Peer influence as a driver of technological innovation in the UK National Health Service: a qualitative study of clinicians’ experiences and attitudes

Background Accelerating innovation to improve quality is a key policy target for healthcare systems around the world. Effectively influencing individuals’ behaviour is crucial to the success of innovation initiatives. This study explores UK clinicians’ lived experiences of, and attitudes towards, clinical peers endorsing healthcare innovations. Methods Qualitative interviews with UK-based clinicians in one of two groups: (1) clinicians working in ‘front-line’ service provision and (2) clinicians in strategic leadership roles within health institutions. Participants were identified through purposive sampling, and participated in semistructured telephone interviews. Thematic analysis was used to identify and analyse themes in the data. Results 17 participants were recruited: eight clinicians from front-line UK healthcare settings and nine clinicians in leadership roles. Two major themes were identified from the interviews: power and trust. Participants recognised and valued peers’ powerful influence, exerted in person via social networks and routine work-related activities. Peers were implicitly trusted, although often on condition of their credibility and deservingness of respect, supporting evidence and absence of conflict of interest. While the groups shared similar views, they diverged on the subject of institutions, felt to be powerful by strategic leaders yet scarcely mentioned by front-line clinicians. Conclusions UK clinicians view peers as a powerful and trustworthy source to promote innovative technologies. Policies that aim to support this process should seek to control the wider conditions that nurture peer-to-peer influence. Further research into interpersonal influence in health settings may improve implementation of change initiatives

From traditional to modern: easing students transition to problem-based learning.

Letter to the Edito

SDN next generation integrated architecture for HEP and global science

I describe a software-defined global system under development by Caltech and partner network teams in support of the LHC and other major science programs that coordinates workflows among hundreds of multi-petabyte data stores and petascale computing facilities interlinked by 100 Gbps networks, and the Exascale systems needed by the next decade

Cone and seed maturity indices in Pinus wallichiana under temperate conditions of Kashmir Himalayas, India

Pinus wallichiana (Blue pine) does not have a good seed every year and hence it becomes necessary to collect abundant quantity of seed during good seed year. It becomes necessary to know the exact time of seed ma-turity. To overcome this problem, the present investigation was conducted in Kashmir valley at four different altitudes and locations i.e. (1,600-2,000 masl–KFD), (2,000-2,400 masl -LFD), (2,400-2,800-PFD) and (2,800-3200 masl– SFD). The results revealed that seed collection clearly showed wide variation in the maturity of cones. Cone colour served as an indicator of maturity and it changed from light green to green and green with brown patches at maturity-ty. Seed colour changed from whitish to light brown and dark brown at maturity. The mean cone weight (118.67- 88.17gm) and specific gravity (1.13-0.90) decreased as the cones proceeded towards maturity. The mean seed weight of 21.79 to 57.13gm increased at all altitudes as the cones advanced towards maturity. Cone length, cone diameter and germination percent differed (P?0.05) significantly between altitudes and increased when the cones advanced towards maturity. The germination per cent was recorded more at altitudinal range of 1,600-2,400 masl (67.25-70.26%) at maturity, while as it was recorded lower at higher altitudes (42.12-47.25%). It is concluded that the altitudinal range of 1,600-2,400 masl is best sites for collection of phenotypically superior seeds in terms of maxi-mum cone length (18.18cm), diameter (5.23mm) and weight (108.94gm), number of seeds per cone (117.72), seed weight (79.99) and germinability (68.75)

Lepton Flavor Violating Z Decays in the Zee Model

We calculate lepton flavor violating (LFV) Z decays Z \to {{e_i^\pm}}e_j^\mp (i, j = e, \mu, \tau ; i\neq j) in the Zee model keeping in view the radiative leptonic decays e_i\to e_j\gamma (i = \mu, \tau ; j = e, \mu ; i\neq j), \mu decay and anomalous muon magnetic moment (\mu AMM). We investigate three different cases of Zee f_{ij} coupling (A) f_{e\mu}^2 = f_{\mu\tau}^2= f_{\tau e}^2, (B) f_{e\mu}^2 \gg f_{\tau e}^2 \gg f_{\mu\tau}^2, and (C) f_{\mu\tau}^2 \gg f_{e\mu}^2 \gg f_{\tau e}^2 subject to the neutrino phenomenology. Interestingly, we find that, although the case (C) satisfies the large excess value of \mu AMM, however, it is unable to explain the solar neutrino experimental result, whereas the case (B) satisfies the bi-maximal neutrino mixing scenario, but confronts with the result of \mu AMM experiment. We also find that among all the three cases, only the case (C) gives rise to largest contribution to the ratio B(Z\to e^\pm\tau^\mp)/B(Z\to \mu^\pm \mu^\mp) \simeq {10}^{-8} which is still two order less than the accessible value to be probed by the future linear colliders, whereas for the other two cases, this ratio is too low to be observed even in the near future for all possible LFV Z decay modes.Comment: 12 pages, RevTex, 2 figures, 3 Tables, typos corrected, reference added, version to appear in Phys. Rev.

