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Wide variation in visual field configuration across avian species is hypothesized to be driven primarily by foraging ecology and predator detection. While some studies of selected taxa have identified relationships between foraging ecology and binocular field characteristics in particular species, few have accounted for the relevance of shared ancestry. We conducted a large-scale, comparative analysis across 39 Anatidae species to investigate the relationship between the foraging ecology traits of diet or behaviour and binocular field parameters, while controlling for phylogeny. We used phylogenetic models to examine correlations between traits and binocular field characteristics, using unidimensional and morphometric approaches. We found that foraging behaviour influenced three parameters of binocular field size: maximum binocular field width, vertical binocular field extent, and angular separation between the eye-bill projection and the direction of maximum binocular field width. Foraging behaviour and body mass each influenced two descriptors of binocular field shape. Phylogenetic relatedness had minimal influence on binocular field size and shape, apart from vertical binocular field extent. Binocular field differences are associated with specific foraging behaviours, as related to the perceptual challenges of obtaining different food items from aquatic and terrestrial environments. [ABSTRACT FROM AUTHOR]

Background The Perioperative care for Older People undergoing Surgery (POPS) service model is increasingly being implemented across care providers in the English and Welsh National Health Services. Objective The study aimed to produce evidence regarding clinical leaders' activities to implement POPS across different service contexts and to produce generalisable recommendations for future implementation. Methods A qualitative interview study was undertaken across six National Health Services hospitals with established POPS services. Interview participants were recruited on the basis of their direct involvement in the implementation and leadership of the service. Data collection involved semi-structured interviews with 26 people carried out between November 2022 and May 2023. Results The implementation of POPS is often hampered by a lack of managerial and financial support, and apprehension amongst surgeons and anaesthetist about new ways of working. POPS leaders address these through five interconnected activities, each targeted at a combination of implementation factors. (i) Securing management and financial support. (ii) Professional engagement. (iii) Evidence building as a resource for demonstrating the clinical and operational benefits of POPS. (iv) Communication and engagement activities to promote and legitimise POPS to stakeholder groups. (v) Designated and distributed leadership to promote and coordinate implementation activities and to spread the service to new pathways. Conclusions Through a combination of activities POPS can be effectively implemented across different organisational contexts. Some aspects of these activities can be guided by shared resources and learning across sites, but others require adaption to local contextual barriers and drivers. [ABSTRACT FROM AUTHOR]

Introduction: A range of nonpharmaceutical public health interventions has been introduced in many countries following the rapid spread of Covid‐19 since 2020, including recommendations or mandates for the use of face masks or coverings in the community. While the effectiveness of face masks in reducing Covid‐19 transmission has been extensively discussed, scant attention has been paid to the lived experience of those wearing face masks. Method: Drawing on 40 narrative interviews with a purposive sample of people in the United Kingdom, with a particular focus on marginalised and minoritized groups, our paper explores experiences of face mask use during the pandemic. Results: We find that face masks have a range of societal, health and safety impacts, and prompted positive and negative emotional responses for users. We map our findings onto Lorenc and Oliver's framework for intervention risks. We suggest that qualitative data offer particular insights into the experiences of public health interventions, allowing the potential downsides and risks of interventions to be more fully considered and informing public health policies that might avoid inadvertent harm, particularly towards marginalised groups. Patient or Public Contribution: The study primarily involved members of the public in the conduct of the research, namely through participation in interviews (email and telephone). The conception for the study involved extensive discussions on social media with a range of people, and we received input and ideas from presentations we delivered on the preliminary analysis. [ABSTRACT FROM AUTHOR]

Objective: The National Health Service (NHS) in England has introduced a range of policy measures aimed at fostering greater openness, transparency and candour about quality and safety. We draw on the findings of an evaluation of the implementation of these policies in NHS organisations, with the aim of identifying key implications for policy and practice. Methods: We undertook a mixed-methods policy evaluation, comprising four substudies: a longitudinal analysis of data from surveys of NHS staff and service users; interviews with senior stakeholders in NHS provider organisations and the wider system; a survey of board members of NHS provider organisations and organisational case studies across acute, community and mental health, and ambulance services. Results: Our findings indicate a mixed picture of progress towards improving openness in NHS organisations, influenced by organisational history and memories of past efforts, and complicated by organisational heterogeneity. We identify four features that appear to be necessary conditions for sustained progress in improving openness: (1) authentic integration into organisational mission is crucial in making openness a day-to-day concern; (2) functional and effective administrative systems are vital; (3) these systems must be leavened by flexibility and sensitivity in implementation and (4) a spirit of continuous inquiry, learning and improvement is required to avoid the fallacy that advancing openness can be reduced to a time-limited project. We also identify four persistent challenges in consolidating and sustaining improvement: (1) a reliance on goodwill and discretionary effort; (2) caring for staff, patients and relatives who seek openness; (3) the limits of values-driven approaches on their own and (4) the continued marginality of patients, carers and families. Conclusions: Variation in policy implementation offers important lessons on how organisations can better deliver openness, transparency and candour. These lessons highlight practical actions for policymakers, managers and senior clinicians. [ABSTRACT FROM AUTHOR]

Simple Summary: Aspects of the vision of birds pertinent to the design and deployment of power line bird diverters are described. Their application is illustrated using Canada Geese as a putative worst-case example of a species prone to power line collision. The design of bird diverters should be based upon the perception of birds, not the perception of humans, but until now it is human vision that has guided diverter design. Aspects of bird vision pertinent to diverter design are reviewed. These are applied in an example that uses Canada Geese Branta canadensis as a putative worst-case example of a collision-prone species. The proposed design uses an achromatic checkerboard pattern of high contrast whose elements match the low spatial resolution of these birds when they are active under twilight light levels. The detectability of the device will be increased by movement, and this is best achieved with a device that rotates on its own axis driven by the wind. The recommended spacing of diverters along a power line is based upon the maximum width of the bird's binocular field and the linear distance that it subtends at a distance sufficient to allow a bird to alter its flight path before possible impact. Given the worst-case nature of this example, other bird species should detect and avoid such a device. The basic design can be modified for use with specific target species if sufficient is known about their vision. Field trials of devices based on these design criteria are now required. [ABSTRACT FROM AUTHOR]

