascular disease (CVD) risk and improving CVD-related physiological indices have been well-documented. However, the exact MD adherence duration needed for these effects to occur is under-researched. The aim of the present, two-arm, two-site study clinical trial was to assess the effects of long- vs. short-term MD adherence on the skin microvascular circulation, and quality of life. Two groups were recruited, one being long-term MD adherers (>5 years; from Greece; control group), and one of the non-adherers (from the UK), with the latter participating in a four-week MD intervention (intervention group). Our main outcome was skin microvascular function assessed by cutaneous vascular conductance (CVC). Secondary outcomes included quality of life, dietary intake, blood pressure and lipidemic profile. At the end of the intervention, both groups had high MD adherence. For the intervention group, significantly improved post-intervention CVC values were noted concerning the initial peak phase (2.0 ± 0.6 vs. 2.8 ± 0.8; p 0.05). CVC values of the control group, were however higher at the plateau phase in comparison to the intervention group (intervention end; 3.8 ± 0.8 vs. 3.1 ± 1.2; p 0.05). As per QoL, the physical domain was improved post-intervention (13.7 ± 1.2 vs. 15.9 ± 1.2; p 0.05). No differences were observed in the lipidemic profile between groups, or between the baseline and final intervention phases. The findings indicate that although short-term MD adherence is effective in improving certain microvascular physiological properties and QoL domains, there is room for additional improvement, observed in long-term adherers. Our findings are important in the design of future, MD-based, lifestyle interventions, with the advisable durations differing between target groups

5G infrastructures supporting end-user and operational services:The 5G-XHaul architectural perspective

We propose an optical-wireless 5G infrastructure offering converged fronthauling/backhauling functions to support both operational and end-user cloud services. A layered architectural structure required to efficiently support these services is shown. The data plane performance of the proposed infrastructure is evaluated in terms of energy consumption and service delay through a novel modelling framework. Our modelling results show that the proposed architecture can offer significant energy savings but there is a clear trade-off between overall energy consumption and service delay.Peer ReviewedPostprint (author's final draft

Phenotypic characterization of Ethiopian indigenous goat populations

A survey was conducted to study the morphological characteristics of indigenous goats in representative zones and districts of Amhara Region of Ethiopia as a first step towards characterization and designing of breeding programs. A pre-tested questionnaire was used for recording morphological features, body weights and linear body measurements. Both qualitative and quantitative traits were recorded on 158 goats randomly sampled from six goat populations and the data were analyzed using GenStat version 13 software. Live body weights were also associated and predicted using linear body measurements. Results confirmed that six distinct indigenous goat populations were identified and characterized in the region viz. Gumuz, Begia-Medir, Agew, Bati, Central Abergelle and Abergelle. There were clear morphological variations between and within these goat ecotypes in terms of body coat color, head profile, horn orientation, ear form and head shape. The Ethiopian goat ecotypes found in Amhara Region of Ethiopia could be clustered into two main groups viz. Gumuz, Agew and Begia-Medir cluster as one group and Bati, Abergelle and Central Abergelle as the second group. The high variations observed in the morphological traits suggest that these goat ecotypes have not yet been selected through structured selective breeding. The high correlation coefficients of heart girth with body weight for west (r = 0.899) and east (r = 0.832) Amhara Region goat populations demonstrated a strong relationship between these variables with regression equations of y = 1.273x – 61.329, R² = 0.807 and y = 0.486 x – 5.798, R² = 0.095, respectively, which allows for predicting live weight from heart girth in these goats. In general, the observed morphological characteristics of the goats’ genetic resources in Amhara region together with the characterization at molecular level will contribute to designing of improvement strategies for these goat populations, which will need to be complemented with performance data.Keywords: Ethiopia, goat types, Amhara region, morphological feature

Does deregulation drive innovation intensity? Lessons learned from the OECD telecommunications sector

The channel between innovation and industry regulation constitutes a non-lasting debate among the economists and researchers within the recent years. Despite the significant contributions on this field, mostly made from the empirical standpoint, the existing literature is still incomplete. This might be attributed to the fact that existing studies fail to combine a strong theoretical framework with the empirical scrutiny in order to exemplify and decompose the relationship between regulation intensity and innovation activity. We attempt to shed light on this limitation by theoretically modeling the telecommunications sector, in which access regulation impacts the non-separable activity in process and product innovation. We then empirically test our model by deploying an efficient panel threshold technique along the lines of Hansen (1999). Our balanced panel dataset comprises of 32 OECD countries over the period 1995-2012. The empirical results unveil a non-monotonic relationship of an “inverted V-shaped” form between regulation and innovation. We argue that beyond certain thresholds increasing the regulatory stringency further results in decreasing sector innovation. Our findings survive robustness checks after the inclusion of two alternative threshold variables (market structure and entry regulation) incurring significant implications for the policy makers and government officials

Scene integration for online VR advertising clouds

This paper presents a scene composition approach that allows the combinational use of standard three dimensional objects, called models, in order to create X3D scenes. The module is an integral part of a broader design aiming to construct large scale online advertising infrastructures that rely on virtual reality technologies. The architecture addresses a number of problems regarding remote rendering for low end devices and last but not least, the provision of scene composition and integration. Since viewers do not keep information regarding individual input models or scenes, composition requires the consideration of mechanisms that add state to viewing technologies. In terms of this work we extended a well-known, open source X3D authoring tool