Innovation in urban political leadership. Reflections on the introduction of a directly-elected mayor in Bristol, UK

In May 2012, 10 of England's largest cities, outside London, were required to hold referendums giving citizens the option of introducing a directly-elected mayor. Bristol was the only city to vote in favour of the mayoral model. This paper outlines the main themes that feature in current debates about urban leadership. It presents a framework for understanding place-based leadership and, by drawing on a current researchproject on mayoral governance in Bristol, highlights the existence of very different perceptions of how to improve city leadership and democratic accountability. © 2014 CIPFA

Diagnosis, surveillance, and screening for fetal alcohol spectrum disorders: methods and dilemmas

Fetal Alcohol Spectrum Disorder (FASD) is a prevalent preventable disorder with a significant societal burden related to the cognitive and behavioral disabilities associated with this disorder. This paper reviews the published work on FASD diagnosis, surveillance, and screening programs. Challenges inherent to FASD diagnosis remain and complicate attempts to estimate FAS prevalence. In addition, the drive toward diagnostic accuracy has led to the formulation of screening children at school ages after many disabilities associated with FASD are established. We present the design and selected findings from a regional multi-stage screening project piloted in Wisconsin. Small for gestational age (SGA) newborns with birth head circumference less than 10th percentile were selected in the first screening stages. Those meeting these criteria were evaluated for growth, development and FAS facial features at about 2 years of age. Of newborns meeting the initial screening criteria, 30% demonstrated growth deficits and developmental delays at about 2 years of age. Children with any FS facial feature (of 177 children assessed, n=13 with 2 or 3 facial findings, n=77 with one facial finding) showed greater deficits in growth and a greater proportion were developmentally delayed. The findings demonstrate the potential value of embedding screening for FASA within a multistage screening method to identify infants at risk for any developmental delay. Because this model would be a part of larger population screening for developmental delay, cost efficiencies could be achieved. Problems relating to protection and confidentiality that inevitably accompany screening to identify FASD would also be reduced