UK community health visiting: challenges faced during lean implementation

This paper presents an overview of the challenges and potential of lean implementation for the health visiting service in England and examines the rhetoric and the reality of the situation. It is coauthored by academic researchers and senior service providers so as to embrace the multidimensional issues impacting on this subject. If lean thinking is to be implemented in relation to health visiting, it is important to understand how it is likely to be viewed by practitioners and line managers in settings where it is used. In order to contextualize the discussion, an introduction to the roles, systems, and structures of health visiting are provided. The literature on what lean implementation is, what it means, and in particular the application and potential of the approach to primary care and public health services is reviewed. The process and findings from a focus group convened within a large primary care organization in the National Health Service during their lean implementation is reported. The paper concludes that it is important for staff at all levels to see a clear link between strategic aims and objectives and the planning processes operated by providers and commissioners. It appears that the successful introduction of lean thinking should focus more on productive working and thereby reducing waste. This has the potential to refresh workforce models to ensure that health visiting and other practitioners liberate the use of their specialist knowledge and skills. In a context of enhanced partnership working, the stage is then set for providers to add value to the whole system and together improve service user outcomes

Impulsivity Like Traits and Risky Driving Behaviors Among College Students

The present study examined the predictive effects of five impulsivity-like traits (Premeditation, Perseverance, Sensation Seeking, Negative Urgency, and Positive Urgency) on driving outcomes (driving errors, driving lapses, driving violations, cell phone driving, traffic citations, and traffic collisions). With a convenience sample of 266 college student drivers, we found that each of the impulsivity-like traits was related to multiple risky driving outcomes. Positive Urgency (tendency to act impulsively when experiencing negative affect) was the most robust predictor of risky driving outcomes. Positive Urgency is a relatively newly conceptualized impulsivity-like trait that was not examined in the driving literature previously, suggesting a strong need to further examine its role as a personality trait related to risky driving. These findings generally support the multidimensional assessment of impulsivity-like traits, and they specifically support the addition of Positive Urgency to a list of risk factors for risky driving behaviors

Bendings of radio jets in BL Lacertae objects I: EVN and MERLIN observations

Several blazars, and BL Lac objects in particular, show a misalignment between the jet orientation on parsec and kiloparsec scales. Some authors (i.e. Conway & Murphy, 1993) have attempted to explain this behaviour invoking helical jets for misalignment angles around 90\degr, showing how in this case there are interesting implications for the understanding of the medium into which the jet is expanding. By comparing sensitive VLA observations (Cassaro et al., 1999) with images available in the literature for the BL Lac objects from the 1-Jy Sample (Stickel et al., 1991), it is clear that there is a wide range of misalignments between the initial jet direction and the kpc-scale jet, when detected. We have carried out VLBI observations of these BL Lac objects, in order to investigate the spatial evolution of the radio jets from few tens to hundreds of mas, and to search for helical jets in this class of sources. We present here the first dataset obtained from EVN+MERLIN observations at 5 GHz for seven objects. From these observations we never have a clear detection of helical jets, we only have a possible signature of their presence in 2 objects. In only one of the sources with a misalignment angle around 90\degr the presence of helical jets can be ruled out. This implies that it is not possible to invoke helical jets to explain the morphology of all the sources showing a misalignment of about 90\degr between the parsec and the kiloparsec scale jets.Comment: 12 pages, 9 figures, latex, accepted by Astronomy & Astrophysic

Topological Order in Projected Wave Functions and Effective Theories of Quantum Antiferromagnets

We study the topological order in RVB state derived from Gutzwiller projection of BCS-like mean field state. We propose to construct the topological excitation on the projected RVB state through Gutzwiller projection of mean field state with inserted $Z_{2}$ flux tube. We prove that all projected RVB states derived from bipartite effective theories, no matter the gauge structure in the mean field ansatz, are positive definite in the sense of the Marshall sign rule, which provides a universal origin for the absence of topological order in such RVB state.Comment: 5 pages, 1 figure

LC-MS based quantification of 2’-ribosylated nucleosides Ar(p) and Gr(p) in tRNA

RNA nucleosides are often naturally modified into complex non-canonical structures with key biological functions. Here we report LC-MS quantification of the Ar(p) and Gr(p) 2'-ribosylated nucleosides in tRNA using deuterium labelled standards, and the first detection of Gr(p) in complex fungi

Fast interior point solution of quadratic programming problems arising from PDE-constrained optimization

Interior point methods provide an attractive class of approaches for solving linear, quadratic and nonlinear programming problems, due to their excellent efficiency and wide applicability. In this paper, we consider PDE-constrained optimization problems with bound constraints on the state and control variables, and their representation on the discrete level as quadratic programming problems. To tackle complex problems and achieve high accuracy in the solution, one is required to solve matrix systems of huge scale resulting from Newton iteration, and hence fast and robust methods for these systems are required. We present preconditioned iterative techniques for solving a number of these problems using Krylov subspace methods, considering in what circumstances one may predict rapid convergence of the solvers in theory, as well as the solutions observed from practical computations

Preconditioners for state constrained optimal control problems with Moreau-Yosida penalty function

Optimal control problems with partial differential equations as constraints play an important role in many applications. The inclusion of bound constraints for the state variable poses a significant challenge for optimization methods. Our focus here is on the incorporation of the constraints via the Moreau-Yosida regularization technique. This method has been studied recently and has proven to be advantageous compared to other approaches. In this paper we develop robust preconditioners for the efficient solution of the Newton steps associated with solving the Moreau-Yosida regularized problem. Numerical results illustrate the efficiency of our approach

Durrington Walls to West Amesbury by way of Stonehenge: a major transformation of the Holocene landscape

A new sequence of Holocene landscape change has been discovered through an investigation of sediment sequences, palaeosols, pollen and molluscan data discovered during the Stonehenge Riverside Project. The early post-glacial vegetational succession in the Avon valley at Durrington Walls was apparently slow and partial, with intermittent woodland modification and the opening-up of this landscape in the later Mesolithic and earlier Neolithic, though a strong element of pine lingered into the third millennium BC. There appears to have been a major hiatus around 2900 cal BC, coincident with the beginnings of demonstrable human activities at Durrington Walls, but slightly after activity started at Stonehenge. This was reflected in episodic increases in channel sedimentation and tree and shrub clearance, leading to a more open downland, with greater indications of anthropogenic activity, and an increasingly wet floodplain with sedges and alder along the river’s edge. Nonetheless, a localized woodland cover remained in the vicinity of DurringtonWalls throughout the third and second millennia BC, perhaps on the higher parts of the downs, while stable grassland, with rendzina soils, predominated on the downland slopes, and alder–hazel carr woodland and sedges continued to fringe the wet floodplain. This evidence is strongly indicative of a stable and managed landscape in Neolithic and Bronze Age times. It is not until c 800–500 cal BC that this landscape was completely cleared, except for the marshy-sedge fringe of the floodplain, and that colluvial sedimentation began in earnest associated with increased arable agriculture, a situation that continued through Roman and historic times