bluuebunny/crossref_metadata_2025 huggingface dataset:
Aging village doctors in five counties in rural China: situation and implications
Authors: Xu Huiwen , Zhang Weijun , Gu Linni , Qu Zhiyong , Sa Zhihong , Zhang Xiulan , Tian Donghua
Published: June 2014

Background

The aging population, rapid urbanization, and epidemiology transition in China call for the improvement and adaptation of the health workforce, especially in underserved rural areas. The aging of village doctors (the former “barefoot doctors”) who have served the rural residents for many decades has become a warning signal for the human resources for health in China. This study aims to investigate the village doctors’ aging situation and its implications in rural China.

Methods

The data reviewed were obtained from the baseline survey of a longitudinal study of rural health workforce in five counties in rural China in 2011. Using a stratified multi-stage cluster sampling process, the baseline data was collected through the self-administered structured Village Doctor Questionnaire. Descriptive analyses, correlation analyses, and multivariate linear regression with interaction terms were conducted with the statistics software Stata 12.0.

Results

The average age of the 1,927 village doctors was 49.3 years (95% CI 48.8 to 49.9), 870 (45.2%) of whom were aging (50 years or older). Both the age and the recruitment time of the village doctors were demonstrated to have a bimodal distribution. A greater proportion of the male village doctors were aging. Furthermore, aging of the village doctors was significantly correlated to their education level, type of qualification, practicing methods, and their status as village clinic directors (P <0.05, respectively). As shown in the regression models, aging village doctors provided significantly more outpatient services to rural residents (P <0.01) but without an increase in income, and their expected pension was lower (P <0.01), compared with their non-aging counterparts.

Conclusions

Aging of village doctors is a serious and imperative issue in China, which has a complex and profound impact on the rural health system. Greater attention should be paid to the construction of the pension system and the replenishment of the village doctors with qualified medical graduates.
Research progress on electronic phase separation in low-dimensional perovskite manganite nanostructures
Authors: Liang Lizhi , Li Lei , Wu Heng , Zhu Xinhua
Published: June 2014

Perovskite oxide manganites with a general formula of R1-x
Ax MnO3 (where R is a trivalent rare-earth element such as La, Pr, Sm, and A is a divalent alkaline-earth element such as Ca, Sr, and Ba) have received much attention due to their unusual electron-transport and magnetic properties, which are indispensable for applications in microelectronic, magnetic, and spintronic devices. Recent advances in the science and technology have resulted in the feature sizes of microelectronic devices based on perovskite manganite oxides down-scaling into nanoscale dimensions. At the nanoscale, low-dimensional perovskite manganite oxide nanostructures display novel physical properties that are different from their bulk and film counterparts. Recently, there is strong experimental evidence to indicate that the low-dimensional perovskite manganite oxide nanostructures are electronically inhomogeneous, consisting of different spatial regions with different electronic orders, a phenomenon that is named as electronic phase separation (EPS). As the geometry sizes of the low-dimensional manganite nanostructures are reduced to the characteristic EPS length scale (typically several tens of nanometers in manganites), the EPS is expected to be strongly modulated, leading to quite dramatic changes in functionality and more emergent phenomena. Therefore, reduced dimensionality opens a door to the new functionalities in perovskite manganite oxides and offers a way to gain new insight into the nature of EPS. During the past few years, much progress has been made in understanding the physical nature of the EPS in low-dimensional perovskite manganite nanostructures both from experimentalists and theorists, which have a profound impact on the oxide nanoelectronics. This nanoreview covers the research progresses of the EPS in low-dimensional perovskite manganite nanostructures such as nanoparticles, nanowires/nanotubes, and nanostructured films and/or patterns. The possible physical origins of the EPS are also discussed from the signatures of electronic inhomogeneities as well as some theoretical scenarios, to shed light on understanding this phenomenon. Finally, the perspectives to the future researches in this area are also outlined.
Thermal conductivity reduction of crystalline silicon by high-pressure torsion
Authors: Harish Sivasankaran , Tabara Mitsuru , Ikoma Yoshifumi , Horita Zenji , Takata Yasuyuki , Cahill David G , Kohno Masamichi
Published: June 2014

We report a dramatic and irreversible reduction in the lattice thermal conductivity of bulk crystalline silicon when subjected to intense plastic strain under a pressure of 24 GPa using high-pressure torsion (HPT). Thermal conductivity of the HPT-processed samples were measured using picosecond time domain thermoreflectance. Thermal conductivity measurements show that the HPT-processed samples have a lattice thermal conductivity reduction by a factor of approximately 20 (from intrinsic single crystalline value of 142 Wm−1 K−1 to approximately 7.6 Wm−1 K−1). Thermal conductivity reduction in HPT-processed silicon is attributed to the formation of nanograin boundaries and metastable Si-III/XII phases which act as phonon scattering sites, and because of a large density of lattice defects introduced by HPT processing. Annealing the samples at 873 K increases the thermal conductivity due to the reduction in the density of secondary phases and lattice defects.
Correlates of foot pain severity in adults with hallux valgus: a cross‐sectional study
Authors: Hurn Sheree E , Vicenzino Bill T , Smith Michelle D
Published: June 2014

Background

Hallux valgus (HV) is highly prevalent and associated with progressive first metatarsophalangeal joint subluxation and osteoarthritis. The link between structural HV deformity and foot pain is unclear. This study investigated possible explanatory factors surrounding foot pain in HV, including radiographic HV angle and signs of joint degeneration.

