Effecting a national implementation project through distributed leadership in the West Midlands: rising to the spread challenge

We describe the utility and impact of a distributed leadership model to implement a National Health Service (NHS) England Academic Health Sciences national quality improvement programme, in the West Midlands. This model was adopted to address the inherent difficulties of implementing change in practice in a large geographical region with a diverse population of health service personnel. We report on the inclusion of a senior trainee as part of the implementation team, supported by a multidisciplinary clinical consultant team, with equal agency in decision making, acting as mentors and activators in the background.

Weather During Key Growth Stages Explains Grain Quality and Yield of Maize

Maize (Zea mays L.) grain yield and compositional quality are interrelated and are highly influenced by environmental factors such as temperature, total precipitation, and soil water storage. Our aim was to develop a regression model to account for this relationship among grain yield and compositional quality traits across a large geographical region. Three key growth periods were used to develop algorithms based on the week of emergence, the week of 50% silking, and the week of maturity that enabled collection and modeling of the effect of weather and climatic variables across the major maize growing region of the United States. Principal component analysis (PCA), stepwise linear regression models, and hierarchical clustering analyses were used to evaluate the multivariate relationship between weather, grain quality, and yield. Two PCAs were found that could identify superior grain compositional quality as a result of ideal environmental factors as opposed to low-yielding conditions. Above-average grain protein and oil levels were favored by less nitrogen leaching during early vegetative growth and higher temperatures at flowering, while greater oil than protein concentrations resulted from lower temperatures during flowering and grain fill. Water availability during flowering and grain fill was highly explanatory of grain yield and compositional quality.

THE SANCTUARIES OF APOLLO MALEATAS AND APOLLO TYRITAS IN LACONIA: RELIGION IN SPARTAN–PERIOIKIC RELATIONS

This article examines how religion contributed to the interconnectivity of the large geographical region of Laconia which was under Spartan control for most of the Archaic and Classical periods. With a particular focus on two Laconian sanctuaries, that of Apollo Maleatas and that of Apollo Tyritas, located in the area of the Thyreatis/Kynouria, which had traditionally been a disputed region between Sparta and Argos, it considers how sanctuaries played a part in Spartan–perioikic relations. The votives from the two sanctuaries vary: the sanctuary of Apollo Maleatas is rich in weapon dedications, while that of Apollo Tyritas has a diverse array of offerings, including bronzes, pottery and weapons. I argue that the sanctuary of Apollo Maleatas served as a central gathering place that united the Lakedaimonians, both Spartans and perioikoi, and where they celebrated the military qualities of Apollo. The sanctuary of Apollo Tyritas may reflect Spartan interests in the disputed region from the late seventh/early sixth century, and it too presents evidence for the military preoccupations affecting the area. The warrior-god Apollo, prominently worshipped in Sparta and Laconia, was appropriately offered offensive weapons of spears and arrowheads, both real size and miniature. The Spartans and perioikoi celebrated the Maleateia festival, at the sanctuary of Apollo Maleatas, which presented an opportunity for Spartans and perioikoi to gather together. A Laconian sacred landscape was formed through the celebration of common cults and festivals, thus uniting the centre (Sparta) with the Laconian (and Messenian) countryside.

ADHD Treatment in Primary Care: Demographic Factors, Medication Trends, and Treatment Predictors

Background: The aim of this study is to determine the prevalence and characteristics of youth with attention-deficit hyperactivity disorder (ADHD) in Ontario, Canada, and to determine the predictors of psychotropic medication prescriptions in youth with ADHD. Method: This is a cross-sectional retrospective chart abstraction of more than 250 000 medical records from youth aged 1 to 24 years in a large geographical region in Ontario, Canada, linked to population-based health administrative data. A total of 10 000 charts were randomly selected and manually reviewed using predetermined criteria for ADHD and comorbidities. Prevalence, comorbidities, demographic indicators, and health service utilization characteristics were calculated. Predictors of treatment characteristics were determined using logistic regression modelling. Results: The prevalence of ADHD was 5.4% (7.9% males, 2.7% females). Youth with ADHD had significant psychiatric comorbidities. The majority (70.0%) of ADHD patients received prescriptions for stimulant or nonstimulant ADHD medication. Antipsychotic prescriptions were provided to 11.9% of ADHD patients versus 0.9% of patients without ADHD. Antidepressant prescriptions were provided to 19.8% versus 5.4% of patients with and without ADHD, respectively. Predictors of antidepressant prescriptions were increasing age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.07 to 1.21), psychiatric consultation (OR, 2.04; 95% CI, 1.16 to 3.58), and diagnoses of both anxiety and depression (OR, 18.4; 95% CI, 8.03 to 42.1), whereas the only predictor of antipsychotic prescriptions was psychiatric consultation (OR, 3.85; 95% CI, 2.11 to 7.02). Conclusions: Youth with ADHD have more psychiatric comorbidities than youth without ADHD. The majority of youth with ADHD received stimulant medications, and a significant number received additional psychotropic medications, with psychiatric consultation predicting medication use.

Diversity Analysis of Arabidopsis thaliana (L.) Heynh Ecotypes for Glucosinolates in Shoots and Seeds

Glucosinolates (GS) are important secondary plant metabolites present in several plant species, including Arabidopsis thaliana (L.) Heynh. Although genotypic differences among a limited number of samples from a limited geographical range have been reported, there have been few studies exploring the variation from a wider genetic base. The objective of this study was to explore the genetic variation for GS in A. thaliana collected throughout the world. We screened 58 A. thaliana ecotypes collected from the geographic area of lat. 15° N to lat. 59° N and long. 137° E to long. 123° W. Elevation in these areas ranged from sea level to over 480 m. We believe that this study has covered a large geographical region and captured most of the available genetic variation in A. thaliana for GS. There was no geographical trend in A. thaliana shoot or seed tissue for GS concentration. Total shoot GS ranged from 1.1 to 52.8 μmol·g−1 dry weight (DW), averaging 9.3 μmol·g−1 DW among all ecotypes. Total seed GS ranged from 1.6 to 41.8 μmol·g−1 DW with an average of 16.8 μmol·g−1 DW among all ecotypes. Low and high GS-accumulating A. thaliana ecotypes identified in this study may provide a basis for further genetic analysis for GS metabolism. Information provided may also prove useful for improving concentrations of nutritionally beneficial GS in vegetable Brassicas.

Detection of diverse astroviruses from bats in China

Astroviruses infect humans and many different animal species and are associated with gastroenteritis. Recent studies first detected the virus from bat species in Hong Kong. To understand astrovirus distribution in the wider region further, we examined the prevalence of this virus family in bat specimens collected from a large geographical region of mainland China. We collected 500 anal swabs from 20 bat species in 51 natural habitats from 11 provinces of China and tested these for astroviruses. Our study revealed a remarkably high genetic diversity of astroviruses; five monophyletic groups were identified in bats, including two novel groups. Evidence for varying degrees of host restriction for astroviruses from bats has been found. Phylogenetic analyses also provided insight into the inter-species transmission of Mamastrovirus.

Empirical Bayes Estimation of Relative Risks in Disease Mapping

Standardized mortality ratio (SMR) is a popular index of incidence and mortality from diseases such as cancer. Although SMR is quite reliable to measure relative risk for a large geographical region (e.g., a country), it is unreliable for a small-area (e.g. , a district) . In this paper, we introduce an empirical Bayes method to produce an alternative index as well as its measure of uncertainty. An example is provided to demonstrate the method.