The use of face masks and coverings has been a central component of efforts to mitigate the impact of the COVID‐19 pandemic and has been legally mandated in some countries. Most academic studies to date, however, have focussed primarily on its effectiveness in reducing SARS‐CoV‐2 transmission, largely neglecting the social dimensions of mask mandates. In this narrative interview‐based study, we consider experiences of face masks, with a particular focus on groups considered to be at a potential disadvantage from compulsory masking. Drawing on 40 telephone, video‐call and e‐mail interviews, we highlight the impact of inconsistent communication and the notion of mask wearing as an act of altruism on participants' experiences. In particular, we show how intolerance towards individuals who did not wear masks could result in stigma and exclusion, regardless of the legitimacy of their reasons. We suggest that more is needed to mitigate the 'dark side' of discourses of collective effort and altruism at a time of societal stress and fracture, and to account for the needs and interests of groups for whom compulsory masking may result in further marginalisation. [ABSTRACT FROM AUTHOR]

The primary reliance of birds on vision is readily and frequently asserted. Casual observations of birds completing their everyday behaviours is sufficient to convince most observers that birds are using vision to control their key behaviours. This assertion is supported by evidence that in most bird species relatively large portions of their brains are devoted to the analysis of information from vision. Also, the so-called intelligent behaviours of birds seem to be based primarily upon visual information. Thus, gaining information from vision, and using it to guide sophisticated behaviours, is seen as a vital component of what makes birds so fascinating. Martin provides an overview of bird vision, its underlying physiology and anatomy, and the key factors that have driven its diversity. [ABSTRACT FROM AUTHOR]

Background: Referral and uptake rates of structured self-management education (SSME) for Type 2 diabetes (T2DM) in the UK are variable and relatively low. Research has documented contributing factors at patient, practitioner and organisational levels. We report a project to develop an intervention to improve referral to and uptake of SSME, involving an integrative synthesis of existing datasets and stakeholder consultation and using Normalisation Process Theory (NPT) as a flexible framework to inform the development process.Methods: A three-phase mixed-methods development process involved: (1) synthesis of existing evidence; (2) stakeholder consultation; and (3) intervention design. The first phase included a secondary analysis of data from existing studies of T2DM SSME programmes and a systematic review of the literature on application of NPT in primary care. Influences on referral and uptake of diabetes SSME were identified, along with insights into implementation processes, using NPT constructs to inform analysis. This gave rise to desirable attributes for an intervention to improve uptake of SSME. The second phase involved engaging with stakeholders to prioritise and then rank these attributes, and develop a list of associated resources needed for delivery. The third phase addressed intervention design. It involved translating the ranked attributes into essential components of a complex intervention, and then further refinement of components and associated resources.Results: In phase 1, synthesised analysis of 64 transcripts and 23 articles generated a longlist of 46 attributes of an embedded SSME, mapped into four overarching domains: valued, integrated, permeable and effectively delivered. Stakeholder engagement in phase 2 progressed this to a priority ranked list of 11. In phase 3, four essential components attending to the prioritised attributes and forming the basis of the intervention were identified: 1) a clear marketing strategy for SSME; 2) a user friendly and effective referral pathway; 3) new/amended professional roles; and 4) a toolkit of resources.Conclusions: NPT provides a flexible framework for synthesising evidence for the purpose of developing a complex intervention designed to increase and reduce variation in uptake to SSME programmes in primary care settings. [ABSTRACT FROM AUTHOR]

Frailty is increasingly used in clinical settings to describe a physiological state resulting from a combination of age-related co-morbidities. Frailty also has a strong 'lay' meaning that conjures a particular way of being. Recent studies have reported how frail older people perceive the term frailty, showing that frailty is often an unwanted and resisted label. While there are many scores and measures that clinicians can use to determine frailty, little has been published regarding how health-care professionals use and make sense of the term. This paper reports the findings of a qualitative study that explored how health professionals perceive frailty. Forty situated interviews were conducted with health-care professionals working in an emergency department in the English Midlands. The interview talk was analysed using discourse analysis. The findings show that the health professionals negotiate an 'ideological dilemma' – a tension between contradictory sets of meanings and consequences for action – based on their 'lay' and clinical experience of the term frailty. It is concluded that this dilemma could have a negative impact on the assessment of frailty depending on the system of assessment used. [ABSTRACT FROM AUTHOR]

Employee voice is an important source of organizational intelligence about possible problems in quality and patient safety, but effective systems for encouraging and supporting those who seek to speak up have remained elusive. In the English National Health Service, a novel role known as the 'Freedom to Speak Up Guardian' has been introduced to address this problem. We critically examine the role and its realization in practice, drawing on semi-structured interviews with 51 key individuals, including Guardians, clinicians, managers, policymakers, regulators and others. Operationalizing the new role in organizations was not straightforward, since it had to sit in a complex set of existing systems and processes. One response was to seek to bound the scope of Guardians, casting them in a signposting or coordinating role in relation to quality and safety concerns. However, the role proved hard to delimit, not least because the concerns most frequently voiced in practice differed in character from those anticipated in the role's development. Guardians were tasked with making sense of and dealing with issues that could not always straightforwardly be classified, deflected to the right system or escalated to the appropriate authority. Our analysis suggests that the role's potential contribution might be understood less as supporting whistleblowers who bear witness to clear-cut wrongdoing, and more as helping those with lower-level worries to construct their concerns and what to do with them. These findings have implications for how voice is understood, imagined and addressed in healthcare organizations. [ABSTRACT FROM AUTHOR]