Methods

Participants were 60 adults (53 female) with HV aged 20 to 75 years. Participant demographics and a range of radiographic, clinical and functional measures were considered potential correlates of foot pain. Self‐reported foot pain (visual analogue scales and a dichotomous definition) was considered the dependent variable. Multivariate modelling was used to determine which characteristics and measures explained pain, with univariate analyses first used to screen potential variables.

Results

Approximately 20 to 30% of the variance in foot pain associated with HV could be explained by patient characteristics such as poorer general health status, lower educational attainment and increased occupational physical activity levels, in combination with some dynamic physical characteristics such as hallux plantarflexion weakness and reduced force‐time integral under the second metatarsal during gait. Neither increasing lateral deviation of the hallux (HV angle) nor presence of first metatarsophalangeal joint osteoarthritis was associated with foot pain.

Conclusions

This study shows that passive structural factors, including HV angle, do not appear to be significant correlates of foot pain intensity in HV. Our data demonstrate the importance of considering patient characteristics such as general health and physical activity levels when assessing foot pain associated with HV.
Proteochemometric modeling in a Bayesian framework
Authors: Cortes-Ciriano Isidro , van Westen Gerard JP , Lenselink Eelke Bart , Murrell Daniel S , Bender Andreas , Malliavin Thérèse
Published: June 2014

Proteochemometrics (PCM) is an approach for bioactivity predictive modeling which models the relationship between protein and chemical information. Gaussian Processes (GP), based on Bayesian inference, provide the most objective estimation of the uncertainty of the predictions, thus permitting the evaluation of the applicability domain (AD) of the model. Furthermore, the experimental error on bioactivity measurements can be used as input for this probabilistic model.

In this study, we apply GP implemented with a panel of kernels on three various (and multispecies) PCM datasets. The first dataset consisted of information from 8 human and rat adenosine receptors with 10,999 small molecule ligands and their binding affinity. The second consisted of the catalytic activity of four dengue virus NS3 proteases on 56 small peptides. Finally, we have gathered bioactivity information of small molecule ligands on 91 aminergic GPCRs from 9 different species, leading to a dataset of 24,593 datapoints with a matrix completeness of only 2.43%.

GP models trained on these datasets are statistically sound, at the same level of statistical significance as Support Vector Machines (SVM), with

R

0

2

values on the external dataset ranging from 0.68 to 0.92, and RMSEP values close to the experimental error. Furthermore, the best GP models obtained with the normalized polynomial and radial kernels provide intervals of confidence for the predictions in agreement with the cumulative Gaussian distribution. GP models were also interpreted on the basis of individual targets and of ligand descriptors. In the dengue dataset, the model interpretation in terms of the amino-acid positions in the tetra-peptide ligands gave biologically meaningful results.
A software framework for data dimensionality reduction: application to chemical crystallography
Authors: Samudrala Sai Kiranmayee , Balachandran Prasanna Venkataraman , Zola Jaroslaw , Rajan Krishna , Ganapathysubramanian Baskar
Published: June 2014

Materials science research has witnessed an increasing use of data mining techniques in establishing process‐structure‐property relationships. Significant advances in high‐throughput experiments and computational capability have resulted in the generation of huge amounts of data. Various statistical methods are currently employed to reduce the noise, redundancy, and the dimensionality of the data to make analysis more tractable. Popular methods for reduction (like principal component analysis) assume a linear relationship between the input and output variables. Recent developments in non‐linear reduction (neural networks, self‐organizing maps), though successful, have computational issues associated with convergence and scalability. Another significant barrier to use dimensionality reduction techniques in materials science is the lack of ease of use owing to their complex mathematical formulations. This paper reviews various spectral‐based techniques that efficiently unravel linear and non‐linear structures in the data which can subsequently be used to tractably investigate process‐structure‐property relationships. In addition, we describe techniques (based on graph‐theoretic analysis) to estimate the optimal dimensionality of the low‐dimensional parametric representation. We show how these techniques can be packaged into a modular, computationally scalable software framework with a graphical user interface ‐ Scalable Extensible Toolkit for Dimensionality Reduction (SETDiR). This interface helps to separate out the mathematics and computational aspects from the materials science applications, thus significantly enhancing utility to the materials science community. The applicability of this framework in constructing reduced order models of complicated materials dataset is illustrated with an example dataset of apatites described in structural descriptor space. Cluster analysis of the low‐dimensional plots yielded interesting insights into the correlation between several structural descriptors like ionic radius and covalence with characteristic properties like apatite stability. This information is crucial as it can promote the use of apatite materials as a potential host system for immobilizing toxic elements.
Markerless 3D motion capture for animal locomotion studies
Authors: Sellers William Irvin , Hirasaki Eishi
Published: June 2014

Obtaining quantitative data describing the movements of animals is an essential step in understanding their locomotor biology. Outside the laboratory, measuring animal locomotion often relies on video-based approaches and analysis is hampered because of difficulties in calibration and often the limited availability of possible camera positions. It is also usually restricted to two dimensions, which is often an undesirable over-simplification given the essentially three-dimensional nature of many locomotor performances. In this paper we demonstrate a fully three-dimensional approach based on 3D photogrammetric reconstruction using multiple, synchronised video cameras. This approach allows full calibration based on the separation of the individual cameras and will work fully automatically with completely unmarked and undisturbed animals. As such it has the potential to revolutionise work carried out on free-ranging animals in sanctuaries and zoological gardens where ad hoc approaches are essential and access within enclosures often severely restricted. The paper demonstrates the effectiveness of video-based 3D photogrammetry with examples from primates and birds, as well as discussing the current limitations of this technique and illustrating the accuracies that can be obtained. All the software required is open source so this can be a very cost effective approach and provides a methodology of obtaining data in situations where other approaches would be completely ineffective.
The Drosophila MCPH1-B isoform is a substrate of the APCCdh1 E3 ubiquitin ligase complex
Authors: Hainline Sarah G. , Rickmyre Jamie L. , Neitzel Leif R. , Lee Laura A. , Lee Ethan
Published: June 2014