Mapping and functional characterization of the murine Smoothelin-like 1 promoter

BACKGROUND: Smoothelin-like 1 (SMTNL1, also known as CHASM) plays a role in promoting relaxation as well as adaptive responses to exercise, pregnancy and sexual development in smooth and skeletal muscle. Investigations of Smtnl1 transcriptional regulation are still lacking. Thus, in this study, we identify and characterize key regulatory elements of the mouse Smtnl1 gene. RESULTS: We mapped the key regulatory elements of the Smtnl1 promoter region: the transcriptional start site (TSS) lays -44 bp from the translational start codon and a TATA-box motif at -75 bp was conserved amongst all mammalian Smtnl1 promoters investigated. The Smtnl1 proximal promoter enhances expression up to 8-fold in smooth muscle cells and a second activating region lays 500 bp further upstream. Two repressing motifs were present (-118 to -218 bp and -1637 to -1869 bp). The proximal promoter is highly conserved in mammals and contains a mirror repeat sequence. In silico analysis suggests many transcription factors (notably MyoD) could potentially bind within the Smtnl1 proximal promoter sequence. CONCLUSION: Smtnl1 transcript was identified in all smooth muscle tissues examined to date, albeit at much lower levels than found in skeletal muscle. It is unlikely that multiple SMTNL1 isoforms exist since a single Smtnl1 transcription start site was identified in both skeletal and intestinal smooth muscle. Promoter studies suggest restrictive control of Smtnl1 expression in non-muscle cells

Sun exposure behaviour, seasonal vitamin D deficiency, and relationship to bone health in adolescents

YesContext: Vitamin D is essential for bone health in adolescence, where there is rapid bone mineral content accrual. As cutaneous sun-exposure provides vitamin D, there is no recommended oral intake for UK adolescents. Objective: Assess seasonal vitamin D status and its contributors in white Caucasian adolescents, and examine bone health in those found deficient. Design: Prospective cohort study. Setting: Six schools in Greater Manchester, UK. Participants: 131 adolescents, 12–15 years. Intervention(s): Seasonal assessment of circulating 25-hydroxyvitamin D (25OHD), personal sunexposure and dietary vitamin D. Adolescents deficient (25OHD <10 ng/mL/25 nmol/L) in ≥one season underwent dual-energy X-ray absorptiometry (lumbar spine, femoral neck), with bone mineral apparent density (BMAD) correction for size, and peripheral quantitative computed tomography (distal radius) for volumetric (v)BMD. Main Outcome Measure: Serum 25OHD; BMD. Results: Mean 25OHD was highest in September: 24.1 (SD 6.9) ng/mL and lowest in January: 15.5 (5.9) ng/mL. Over the year, 16% were deficient in ≥one season and 79% insufficient (25OHD <20 ng/mL/50 nmol/L) including 28% in September. Dietary vitamin D was low year-round while personal sun-exposure was seasonal and predominantly across the school week. Holidays accounted for 17% variation in peak 25OHD (p<0.001). Nineteen adolescents underwent bone assessment, which showed low femoral neck BMAD versus matched reference data (p=0.0002), 3 with Z≤ -2.0 distal radius trabecular vBMD. Conclusions: Sun-exposure levels failed to provide adequate vitamin D, ~one-quarter adolescents insufficient even at summer-peak. Seasonal vitamin D deficiency was prevalent and those affected had low BMD. Recommendations on vitamin D acquisition are indicated in this age-group.The Bupa Foundation (Grant number TBF-M10-017)

Broken R Parity Contributions to Flavor Changing Rates and CP Asymmetries in Fermion Pair Production at Leptonic Colliders

We examine the effects of the R parity odd renormalizable interactions on flavor changing rates and CP violation asymmetries in the production of fermion-antifermion pairs at $e^-- e^+$ leptonic colliders. The produced fermions may be leptons, down-quarks or up-quarks, and the center of mass energies may range from the Z-boson pole up to $1000$ GeV. Off the Z-boson pole, the flavor changing rates are controlled by tree level amplitudes and the CP asymmetries by interference terms between tree and loop level amplitudes. At the Z-boson pole, both observables involve loop amplitudes. The lepton number violating interactions, associated with the coupling constants, \l_{ijk}, \l'_{ijk}, are only taken into account. The consideration of loop amplitudes is restricted to the photon and Z-boson vertex corrections. We briefly review flavor violation physics at colliders. We present numerical results using a single, species and family independent, mass parameter, $\tilde m$, for all the scalar superpartners and considering simple assumptions for the family dependence of the R parity odd coupling constants.Comment: Latex File. 23 pages. 4 postscript figures. 1 table. Revised version with new results and several corrections in numerical result

Isolated bladder exstrophy associated with a de novo 0.9 Mb microduplication on chromosome 19p13.12.

The exstrophy-epispadias complex (BEEC) is a urogenital birth defect of varying severity. The causes of the BEEC are likely to be heterogeneous, with individual environmental or genetic risk factors still being largely unknown. In this study, we aimed to identify de novo causative copy number variations (CNVs) that contribute to the BEEC. METHODS Array-based molecular karyotyping was performed to screen 110 individuals with BEEC. Promising CNVs were tested for de novo occurrence by investigating parental DNAs. Genes located in regions of rearrangements were prioritized through expression analysis in mice to be sequenced in the complete cohort, to identify high-penetrance mutations involving small sequence changes. RESULTS A de novo 0.9 Mb microduplication involving chromosomal region 19p13.12 was identified in a single patient. This region harbors 20 validated RefSeq genes, and in situ hybridization data showed specific expression of the Wiz gene in regions surrounding the cloaca and the rectum between GD 9.5 and 13.5. Sanger sequencing of the complete cohort did not reveal any pathogenic alterations affecting the coding region of WIZ. CONCLUSIONS The present study suggests chromosomal region 19p13.12 as possibly involved in the development of CBE, but further studies are needed to prove a causal relation. The spatiotemporal expression patterns determined for the genes encompassed suggest a role for Wiz in the development of the phenotype. Our mutation screening, however, could not confirm that WIZ mutations are a frequent cause of CBE, although rare mutations might be detectable in larger patient samples