Biographical disruption positions the onset of chronic illness as a major life disruption in which changes to body, self and resources occur (Sociology of Health & Illness, 4, 1982, 167–182). The concept has been used widely in medical sociology. It has also been subject to critique and development by numerous scholars. In this paper, we build on recent developments of the concept, particularly those taking a phenomenological approach, to argue that it can also help in understanding other disruptive health‐related experiences across the life course, in this case the onset of frailty. We draw on the findings of 30 situated interviews with frail older people, relating their experiences of frailty to the concept of biographical disruption. We show that frailty shares many similarities with the experience of chronic illness. Using the lens of biographical disruption to understand frailty also offers insights relevant to recent debates around both concepts, and on the continued relevance of the idea of biographical disruption given changing experiences of health and illness, including the circumstances in which biographical disruption is more and less likely to be experienced. Finally, we reflect on the potentials and limitations of applying the concept to a health‐related condition that cannot be categorised as a disease. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has had enormous effects on health, wellbeing, and economies worldwide. Governments have responded with rapid and sometimes radical public health interventions. As nations grapple with the question of how to regain normality without unnecessarily endangering lives or healthcare systems, some scientists have argued for policies to encourage or compel the use of face coverings in community (non-clinical) settings, despite acknowledged gaps in the evidence base for the effectiveness of such a measure. This commentary has two objectives. First, in the face of strong arguments that face coverings are a commonsense intervention, with negligible downsides, that can only do good, we make the case for caution in changing policy. Many seemingly benign public health interventions have the potential to cause harm, and that harm is often socially differentiated. We present five arguments for caution in policy change. Second, we reflect on the wider implications of the increasingly overt approaches to policy advocacy taken by some scientists. Drawing from the theory of post-normal science, we argue that the science–policy interface in the case of face coverings has taken a surprisingly traditional form, falling short of interdisciplinary integration and failing to incorporate insights of the full range of relevant experts and affected stakeholders. We sketch a vision for an alternative, more mature, relationship between science and society that accepts uncertainty, embraces deliberation, and rises to the challenge of developing knowledge to improve public health. [ABSTRACT FROM AUTHOR]

Objectives: The prominence given to issues of patient safety in health care organizations varies, but little is known about how or why this variation occurs. We sought to compare and contrast how three English hospitals came to identify, prioritize and address patient safety issues, drawing on insights from the sociological and political science literature on the process of problem definition. Methods: In-depth qualitative fieldwork, involving 99 interviews, 246 hours of ethnographic observation, and document collection, was carried out in three case-study hospitals as part of a wider mixed-methods study. Data analysis was based on the constant comparative method. Results: How problems of patient safety came to be recognized, conceptualized, prioritized and matched to solutions varied across the three hospitals. In each organization, it took certain 'triggers' to problematize safety, with crises having a particularly important role. How problems were constructed – and whose definitions were prioritized in the process – was highly consequential for organizational response, influencing which solutions were seen as most appropriate, and allocation of responsibility for implementing them. Conclusions: A process of problem definition is crucial to raising the profile of patient safety and to rendering problems amenable to intervention. How problems of patient safety are defined and constructed is highly consequential, influencing selection of solutions and their likely sustainability. [ABSTRACT FROM AUTHOR]

Michel Foucault's concept of governmentality has been hugely influential in sociology and other disciplinary fields. However, its application has been criticised by those who suggest it neglects agency, and gives overwhelming power to governmental discourses in constituting subjectivities, determining behaviour and reproducing social reality. Drawing on posthumously translated lecture transcripts, in this article the authors suggest that Foucault's nascent concept of pastoral power offers a route to a better conceptualisation of the relationship between discourse, subjectivity and agency, and a means of understanding the (contested, non-determinate, social) process through which governmental discourses are shaped, disseminated and translated into action. The authors offer empirical examples from their work in healthcare of how this process takes place, present a model of the key mechanisms through which contemporary pastoral power operates, and suggest future research avenues for refining, developing or contesting this model. [ABSTRACT FROM AUTHOR]

Internationally, debates are taking place about sustainable healthcare. In England, guidance on patient and public involvement (PPI) advocates ‘engagement’ and references Arnstein’s ladder of participation, but recent proposals provoked controversy around service closures and the perceived exclusion of patients and the public. This article reports an ethnography of engagement, prior to formal public consultation on plans for major service change. Our analysis uses Cultural Political Economy, linking micro interactions between staff and ‘involvees’ to processes of political economy. We found that co-optation and contestation both occurred. Involvees queried whether the forthcoming consultation was genuine or whether decisions had already been made but the issue of whether NHS services should be delivered by public or private bodies was kept off the agenda. We conclude that engagement in system transformation programmes implicates PPI in a neoliberal agenda that rations state support for healthcare and introduces service models from the USA and elsewhere. [ABSTRACT FROM AUTHOR]

The article focuses on the 2012 Health and Social Care Act that was heralded to be among the most significant changes in policy for the National Health Service (NHS) in England; and also mentions that patient, public involvement in the development of transformation plans has been restricted.

Objectives: Calls for major reconfigurations of health services have been accompanied by recommendations that wide ranging stakeholders be involved. In particular, patients and the wider public are seen as critical contributors as both funders and beneficiaries of public health care. But public involvement is fraught with challenges, and little research has focused on involvement in the health service transformation initiatives. This paper examines the design and function of public involvement in reconfiguration of health services within the English NHS. Methods: Qualitative data including interviews, observation and documents were collected in two health service 'transformation' programmes; interviews include involved public and professional participants. Data were analysed using parallel deductive and inductive approaches. Results: Public involvement in the programmes was extensive but its terms of reference, and the individuals involved, were restricted by policy pressures and programme objectives. The degree to which participants descriptively or substantively represented the wider public was limited; participants sought to 'speak for' this public but their views on what was 'acceptable' and likely to influence decision-making led them to constrain their contributions. Conclusions: Public involvement in two major service reconfiguration programmes in England was seen as important and functional, and could not be characterized as tokenistic. Yet involvement in these programmes fell short of normative ideals, and could inadvertently reduce, rather than enlarge, public influence on health service reconfiguration decisions. [ABSTRACT FROM AUTHOR]