The Anaphase-Promoting Complex (APC) is a multi-subunit E3 ubiquitin ligase that coordinates progression through the cell cycle by temporally and spatially promoting the degradation of key proteins. Many of these targeted proteins have been shown to play important roles in regulating orderly progression through the cell cycle. Using a previously described Drosophila in vitro expression cloning approach, we screened for new substrates of the APC in Xenopus egg extract and identified Drosophila MCPH1 (dMCPH1), a protein encoded by the homolog of a causative gene for autosomal recessive primary microcephaly in humans. The dMCPH1-B splice form, but not the dMCPH1-C splice form, undergoes robust degradation in Xenopus interphase egg extract in a Cdh1-dependent manner. Degradation of dMCPH1-B is controlled by an N-terminal destruction box (D-box) motif as its deletion or mutation blocks dMCPH1-B degradation. dMCPH1 levels are increased in Drosophila morula (APC2) mutant embryos, consistent with dMCPH1 being an APC substrate in vivo. Using a purified, reconstituted system, we show that dMCPH1-B is ubiquitinated by APCCdh1, indicating that the effect of APC on dMCPH1-B ubiquitination and degradation is direct. Full-length human MCPH1 (hMCPH1) has been predicted to be an APC substrate based on its interaction with the APC subunit Cdc27. We were not able to detect changes in hMCPH1 levels during the cell cycle in cultured human cells. Overexpression of hMCPH1 (or dMCPH1-B) in developing Xenopus embryos, however, disrupts cell division, suggesting that proper regulation of hMCPH1 and dMCPH1-B activity plays a critical role in proper cell-cycle progression.
Orthosiphon stamineus protects Caenorhabditis elegans against Staphylococcus aureus infection through immunomodulation
Authors: Kong Cin , Tan Man-Wah , Nathan Sheila
Published: June 2014

Amidst growing concerns over the spread of antibiotic-resistant Staphylococcus aureus strains, the identification of alternative therapeutic molecules has become paramount. Previously, we utilized a Caenorhabditis elegans–S. aureus screening platform to identify potential anti-infective agents from a collection of natural extracts and synthetic compounds. One of the hits obtained from the screen was the aqueous extract of Orthosiphon stamineus leaves (UE-12) that enhanced the survival of infected nematodes without interfering with bacterial growth. In this study, we used a fluorescent transgenic reporter strain and observed that the repressed expression of the lys-7 defense gene in infected nematodes was restored in the presence of UE-12. Analysis of a selected panel of PMK-1 and DAF-16-regulated transcripts and loss-of-function mutants in these pathways indicates that the protective role of UE-12 is mediated via the p38 MAP kinase and insulin-like signaling pathways. Further analysis of a panel of known bioactive compounds of UE-12 proposed eupatorin (C18H16O7) as the possible candidate active molecule contributing to the anti-infective property of UE-12. Taken together, these findings strongly suggest that the O. stamineus leaf extract is a promising anti-infective agent that confers an advantage in survival against S. aureus infection by modulating the immune response of the infected host.
Ευφυή και έμπειρα συστήματα διαχείρισης ανθρώπινων πόρων
Authors: Κελεμένης Αλέξανδρος
Published: July 2014

Η παρούσα διατριβή πραγματεύεται το πρόβλημα επιλογής διοικητικών στελεχών στους σύγχρονους οργανισμούς. Λαμβάντοντας υπόψη ότι 1) η βάση του ανταγωνιστικού πλεονεκτήματος ενός οργανισμού έγκειται στην κινητοποίηση των πόρων που διαθέτει, 2) οι ανθρώπινοι πόροι είναι ο σημαντικότερος πόρος ενός οργανισμού και 3) τα στελέχη είναι οι πιο σημαντικοί ανθρώπινοι πόροι για έναν οργανισμό, αυτοί που λαμβάνουν τις αποφάσεις, που καθορίζουν στρατηγικές και διοικούν τους μη διοικητικούς εργαζόμενους, αντικείμενο της διατριβής είναι η ανάπτυξη μιας ολοκληρωμένης μεθοδολογίας υποστήριξης της αξιολόγησης και απόφασης επιλογής διοικητικών στελεχών. Η διατριβή εστιάζει στον πολυκριτήριο χαρακτήρα του προβλήματος και προτείνει μια σειρά από προσαρμογές της πολυκριτήριας μεθόδου TOPSIS (Hwang και Yoon, 1981) έτσι ώστε 1) να επεκτείνεται η μέθοδος σε περιβάλλον ομάδας αποφασιζόντων, 2) να λαμβάνεται υπόψη η ασάφεια των δεδομένων καθώς και η ασάφεια των προτιμήσεων των αποφασιζόντων, 3) να αποτρέπονται φαινόμενα μεροληψίας, 4) να λαμβάνεται υπόψη η ιδιότητα του κάθε αποφασίζοντος και 5) να λαμβάνονται υπόψη οι ιδιαίτερες προτιμήσεις των αποφασιζόντων. Για αυτό το σκοπό εισάγονται τρεις νέες παραμέτροι, η σχετική σημαντικότητα των αποφασιζόντων ανά κριτήριο αξιολόγησης, οι βαθμοί εγγύτητας και συμφωνίας μεταξύ των αποφασιζόντων και τα σημεία ελαχίστων απαιτήσεων των αποφασιζόντων. Επιπλέον, τα κριτήρια αξιολόγησης που έχουν επιλεχθεί και προτείνονται αντιστοιχούν στις σύγχρονες εκείνες διοικητικές ικανότητες, συνδεδεμένες με συγκεκριμένες συμπεριφορές, που απαιτούνται από τα διοικητικά στελέχη για επιτυχημένη εφαρμογή διοικητικών πρακτικών. Η εφαρμογή του βασικού μέρους της μεθοδολογίας υλοποιήθηκε σε ελληνική εταιρία τηλεπικοινωνιών, η οποία και επιβεβαίωσε την εφικτότητα εφαρμογής της μεθόδου κάτω από πραγματικές συνθήκες.
Ο δάσκαλος ως οργανωτής και διευκολυντής της μαθησιακής διαδικασίας
Authors: Τσαγγάρη Χρυσούλα
Published: July 2014

[…] Η μεταβολή της διάστασης του ρόλου των εκπαιδευτικών, από μεταδοτών γνώσεων σε διευκολυντών της μαθησιακής διαδικασίας προϋποθέτει από πλευράς εκπαιδευτικών την υιοθέτηση μιας διαφορετικής αντίληψης για το ρόλο τους, για τις εκπαιδευτικές τους πρακτικές και για τον τρόπο συμμετοχής των μαθητών στη διαδικασία μάθησης. Το στοιχείο αυτό αποτέλεσε και το κίνητρο για την πραγματοποίηση της παρούσας έρευνας, η οποία επιχειρεί να αναδείξει, αν και σε ποιο βαθμό, οι αντιλήψεις των Ελλήνων εκπαιδευτικών της πρωτοβάθμιας εκπαίδευσης ανταποκρίνονται στη νέα διάσταση του ρόλου τους ως οργανωτών και διευκολυντών της μαθησιακής διαδικασίας, γεγονός που επηρεάζει με τη σειρά του, σε μικρότερο ή μεγαλύτερο βαθμό, την υιοθέτηση αντίστοιχων διδακτικών πρακτικών. Σε αυτό το σημείο πρέπει να επισημανθεί πως δεν έγινε συστηματική προσπάθεια από το Υπουργείο Παιδείας Δια Βίου Μάθησης και Θρησκευμάτων (ΥΠΔΒΜΘ) να αναλυθούν στους εκπαιδευτικούς συνολικά οι λόγοι για τους οποίους προωθούνται οι αλλαγές στο περιεχόμενο των προγραμμάτων σπουδών και κατ’ επέκταση και στο ρόλο των εκπαιδευτικών. Οι αποσπασματικές προσπάθειες που καταβλήθηκαν μέχρι τώρα περιορίζονται στην επιμόρφωση των εκπαιδευτικών για τη χρήση της τεχνολογίας πληροφοριών επικοινωνίας (ΤΠΕ) και την παρουσίαση των διδακτικών μεθόδων (σχέδια εργασίας, εργασία σε ομάδες κλπ) χωρίς να εξηγούνται συνολικά οι λόγοι των συγκεκριμένων αλλαγών. Το συγκεκριμένο γεγονός εντοπίζεται και στη μελέτη διερεύνησης των επιμορφωτικών αναγκών των εκπαιδευτικών (Παιδαγωγικό Ινστιτούτο, 2010). Φαίνεται πως επιχειρείται μια αλλαγή εκ των κάτω προς τα άνω, αλλάζουν δηλαδή υποχρεωτικά οι πρακτικές στη σχολική τάξη με απώτερο σκοπό την αλλαγή των αντιλήψεων των εκπαιδευτικών για το ρόλο τους σε θεωρητικό επίπεδο. […]
Μελέτη της επίδρασης της συστηματικής έγχυσης ενδοθηλιακών προγονικών κυττάρων σε επίμυες Apo E-/- στην αθηρωμάτωση
Authors: Μπριασούλης Αλέξανδρος
Published: July 2014