Care pathways are a prominent feature of efforts to improve healthcare quality, outcomes and accountability, but sociological studies of pathways often find professional resistance to standardisation. This qualitative study examined the adoption and adaptation of a novel pathway as part of a randomised controlled trial in an unusually complex, non-linear field - emergency general surgery - by teams of surgeons and physicians in six theoretically sampled sites in the UK. We find near-universal receptivity to the concept of a pathway as a means of improving peri-operative processes and outcomes, but concern about the impact on appropriate professional judgement. However, this concern translated not into resistance and implementation failure, but into a nuancing of the pathways-as-realised in each site, and their use as a means of enhancing professional decision-making and inter-professional collaboration. We discuss our findings in the context of recent literature on the interplay between managerialism and professionalism in healthcare, and highlight practical and theoretical implications. [ABSTRACT FROM AUTHOR]

An improved rate control algorithm, designed for scalable video coders incorporating interlayer prediction, is proposed. Firstly, a Rate Distortion (RD) model for interlayer prediction involving the spatial enhancement layers is devised. An optimised Mean Absolute Difference (MAD) prediction model for the spatial enhancement layers that considers both the MAD from the spatial base layer in the same frame and the MAD from the corresponding macroblock in previous frames is also proposed. Simulation results show that the resulting algorithm produces accurate rate control with an average bit rate error of less than 0.26%. Compared with the JVT-W043 default rate control algorithm of the JSVM, the proposed algorithm improves the average PSNR by up to 0.53 dB or reduces the bit rate by an average of 10.95%. Furthermore, the proposed algorithm can be combined with the existing rate control scheme for H.264/AVC, resulting in further improvements. [ABSTRACT FROM AUTHOR]

The paper adopts an interpretive institutionalist framework [Hay (2011), “Interpreting Interpretivism Interpreting Interpretations: The New Hermeneutics of Public Administration.” Martin (2015), “‘Ahora tienen que escucharnos’ [now they have to listen to us]: Actors’ Understandings and Meanings of Planning Practices in Venezuela’s ‘Participatory Democracy.” PhD Thesis, Cardiff University, to unpack participants’ involvement in communal councils (CCs) and a commune, two Venezuelan reforms seeking to incorporate citizens into planning processes. The paper focuses on how participants in La Silsa, an informal neighbourhood in Caracas, understood and enacted upon community planning opportunities provided by these new councils. Municipal and national government staff and finance heavily supported La Silsa’s emerging commune and CCs. Despite the national government’s rhetoric of ‘constructing a new socialist, communal state’, the article identifies several challenges need to be overcome to successfully shift from existing representative institutional/governmental arrangements towards more participatory repertoires. The article’s findings mirror those of other empirical studies of Latin America’s democratic innovations: citizen participation strengthens representative governmental arrangements, rather than replace them with normative alternatives. [ABSTRACT FROM AUTHOR]

The binocular field of vision differs widely in birds depending on ecological traits such as foraging. Owls (Strigiformes) have been considered to have a unique binocular field, but whether it is related to foraging has remained unknown. While taking into account allometry and phylogeny, we hypothesized that both daily activity cycle and diet determine the size and shape of the binocular field in owls. Here, we compared the binocular field configuration of 23 species of owls. While we found no effect of allometry and phylogeny, ecological traits strongly influence the binocular field shape and size. Binocular field shape of owls significantly differed from that of diurnal raptors. Among owls, binocular field shape was relatively conserved, but binocular field size differed among species depending on ecological traits, with larger binocular fields in species living in dense habitat and foraging on invertebrates. Our results suggest that (i) binocular field shape is associated with the time of foraging in the daily cycle (owls versus diurnal raptors) and (ii) that binocular field size differs between closely related owl species even though the general shape is conserved, possibly because the field of view is partially restricted by feathers, in a trade-off with auditory localization. [ABSTRACT FROM AUTHOR]

The binocular field of vision differs widely in birds depending on ecological traits such as foraging. Owls (Strigiformes) have been considered to have a unique binocular field, but whether it is related to foraging has remained unknown. While taking into account allometry and phylogeny, we hypothesized that both daily activity cycle and diet determine the size and shape of the binocular field in owls. Here, we compared the binocular field configuration of 23 species of owls. While we found no effect of allometry and phylogeny, ecological traits strongly influence the binocular field shape and size. Binocular field shape of owls significantly differed from that of diurnal raptors. Among owls, binocular field shape was relatively conserved, but binocular field size differed among species depending on ecological traits, with larger binocular fields in species living in dense habitat and foraging on invertebrates. Our results suggest that (i) binocular field shape is associated with the time of foraging in the daily cycle (owls versus diurnal raptors) and (ii) that binocular field size differs between closely related owl species even though the general shape is conserved, possibly because the field of view is partially restricted by feathers, in a trade-off with auditory localization. [ABSTRACT FROM AUTHOR]

Summary: Background: Alcohol use is the most important factor in determining the prognosis of patients with alcohol‐related cirrhosis and alcohol‐associated hepatitis. Aim: To conduct a systematic review of interventions for alcohol use disorder specific to patients with cirrhosis or alcohol‐associated hepatitis. Methods: We searched five databases between inception and November 2022. The primary outcomes were abstinence, hepatic decompensation and mortality. We included randomised and non‐randomised studies. Risk of bias was assessed using validated tools. Where possible, meta‐analysis was performed. Results: Twenty‐three studies met the inclusion criteria including six randomised trials and 17 non‐randomised studies of interventions. These included 104,298 patients with a mean/median age range from 44 to 65, of whom 75% were male. Interventions included psychological therapy, pharmacological therapies, specialist clinics, patient education and low alcohol drinks. Baclofen was the only intervention to demonstrate a statistically significant impact on the primary outcomes in a randomised trial (abstinence OR: 6.3, 95% CI: 2.4–16.1). Three non‐randomised studies reported reductions in episodes of hepatic decompensation that were significant in multivariate models. This was in response to psychological therapy, use of any pharmacotherapy, and use of any treatment. A meta‐analysis of non‐randomised studies that examined the impact of psychological therapies revealed statistically non‐significant improvements in abstinence (4 studies, OR: 1.87, 95% CI: 0.38–9.23) and mortality (4 studies, OR: 0.47, 95% CI: 0.12–1.77). Conclusions: Baclofen is the only intervention with randomised trial evidence for significant benefit in patients with cirrhosis. Non‐randomised studies also point to non‐pharmaceutical interventions possibly improving clinical outcomes. [ABSTRACT FROM AUTHOR]