Σκοπός: Η επίδραση της άμεσης έγχυσης προγονικών κυττάρων ή της έμμεσης κινητοποίησης τους από το μυελό των οστών, στη δημιουργία και εξέλιξη της αθηρωματικής πλάκας δεν είναι πλήρως διευκρινισμένα. Μελετήσαμε την επίδραση της χορήγησης αιμοποιητικών προγονικών κυττάρων lin-/sca-1+, νεδοθηλιακών προγονικών κυττάρων (ΕΠΚ) και αυξητικού παράγοντα των κοκκιοκυττάρων G-CSF σε προφλργμονώδη μόρια, μεταβολίτες του οξειδωτικού stress ακθώς και στην εξέλιξη της αθηρωματικής πλάκας.Μέθοδοι: Μύες με έλλειψη του γονιδίου απολιποπρωτεΐνης Ε (Apolipoprotein E-knockout apoE KO) υπέστησαν σπληνεκτομή και υποβλήθηκαν σε δίαιτα με αθηρωματική τροφή υψηλής συγκέντρωσης σε χοληστερόλη με σκοπό τη πρόκληση αθηροσκληρωτικών αλλοιώσεων. Κύτταρα Lin-/sca-1+ απομονώθηκαν από τον μυελό των οστών και καλλιεργήθηκαν περαιτέρω σε ΕΠΚ. Οι μύες διαχωρίστηκαν τυχαία σε 4 ομάδες (ν=10/ομάδα) και έλαβαν 2 ενδοφλέβιες θεραπείες με κύτταρα (5x105 κύτταρα lin-/sca-1+ ή ΕΠΚ), ή G-CSF (100mcg/kg/ημέρα) για 7 ημέρες ή φυσιολογικό ορό. Η επίδραση σε προφλεγμονώδεις παράγοντες, στο οξειδωτικό stress, στο μέγεθος της αθηρωματικής πλάκας και στη βαρύτητα των βλαβών μελετήθηκαν.Αποτελέσματα: Η χορήγηση τόσο του G-CSF όσο και των κυττάρων είχε ως αποτέλεσμα τη μείωση των επιπέδων των παραγόντων sICAM-1, sVCAM-1, sE-Selectin, ox-LDL, PEROX και IL-6, 6 εβδομάδες μετά τη χορήγηση τους. Δεν παρατηρήθηκε στατιστικά σημαντική μείωση των άνωθεν παραγόντων 7 ημέρες μετά τη χορήγηση των πειραματικών σχημάτων. Η επιφάνεια της αθηρωματικής πλάκας μειώθηκε τόσο από τον G-CSF (επιφάνεια 22.94%3.68, P=0.001), τα κύτταρα lin-/sca-1+ (23.27%5.98, P=0.002) και τα ΕΠΚ (23.164.86%, P=0.002). 80% των βλαβών στην ομάδα ελέγχου χαρακτηρισίτηκαν ως επιπλεγμένες σε σύγκριση με 50% στην ομάδα G-CSF (p< 0.05), 46% στην ομάδα lin-/sca-1+ (p< 0.05) και 56% στην ομάδα ΕΠΚ (p<0.05).Συμπέρασμα: Η άμεση έγχυση προγονικών κυττάρων ή η έμμεση κινητοποίηση τους από το μυελό των οστών είχε σημαντική επίδραση στην εξέλιξη της αθηρωματικής πλάκας και τα επίπεδα προφλεγμονωδών παραγόντων.
The business cycle and dynamic economic policy
Authors: Κόλλιας Ηρακλής
Published: July 2014

Στη διδακτορική διατριβή χρησιμοποιήθηκε μια πρωτότυπη μεθοδολογία η οποία βασίζεται στον υπολογισμό δεικτών βέλτιστου ελέγχου με σκοπό να αξιολογηθεί η ικανότητα της οικονομικής πολιτικής (δημοσιονομικής και νομισματικής) να αντισταθμίζει μια ισχυρή αρνητική διαταραχή στο ΑΕΠ. Η υποδειγματοποίηση του οικονομικού κύκλου έγινε με τη χρησιμοποίηση στοχαστικών εξισώσεων διαφορών δεύτερης τάξης ακολουθώντας την ιδέα του Frisch ήδη από το 1933. Η λύση τέτοιων εξισώσεων μοιάζει με μια διαταραγμένη ημιτονοειδή συνάρτηση κύματος. Βασιζόμενοι σε αυτή τη διαδικασία λύθηκαν δύο προβλήματα βέλτιστου ελέγχου ανοιχτού και κλειστού βρόγχου για τη σχεδίαση της κυκλικής συνιστώσας των δημόσιων δαπανών, φόρων και ενός βραχυπρόθεσμου επιτοκίου το οποίο καθορίζεται από την Κεντρική Τράπεζα. Από την επίλυση των προβλημάτων αυτών υπολογίστηκαν οι δείκτες βέλτιστου ελέγχου για μια σειρά από χώρες. Τα αποτελέσματα που πρόεκυψαν δείχνουν οτι η οικονομική πολιτική μπορεί να αντισταθμίσει μια ισχυρή αρνητική διαταραχή στο ΑΕΠ. Η ικανότητα αυτή της οικονομικής πολιτικής ωστόσο διαφέρει από χώρα σε χώρα.
An explanatory evo-devo model for the developmental hourglass
Authors: Akhshabi Saamer , Sarda Shrutii , Dovrolis Constantine , Yi Soojin
Published: July 2014

The "developmental hourglass'' describes a pattern of increasing morphological divergence towards earlier and later embryonic development, separated by a period of significant conservation across distant species (the "phylotypic stage''). Recent studies have found evidence in support of the hourglass effect at the genomic level. For instance, the phylotypic stage expresses the oldest and most conserved transcriptomes. However, the regulatory mechanism that causes the hourglass pattern remains an open question. Here, we use an evolutionary model of regulatory gene interactions during development to identify the conditions under which the hourglass effect can emerge in a general setting. The model focuses on the hierarchical gene regulatory network that controls the developmental process, and on the evolution of a population under random perturbations in the structure of that network. The model predicts, under fairly general assumptions, the emergence of an hourglass pattern in the structure of a temporal representation of the underlying gene regulatory network. The evolutionary age of the corresponding genes also follows an hourglass pattern, with the oldest genes concentrated at the hourglass waist. The key behind the hourglass effect is that developmental regulators should have an increasingly specific function as development progresses. Analysis of developmental gene expression profiles from Drosophila melanogaster and Arabidopsis thaliana provide consistent results with our theoretical predictions.
Reliability Computation of Heat-power Engine Structures Based on Finite Element Modeling
Authors: Прозоровский  , Prozorovskiy A. , Корецкий  , Koretskiy S. , Шиверский  , Shiverskiy E. , Европин  , Evropin S. , Юрин  , Yurin Yu. , Димитриенко  , Dimitrienko Yu.
Published: July 2014