Community-based approaches to healthcare improvement are receiving increasing attention. Such approaches could offer an infrastructure for efficient knowledge-sharing and a potent means of influencing behaviours, but their potential is yet to be optimised. After briefly reviewing challenges to community-based approaches, we describe in detail the clinical community model. Through exploring clinical communities in practice, we seek to identify practical lessons for optimising this community-based approach to healthcare improvement. Through comparative case studies based on secondary analysis, we examine two contrasting examples of clinical communities in practice – the USA-based Michigan Keystone ICU programme, and the UK-based Improving Lung Cancer Outcomes Project. We focus on three main issues. First, both cases were successful in mobilising diverse communities : favourable starting conditions, core teams with personal credibility, reputable institutional backing and embeddedness in wider networks were important. Second, top-down input to organise regular meetings, minimise conflict and empower those at risk of marginalisation helped establish a strong sense of community and reciprocal ties , while intervention components and measures common to the whole community strengthened peer-norming effects. Third, to drive implementation , technical expertise and responsiveness from the core team were important, but so too were ‘hard tactics’ (e.g. strict limits on local customisation); these were more easily deployed where the intervention was standardised across the community and a strong evidence-base existed. Contrary to the idea of self-organising communities, our cases make clear that vertical and horizontal forces depend on each other synergistically for their effectiveness. We offer practical lessons for establishing an effective balance of horizontal and vertical influences, and for identifying the types of quality problems most amenable to community-based improvement. [ABSTRACT FROM AUTHOR]

Objective: The physical events of the first 15 milliseconds of a traumatic brain injury are reviewed from computer simulations using finite element calculations and applied to observed pathology. Methods: The impact creates two shock waves; one through the brain, another through the skull, both injure the brain separately. Two accelerations, anteroposterior and rotary, distort or stretch the brain, because of inertia. The two shockwaves are reflected many times within in the brain, from boundaries where the density or elasticity changes. Results: Overlapping waves form powerful positive or negative pressure nodes. Negative waves are more damaging to neurones and blood vessels, so a random pattern of scattered neural and capillary necroses develop all over the brain. The skull shockwave expands the skull opposite the blow, so creating a damaging negative pressure injury to the brain,contre coupcontusion. Acceleration (or deceleration) follows impact, beginning later and lasting longer. Inertia strains the tissue, where the brain is free to move, inflicting characteristic white matter injuries. Conclusions: In the antero-posterior plane, acceleration and inertia stretch and tear long tracts to the spine and blood vessels running from the brain to the dura. Rotatory accelerations stress the inter-hemispheric connections of the brain, especially the corpus callosum, between the hemispheres. [ABSTRACT FROM PUBLISHER]

This research sought to clarify how some self-injurers cease the behavior, maintaining this for at least 1 year. Using the Experiential Avoidance Model (EAM), we examined whether characteristics of self-injurers remain in people who have successfully ceased self-injury and what, by implication, might be targeted to improve therapeutic efficacy. The study was conducted using an online cross-sectional survey of 215 first-year university students. Past self-injurers (34) scored significantly better on subscales of the General Health Questionnaire, as well as Distress Tolerance, Experiential Avoidance, and Self-blame compared to Current self-injurers (29). The Experiential Avoidance Model is a useful basis for understanding self-injury, and informing therapeutic approaches. Reducing Anxiety, and developing Tolerance and Positive Emotional Intensity may be keys to ceasing self-injury. [ABSTRACT FROM PUBLISHER]

Mindfulness is defined as a non-judgemental awareness and accepting of present-moment experience. With intentional attendance to one's ongoing stream of thoughts, sensations and emotions as they arise, it allows the individual to react with less impulsivity and flexibility. However, empirical findings of mindfulness to date have largely been confined to outcome studies using clinical populations. This cross-sectional study examined the relationships between mindfulness, self-esteem, resiliency and mental health symptoms (anxiety, stress, depression and cognitive inflexibility) in a sample of 106 healthy adolescents. Participants completed a set of questionnaires. First, we found moderate effect size for anxiety, depression and self-esteem and large effect size for cognitive inflexibility. These results, when compared with clinical samples, demonstrated similar trends found in a healthy adolescent sample. Second, predictive value of mindfulness was examined and we found significant contribution of mindfulness to mental and psychological health. [ABSTRACT FROM PUBLISHER]

Objectives: This study investigated associations between sexual orientation and measures of suicidality and non-suicidal self-injury in Australian adults. Previous studies of sexual orientation and suicidality have been limited by unclear conceptualisations of suicidal intent, failure to differentiate between homosexuality and bisexuality, inattention to gender differences and use of convenience-based samples. Methods: A large (N = 10,531) representative national sample of Australian adults was used to investigate associations between sexual orientation (heterosexual, homosexual, bisexual) and (1) suicidal ideation, (2) attempted suicide and (3) non-suicidal self-injury, for males and females separately, in a series of sequentially adjusted logistic regression models. Results: Sexual minority participants were at greater risk of suicidality and self-injury than heterosexuals, after adjusting for age and other covariates, with patterns of risk differing by sexual orientation and gender. Compared with their heterosexual counterparts, gay men, but not bisexual men, were more likely to report suicidal ideation (odds ratio = 3.05, 95% confidence interval = [1.65, 5.60]) and suicide attempts (odds ratio = 4.16, confidence interval = [2.18, 7.93]). Bisexual women, but not lesbian women, were more likely to report suicidal ideation (odds ratio = 4.40, confidence interval = [3.00, 6.37]) and suicide attempts (odds ratio = 4.46, confidence interval = [2.41, 8.24]). Neither bisexual nor gay men were more likely than heterosexual men to report self-injury. However, bisexual women, but not lesbian women, were more likely than heterosexual women to report self-injury (odds ratio = 19.59, confidence interval = [9.05, 42.40]). Overall, bisexual females were at greatest risk of suicidality and self-injury. Conclusion: Clinicians working with sexual minority populations are encouraged to openly discuss suicidal and self-injurious thoughts and behaviours with their clients and may consider using therapeutic strategies to reduce internalised stigma and enhance personal and social resources. [ABSTRACT FROM AUTHOR]

Formal metrics for monitoring the quality and safety of healthcare have a valuable role, but may not, by themselves, yield full insight into the range of fallibilities in organizations. ‘Soft intelligence’ is usefully understood as the processes and behaviours associated with seeking and interpreting soft data—of the kind that evade easy capture, straightforward classification and simple quantification—to produce forms of knowledge that can provide the basis for intervention. With the aim of examining current and potential practice in relation to soft intelligence, we conducted and analysed 107 in-depth qualitative interviews with senior leaders, including managers and clinicians, involved in healthcare quality and safety in the English National Health Service. We found that participants were in little doubt about the value of softer forms of data, especially for their role in revealing troubling issues that might be obscured by conventional metrics. Their struggles lay in how to access softer data and turn them into a useful form of knowing. Some of the dominant approaches they used risked replicating the limitations of hard, quantitative data. They relied on processes of aggregation and triangulation that prioritised reliability, or on instrumental use of soft data to animate the metrics. The unpredictable, untameable, spontaneous quality of soft data could be lost in efforts to systematize their collection and interpretation to render them more tractable. A more challenging but potentially rewarding approach involved processes and behaviours aimed at disrupting taken-for-granted assumptions about quality, safety, and organizational performance. This approach, which explicitly values the seeking out and the hearing of multiple voices, is consistent with conceptual frameworks of organizational sensemaking and dialogical understandings of knowledge. Using soft intelligence this way can be challenging and discomfiting, but may offer a critical defence against the complacency that can precede crisis. [ABSTRACT FROM AUTHOR]

Recent decades have seen the influence of the professions decline. Lately, commentators have suggested a revived role for a "new" professionalism in ensuring and enhancing high-quality health care in systems dominated by market and managerial logics. The form this new professionalism might take, however, remains obscure. This article uses data from an ethnographic study of three English health care improvement projects to analyze the place, potential, and limitations of professionalism as a means of engaging clinicians in efforts to improve service quality. We found that appeals to notions of professionalism had strong support among practitioners, but converting enthusiasm for the principle of professionalism into motivation to change practice was not straightforward. Some tactics used in pursuit of this deviated sharply from traditional models of collegial social control. In systems characterized by fissures between professional groups and powerful market and managerial influences, we suggest that professionalism must interact creatively but carefully with other logics. [ABSTRACT FROM AUTHOR]

Recent decades have seen the influence of the professions decline. Lately, commentators have suggested a revived role for a “new” professionalism in ensuring and enhancing high-quality health care in systems dominated by market and managerial logics. The form this new professionalism might take, however, remains obscure. This article uses data from an ethnographic study of three English health care improvement projects to analyze the place, potential, and limitations of professionalism as a means of engaging clinicians in efforts to improve service quality. We found that appeals to notions of professionalism had strong support among practitioners, but converting enthusiasm for the principle of professionalism into motivation to change practice was not straightforward. Some tactics used in pursuit of this deviated sharply from traditional models of collegial social control. In systems characterized by fissures between professional groups and powerful market and managerial influences, we suggest that professionalism must interact creatively but carefully with other logics. [ABSTRACT FROM AUTHOR]

Background: Self-injury is a complex issue, further complicated by the fact that up to half of young people who self-injure do not receive help. Young people who do receive help for self-injury claim they prefer to access family and friends over more formal sources of help. This original research set out to examine the influence of negative attitudes to professional help and a sense of autonomy on help-seeking intentions. Methods: A cross-section of 220 university students and young adults from the community (Students = 131, other participants = 89; mean age = 24.64) completed anonymous online questionnaires measuring self-injurious behaviour and mental health related problems, attitudes toward seeking professional mental health help, autonomy, and intentions to seek help for self-injury. Two separate mediation models were tested using a bootstrapping approach to investigate intentions to seek help -- one on mental health problems, and one specifically on self-injury. Results: More positive attitudes to help-seeking were significantly associated with greater intentions to seek help, while higher perceived autonomy was associated with lower intentions to seek help. Attitudes fully mediated the negative relationship between autonomy and willingness to seek help for self-injury. The model also maintained partial mediation for willingness to seek help for other mental health problems, beyond self-injury. Current self-injurers expressed significantly more negative attitudes toward help-seeking compared to past self-injurers and those with no history of self-injury. Similarly, current self-injurers reported being less likely to seek help from anyone compared to both other groups. Conclusions: This study appears to be the first to set out to compare self-injurers' attitudes to help-seeking directly with those of non-self-injurers, and the first to show that attitudes mediate the relationship between autonomy and help-seeking. The findings provide evidence that will assist development of interventions targeting negative attitudes toward seeking professional help, in order to increase help-seeking among self-injurers who would otherwise not receive treatment. [ABSTRACT FROM AUTHOR]