The computational method was suggested for reliability of heat-power engine structures under continuous random in-process loads. The method is based on numerical statistical modeling of an in-process stress-strain state (SSS) of a structure with random characteristics of structural materials and computation of damage accumulation and durability of the structure under random stationary loadings. The chemical criterion of durable strength has been applied to calculate damage accumulation. The iteration method for a three-dimensional thermo-mechanics problem and the finite-element method have been used to compute the SSS of structures regarding creep. As an example of application of the developed method, computations for durability and reliability of two-layer cooled structure of a thermo-energetic power plant case have been conducted.
Women in medicine: the first female doctors
Authors: Allan Kate
Published: June 2014

Kate Allan recalls the pioneers who became the first female doctors
Structured educational model for SMBG: A model for primary care delivery
Authors: Edwards Rachel
Published: June 2014

The Diabetes National Service Framework (NSF) highlights the crucial part that education has to play in enabling people with diabetes to effectively take control of their condition, and the National Institute for Health and Care Excellence (NICE) (2009) recommends that self-monitoring of blood glucose (SMBG) is an integral part of an individual's self-management strategy. However, the cost to the NHS of SMBG in 2010 was nearly £150 million on an annual basis, and this figure is set to increase ( National Prescribing Centre, 2009 ). Combining these facts and recommendations with those from the Quality, Innovation, Productivity and Prevention (QIPP) programme, the Aston Healthcare Commissioning Group in Knowsley partnered with LifeScan (part of the Johnson and Johnson family of companies) to develop and initiate a new model of education for SMBG that resulted in: • A 60% uptake of a review model, which covered the consultation and education on SMBG guidelines • 10-minute educational clinics which led to a 25.4% reduction in overall usage of test strips • Prescribing savings to the value of £18 564 on a total annual spend of £73 086 • A net change of + 3.5% in the number of people with diabetes with %HbA1c < 7.5 and a net change of − 3.3% in the number of people with diabetes with %HbA1c 7.5–10 among the 718 type 2 diabetics who took part ( Aston Healthcare, 2009 ).
Enterprise efficiency framework: the English NHS
Authors: Turner Paul , Kane Ros , Jackson Christine
Published: June 2014

This article examines the implementation and efficacy of the enterprise culture: the policy to produce within the NHS the resource utilisation, quality and efficiency improvements demonstrated by leading private organisations. The article also considers the framework underpinning private sector best practice and offers a critical view of how it is reflected in the enterprise culture. The article concludes that despite some success in centralised measures, the enterprise culture does not meet the necessary framework to truly reproduce private sector improvements.
Organisational turbulence for community health
Authors: Allen Pauline , Cameron Ailsa , Williams Lorraine , Durand Mary Alison , Bartlett Will , Perotin Virginie , Hutchings Andrew
Published: June 2014

A policy of separating all NHS community health services (CHS) from commissioning organisations (then primary care trusts) was launched in 2008. Some CHS were to become foundation trusts (FTs—in this case, CFTs). FTs are NHS organizations with greater autonomy from the centre, able to retain any surpluses, which are thought to be able to improve efficiency and quality of services. Those CHS not destined to become CFTs were to be merged with NHS mental health and/or hospital services, or to be ‘spun out’ of the NHS to become independent not-for-profit organisations. We observed the changes made during the preparatory period, and the expectations of the effects of FT status of the managers of CHS and their NHS commissioners, together with those CHS not on the CFT pathway. We found that all CHS in the study were becoming more business-like, and starting to improve service delivery and productivity, irrespective of whether they were destined to become CFTs. Although increased autonomy was appreciated, most CHS wanted to stay within the NHS. Some managers were concerned they would lose their autonomy when merging with other NHS services. The changes and uncertainty about organisational policy for CHS have been disruptive and time consuming.
Trends in elderly diagnoses: links with multi-morbidity
Authors: Jones Rod
Published: June 2014

Since 1998/99 in England, there has been a rapid expansion in the proportion of total admissions arising from the elderly (aged 75 and over). This is exclusively due to the medical specialties, and cannot in any way be described by the demographic shift over that time period. A group of 90 diagnoses have been identified, which account for the bulk of this shift, and this group matches with diagnoses known to be associated with high levels of multi-morbidity. A potential common cause for this increase is explored.
Hip fractures, co-morbidities and clinical coding
Authors: Tilson Richard , Nanjayan Shashi Kumar , McCretton Thomas , Tambe Amol
Published: June 2014

Accurate documentation is important for clinical and financial reasons. In the NHS, inaccurate or incomplete documentation can alter the health resource group (HRG) code, and hence the tariff received by a trust for patient care. We set out to analyse documentation and coding of hip fractures and the assess the impact of inaccuracies on trust revenue. From 1st August 2011, medical records of 100 consecutive patients admitted with femoral neck fractures were reviewed. Data extracted included: demographics, fracture diagnosis, operative procedures, co-morbidities and complications. The HRG coding and tariff data were obtained for the same cohort. Based on our extracted data, coding was repeated and the tariffs recalculated accordingly. The repeat coding was then compared with the original coding. Twenty-five of the 100 cases were found to have discrepancies between the HRG coding data and our repeat coding resulting in reduction in tariff. This led to a total shortfall of £17 686 in the actual tariff obtained for the cohort which, by extrapolation, translates to a predicted annual deficit of over £100 000 for the trust. In all 25 cases, missing or incomplete coding of medical co-morbidities (such as dementia, hypertension, urinary tract infection) resulted in the observed tariff loss. Inaccuracies in clinical coding of medical co-morbidities have resulted in significant tariff loss for our hospital trust. Better education for both coders and clinicians is advised, as well as more direct involvement from clinicians in the coding process.
The law of unintended consequences
Authors: Timmins Nick
Published: June 2014