Migrants and ethnic minorities are under-represented in spaces created to give citizens voice in healthcare governance. Excluding minority groups from the health participatory sphere may weaken the transformative potential of public participation, (re)producing health inequities. Yet few studies have focused on what enables involvement of marginalised groups in participatory spaces. This paper addresses this issue, using the Participation Chain Model (PCM) as a conceptual framework, and drawing on a case study of user participation in a Dutch mental health advocacy project involving Cape Verdean migrants. Data collection entailed observation, documentary evidence and interviews with Cape Verdeans affected by psychosocial problems (n = 20) and institutional stakeholders (n = 30). We offer practice, policy and theoretical contributions. Practically, we highlight the importance of a proactive approach providing minorities and other marginalised groups with opportunities and incentives that attract, retain and enable them to build and release capacity through involvement. In policy terms, we suggest that both health authorities and civil society organisations have a role in creating ‘hybrid’ spaces that promote the substantive inclusion of marginalised groups in healthcare decision-making. Theoretically, we highlight shortcomings of PCM and its conceptualisation of users' resources, suggesting adaptations to improve its conceptual and practical utility. [ABSTRACT FROM AUTHOR]

Background Mindfulness interventions with adolescents are in the early stages of development. This study sought to establish efficacy of a mindfulness-based group intervention for adolescents with mixed mental health disorders. Method One hundred and eight adolescents (ages 13-18) were recruited from community mental health clinics and randomised into two groups (control vs. treatment). All participants received treatment-as-usual ( TAU) from clinic-based therapists independent of the study. Adolescents in the treatment condition received TAU plus a 5-week mindfulness-training programme ( TAU+Mi); adolescents in the control group received only TAU. Assessments including parent/carer reports were conducted at baseline, postintervention and 3-month follow-up. Results At postintervention, adolescents in the mindfulness condition experienced significant decrease in mental distress (measured with the DASS-21) compared to the control group (Cohen's d = 0.43), and these gains were enhanced at 3-month follow-up (Cohen's d = 0.78). Overall outcomes at 3 months showed significant improvement for adolescents in the mindfulness condition; in self-esteem, mindfulness, psychological inflexibility and mental health, but not resilience. Parents/carers also reported significant improvement in their adolescent's psychological functioning (using the CBCL). Mediation analyses concluded mindfulness mediated mental health outcomes. Conclusions Increase in mindful awareness after training leads to improvement in mental health and this is consistent with mindfulness theory. The mindfulness group programme appears to be a promising adjunctive therapeutic approach for clinic-based adolescents with mental health problems. [ABSTRACT FROM AUTHOR]

This paper reports on a prospective study exploring risk factors specifically related to the onset of non-suicidal self-injury (NSSI) during adolescence. We examined cumulative incidence and predictors of onset of NSSI over 1 year among 1,973 school-based adolescents (13-19 years old; M = 14.9, SD = 0.96) from five states in Australia. Data showed cumulative incidence of 3.8 % (95 % CI [3.0-4.7 %]) over 1 year. Multiple socio-demographic and psychosocial factors were assessed using sequential logistic regression models. Onset of NSSI was associated with being female (OR = 3.47, 95 % CI [1.48-8.18]), being born outside of Australia (OR = 3.05, 95 % CI [1.10-8.47]), not identifying as religious or spiritual (OR = 1.80, 95 % CI [1.04-3.10]), increased psychological distress (OR = 1.12, 95 % CI [1.08-1.16]), poor social support from family (OR = 0.89, 95 % CI [0.83-0.95]), poor self-esteem (OR = 0.90, 95 % CI [0.83-0.98]), and poor problem-solving coping (OR = 0.90, 95 % CI [0.82-0.99]). These findings may assist to better identify young people more likely to start self-injuring and also highlight issues to provide a focus for prevention initiatives. [ABSTRACT FROM AUTHOR]

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Wehave used high-speed imaging to study the formation of liquidtracks on a surface with nonzero receding contact angle, by the sequentialdeposition of liquid drops. For small drop spacing we found good agreementwith the track morphology predicted by an existing line stabilitymodel. In addition, we confirmed definitively the preferential drop-to-beadfluid flow and the predicted drop spreading variation in the scallopedline and paired bead formation regimes. However, we found that withoutaccounting for drop impact inertia, the model underestimated the maximumdrop spreading radii and, hence, the instantaneous track width. Inaddition, the printed track became stable at larger drop spacing,in contrast to the expected behavior. We believe that the destabilizingeffect of a receding contact line may be minimized when track radii,as predicted by volume conservation and drop–bead coalescencedynamics, converge as the drop spacing increases. An increase in viscousdissipation and a reduction of the capillary-driven flow may be theadditional stabilization mechanisms. The latter may also be responsiblefor achieving a stable and symmetrical track when printing with ashorter interval (higher print frequency) at a given drop spacing. [ABSTRACT FROM AUTHOR]

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Published prevalence estimates of nonsuicidal self-injury (NSSI) among nonclinical samples are highly heterogeneous, raising concerns about their reliability and hindering attempts to explore the alleged increase in NSSI over time. Accordingly, the objectives of this study were to investigate the influence of methodological factors on heterogeneity in NSSI prevalence estimates, explore changes over time, and estimate overall international NSSI prevalence. Results showed that methodological factors contributed over half (51.6%) of the heterogeneity in prevalence estimates, and, after adjusting for these factors, NSSI prevalence did not increase over time. Overall, pooled NSSI prevalence was 17.2% among adolescents, 13.4% among young adults, and 5.5% among adults. Clearly, development of standardized methodology in NSSI research is crucial if accurate estimates are desired. [ABSTRACT FROM AUTHOR]

Breeding periodicity allows organisms to synchronise breeding attempts with the most favourable ecological conditions under which to raise offspring. For most animal species, ecological conditions vary seasonally and usually impose an annual breeding schedule on their populations; sub-annual breeding schedules will be rare. We use a 16-year dataset of breeding attempts by a tropical seabird, the sooty tern (Onychoprion fuscatus), on Ascension Island to provide new insights about this classical example of a population of sub-annually breeding birds that was first documented in studies 60 years previously on the same island. We confirm that the breeding interval of this population has remained consistently sub-annual. By ringing >17000 birds and re-capturing a large sample of them at equivalent breeding stages in subsequent seasons, we reveal for the first time that many individual birds also consistently breed sub-annually (i.e. that sub-annual breeding is an individual as well as a population breeding strategy). Ascension Island sooty terns appear to reduce their courtship phase markedly compared with conspecifics breeding elsewhere. Our results provide rare insights into the ecological and physiological drivers of breeding periodicity, indicating that reduction of the annual cycle to just two life-history stages, breeding and moult, is a viable life-history strategy and that moult may determine the minimum time between breeding attempts. [ABSTRACT FROM AUTHOR]

Birds show interspecific variation both in the size of the fields of individual eyes and in the ways that these fields are brought together to produce the total visual field. Variation is found in the dimensions of all main parameters: binocular region, cyclopean field and blind areas. There is a phylogenetic signal with respect to maximum width of the binocular field in that passerine species have significantly broader field widths than non-passerines; broadest fields are found among crows (Corvidae). Among non-passerines, visual fields show considerable variation within families and even within some genera. It is argued that (i) the main drivers of differences in visual fields are associated with perceptual challenges that arise through different modes of foraging, and (ii) the primary function of binocularity in birds lies in the control of bill position rather than in the control of locomotion. The informational function of binocular vision does not lie in binocularity per se (two eyes receiving slightly different information simultaneously about the same objects from which higher-order depth information is extracted), but in the contralateral projection of the visual field of each eye. Contralateral projection ensures that each eye receives information from a symmetrically expanding optic flow-field from which direction of travel and time to contact targets can be extracted, particularly with respect to the control of bill position. [ABSTRACT FROM AUTHOR]

Two understandings of the dynamics of power developed by Foucault have been extensively used in analyses of contemporary healthcare: disciplinary power and governmentality. They are sometimes considered alternative or even contradictory conceptual frameworks. Here, we seek to deploy them as complementary ways of making sense of the complexities of healthcare organisation today. We focus on efforts to improve quality and safety in three UK hospitals. We find a prominent role for disciplinary power, including a panoptic gaze that is to some extent internalised by professionals. We suggest, however, that the role of disciplinary power relies for its impact on complementary strategies that are more akin to governmentality. These strategies foster organisational contexts that are receptive to disciplinary work. More fundamentally, we find that both disciplinary power and governmentality work on subjectivities in rather a different manner from that suggested by conventional accounts. We offer an alternative, less individualised and more socialised, understanding of the way in which power acts upon subjectivity and behaviour in professional contexts. [Copyright &y& Elsevier]

[ABSTRACT FROM AUTHOR]

Abstract: Partnership is a prominent approach to delivering healthcare globally, with advocates arguing that partnership has distinctive advantages over alternatives such as hierarchies or markets. There is much debate as to whether partnerships represent a distinctive mode of coordination in practice, however. Furthermore, despite evidence from diverse settings of the challenges of putting partnerships into practice, there has been little cross-pollination between literature from different fields. We bring together existing literature and two partnership case studies in the contrasting contexts of the UK National Health Service and an internationally-funded health intervention in Cambodia. The case studies were conducted between 2005 and 2008. Based on our synthesis of the literature, we propose an analytical distinction between instrumental and transformative partnerships, arguing that it is transformative partnerships that can deliver the unique advantages set out in theory. Comparative analysis of the cases illustrates that although both were able to achieve some valuable successes, they fell short of realising their transformative potential. We identify five common issues that impeded or facilitated transformative partnership-working, at micro, meso- and macro-levels: starting conditions; programme set-up; funding asymmetries and interdependence; accountability mechanisms; and relationships and distance from the field. Through systematic comparison we offer a more nuanced understanding of how programmes themselves create particular architectures for partnership, how underlying globalised institutional logics of managerialism promote instrumental partnerships, and how local-level, interpersonal relationships may help to overcome barriers to partnership's transformative potential. [Copyright &y& Elsevier]

In many developed-world countries, there have been efforts to increase the ‘leadership capacity’ of healthcare professionals, particularly lower-status staff without formal managerial power. Creating frontline ‘leaders’ is seen as a means of improving the quality of healthcare, but such efforts face considerable challenges in practice. This article reports on a qualitative, interview-based study of 23 staff in two UK operating theatre departments, mostly nurses by professional background, who were given formal leadership responsibilities by their hospitals and redesignated as ‘team leaders’ and ‘theatre co-ordinators’. While participants were familiar with leadership theory and could offer clear accounts of good leadership in practice, they were often limited in their ability to enact their leadership roles. Professional and managerial hierarchies constrained participants’ leadership capacity, and consequently the exercise of leadership rested on alignment with managerial relationships and mandates. The findings highlight difficulties with accounts of leadership as something to be distributed across organizations; in healthcare organizations, established institutional structures and norms render this approach problematic. Rather, if fostering leadership capacity is to have the transformational effect that policymakers desire, it may need to be accompanied by other, wider changes that attend to institutional, organizational and professional context. [ABSTRACT FROM PUBLISHER]

[ABSTRACT FROM AUTHOR]

A fast mode decision algorithm for efficient implementation of the scalable video coding (SVC) extension of H.264/AVC is described. SVC incorporates interlayer prediction, a new tool that exploits as much lower layer information as possible in order to improve the coding efficiency of the enhancement layer. However, it also greatly increases the computational complexity. A fast mode selection algorithm that exploits the correlation of a macroblock in the enhancement layer and both the colocated macroblocks in the base layer and neighboring macroblocks in the enhancement layer is proposed. The algorithm examines the level of picture details and motion activity, and utilizes the mode information of the base layer to make faster enhancement layer decisions and thus save coding time. Simulation results show that the proposed algorithm reduces encoding by up to 84% compared with the JSVM 9.18 implementation. This is achieved without any noticeable degradation in rate distortion. [ABSTRACT FROM PUBLISHER]