Nick Timmins, senior fellow at the Institute for Government and the King's Fund, discusses the role of competition
Changing priorities for nursing
Authors: Allan Kate
Published: June 2014

Kate Allan discusses pressures which have helped shape the profession
Challenges in funding new developments in oncology
Authors: Spoors John
Published: June 2014

Pharmaceutical developments in oncology are moving at a considerable pace. This article provides an international perspective from both the USA and UK on the challenges payers are facing with regards to funding new oncology treatments. The article investigates current approaches to appraising oncology treatments in the USA and UK against a background of global austerity. Rising pharmaceutical prices and increased costs of oncological drugs are not sustainable in the mid/long-term. This article highlights the dual role of the media that can not only put pressure on payers to fund new treatments, but also on the pharmaceutical companies to offer discounts and enter pricing arrangements. High-cost innovations in other therapy areas such as rare diseases means that there is less space available to fund new oncology treatments; and therefore, payers have to play the role of managing the rising expectations of both patients and the pharmaceutical companies.
Changing management models in burn care
Authors: Kelly Jamie , Nikkhah Dariush , Wek Caesar , Dheansa Baljit
Published: June 2014

Initial care of burns routinely takes place in accident and emergency (A&E) departments that are frequently stretched and led by clinicians who often have little experience of burns and plastic surgery. Recent changes in management pathways of both acute stroke and ST elevation myocardial infarction have meant patients have received potentially life-saving interventions earlier and had the benefit of bypassing burdened A&E departments. This article challenges this traditional pathway of referrals from A&E departments, and aims to involve earlier liaison with the burns specialist using technology already available to both burns units and ambulances. The authors suggest such interventions could be both clinically and financially appealing in preventing unnecessary delays and potentially further complications in the wound.
The impact of a foundation degree: graduate perspectives
Authors: Griggs Chloe
Published: June 2014

This article aims to gain intelligence on the impact a foundation degree (FD) has on individuals personally and professionally, and to share the findings with employers and managers along with consideration of the wider implications. The FD is becoming more popular as a vehicle to the assistant practitioner (AP) role. To ensure education budgets are used effectively managers need to assess the value of such programmes. A small-scale mixed method study using a postal questionnaire to gather information from FD graduates was used. Benefits of the FD included: enhanced knowledge at work; enhanced skills at work; an impact on personal performance and on the service provided. Employers and managers encouraged to recognise not just the personal benefits of FD education on their employees but also the wider implications: equity of access to education budgets; acquisition of fundamental values; better recruitment and retention of unregistered workforce; diversification and new ways of working.
Analysing excess winter mortality: 2012–13
Authors: Jones Rod
Published: June 2014

In February of 2012 deaths in England and Wales showed a semi-permanent and unexpected increase which endured to around mid-2013. This increase appears to be linked to an increase in A&E attendance and emergency medical admissions. In August of 2013 Public Health England published a report designed to assure everyone that the excess deaths were merely confined to a few weeks during the winter of 2012/2013. However, this report which relies on output from the EuroMOMO methodology and can be shown to contain methodological limitations. The case for a genuine infectious outbreak is investigated.
Putting patient safety at the heart of healthcare
Authors: Nazarko Linda
Published: June 2014

Millennia ago, physicians established the principle that healthcare should do no harm. In the mid-19th century, Semmelweis made the connection between hand washing and prevention of infection. At the beginning of the 21st century, the UK had one of the highest rates of healthcare-associated infections in Europe. Despite the increasing vulnerability of an ageing population, the UK has succeeded in achieving impressive declines in healthcare-associated infections in recent years. Improved anti-microbial stewardship and hand hygiene have resulted in a 69 % reduction in Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia rates and a 59 % reduction in Clostridium difficile infections over the last five years. The barriers to best practice in hand hygiene are lack of time, equipment and inadequate education, and a culture that enables suboptimal hand hygiene to persist. Managers can and should adopt a multifaceted approach to enable and empower staff change workplace culture and promote patient safety.
Improving outcomes in infected wounds
Authors: Jhass Paul
Published: June 2014

Infected wounds can be debilitating and painful for our patients and frequently require costly, protracted management. While healthcare professionals always endeavour to offer care of the highest quality to their patients, in the current financial climate, it must also be affordable. Issues of cost are further compounded by a lack of clear guidance for the management of infected wounds in the community, with practice often dictated by personal experience. To address these issues, the Kent Community Health NHS Trust, in collaboration with academia and industry, plan to benchmark current costs and standards of care, and develop a clear strategy for the management of infected wounds in the community. Our aim is to define measurable parameters that, when improved, will both improve care and deliver cost savings of around 10–15%. These data will allow us to drive improvements in the quality of care, while realising the cost reductions, and also update the knowledge, competencies and capabilities of our staff.
Supporting improvement in a quality collaborative
Authors: Howe Cathy , Randall Katie , Chalkley Sylvia , Bell Derek
Published: June 2014

Quality improvement collaboratives seek to address the mandate to improve healthcare quality and reduce inappropriate variations in care through the use of defined methods and change concepts. There are indications of positive effects, but less evidence of the effectiveness of the methods—the ‘black box’ of the intervention—and how to effectively implement a collaborative. This study uses an assessment framework to quantify engagement with and uptake of collaborative methodology in 17 projects in a quality improvement collaborative in North West London. The framework developed by the NIHR CLAHRC for Northwest London showed variation in uptake and use of methods within and across projects. For example, most projects involved patients and the public and disseminated learning. There was more limited engagement with the NHS Institute for Innovation and Improvement Sustainability Model. The framework provides detailed methods-related information that collaborative leaders could use for generative learning to meet participants’ needs, and identify peer exemplars. This study raises important questions about implementation fidelity and highlights the need to open the ‘black box’ both while the work is in progress to allow generative learning, and for the purposes of evaluation.
The change agent: the manager's role in change
Authors: Stonehouse David
Published: June 2014

Within this article the author will examine the manager's role in the change process. Change within the NHS is an ever-present reality, whether proposed from within your own department and identified by your own staff, or forced upon you from outside. However, participating within the change process can distract managers away from the vital job of managing their service or department. Therefore, as a manager it is vital to recognise the focus of your role and to then support a strong leader and expert who will act as ‘change agent’ to see the change through to a successful conclusion.
Solving the puzzle: improving safety outcomes
Authors: Whitehouse Darren
Published: June 2014

The Berwick Review emphasises the importance of people in promoting the necessary culture change to improve patient safety outcomes. In this article, it is argued that maximising the positive impact of people on safety outcomes can only be achieved if consideration is given to the other elements of the organisation that they interact with. Drawing on theory and the author's practical experience of helping ‘high reliability organisations’ in complex and high-hazard industries, a model is presented in which people represent the central spine of an organisation. Practical tips are offered for NHS organisations who want to improve safety outcomes using this approach.
Knee replacement: lessons from the airline industry
Authors: Logan James , Moonot Pradeep , Harvey Adrian
Published: June 2014

In the current global financial situation, the NHS is under pressure to cut costs and increase productivity without affecting patient outcomes. One area that has been targeted is the procurement of joint replacement hardware. In this article, the authors describe the process for change of total knee replacement at the Royal Bournemouth Hospital, and the early clinical consequences. They attempt to learn lessons from the aviation industry as to how this could be improved in the future.
A&E attendance: the tip of a wider trend
Authors: Jones Rod
Published: June 2014

Rod Jones examines the issues surrounding A&E growth against other aspects of acute activity
Letters to the Editor
Authors: Hendy-Isaac Sonia , Hadland Cheryl
Published: June 2014

MA Education Ltd, St Jude's Church, Dulwich Road, London, SE24 0PB. neil.henty@markallengroup.com
Letting play take a lead
Authors: Burmeister Janina
Published: June 2014

The age of formal schooling, and its impact on assessments, targets and pressure. What we can learn from attitudes to early education across Europe, and are there alternative approaches we can use?
Vitamin D and sunlight
Authors: Day Lin
Published: June 2014

Fears over the effects of excessive exposure to the sun have led to a ‘covering up and slathering on of the sunscreen’, however, this may well have an adverse effect on the development of young children.
Tuning out, tuning in
Authors: Jones Michael
Published: June 2014

Interactions between babies and parents provide the foundations for communication and language. We explore what happens to language when adults and children fail to ‘tune into’ each other early in life.
Why you need posters
Authors: Whitnell Jackie
Published: June 2014

Pretty pictures or informative materials? What does your setting have on its walls or in its staff room? Chances are, you will have the same posters you have had up for years, overlooked and under-used.
Not really wild things
Authors: Brown Paula
Published: June 2014

We take a look at the benefits for children of rough and tumble play, and the place it has in healthy child development, in order to inform your setting's approach on whether to allow, tolerate or ban it.
Childcare in the Emirates
Authors: Watson Clair
Published: June 2014

The United Arab Emirates is developing at an amazing rate, and with a growing population, improving the education sector, especially the early years, is seen as vital to ensuring the nation's continued success.
Singing for language
Authors: Doyle Phoebe
Published: June 2014

The potential of song can go unrecognised and under-valued in settings, but it is a powerful tool for language development, as well as for self-esteem. So how can we best use it in our settings?
Political wheels now in motion
Authors: Lawson Deborah
Published: June 2014

With the next General Election under a year away, politicians and their advisors are setting their sights on vote-winning, headline grabbing, soundbites, with the early years very much high on the agenda.
Political parties are in denial
Authors: Leitch Neil
Published: June 2014

The reaction of the education department to the release of the Alliance's Early Years Agenda survey was one of rejection, although the government is not alone in being oblivious to the true costs of childcare.
What we can learn from… Impressionists
Authors: Chapman Ailsa
Published: June 2014

This month, our focus is on the Impressionists, creators of some of the world's best known and most loved paintings; not to mention the most valuable and frequently visited in museums and galleries.
Explosive imagination
Authors: Leeper Marion
Published: June 2014

The last article in our series explores how storytelling that began with a ‘bang!’ led to explorations of how materials change from one state to another, which lead on to communicating and recording.
Dropping and stopping
Authors: Rhodes Karen
Published: June 2014

The forces of gravity and friction may seem a bit mysterious to young children, but there are an almost limitless number of experiments you can try in your setting that will demonstrate these scientific truths.
The perfect teacher's pet
Authors: Hampshire Vivien
Published: June 2014

Most children will like animals, and some may have pets of their own, but not every child will have had this experience. Vivien Hampshire explores the benefits of introducing animals into your setting.
Holiday with beasties
Authors: Cruickshank Sarah
Published: June 2014

Did you know that National Insect Week fell toward the end of June? You may have missed it, but no need to worry, summer is the perfect time to focus on minibeasts and their favourite environments.
Editorial
Authors: Guadagna Roberto
Published: July 2014

Nota Editorial N° 2