Leadership of healthcare commissioning networks in England: a mixed-methods study on clinical commissioning groups.

To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation.

A Salmonella Typhimurium-Typhi genomic chimera: a model to study Vi polysaccharide capsule function in vivo.

The Vi capsular polysaccharide is a virulence-associated factor expressed by Salmonella enterica serotype Typhi but absent from virtually all other Salmonella serotypes. In order to study this determinant in vivo, we characterised a Vi-positive S. Typhimurium (C5.507 Vi(+)), harbouring the Salmonella pathogenicity island (SPI)-7, which encodes the Vi locus. S. Typhimurium C5.507 Vi(+) colonised and persisted in mice at similar levels compared to the parent strain, S. Typhimurium C5. However, the innate immune response to infection with C5.507 Vi(+) and SGB1, an isogenic derivative not expressing Vi, differed markedly. Infection with C5.507 Vi(+) resulted in a significant reduction in cellular trafficking of innate immune cells, including PMN and NK cells, compared to SGB1 Vi(-) infected animals. C5.507 Vi(+) infection stimulated reduced numbers of TNF-α, MIP-2 and perforin producing cells compared to SGB1 Vi(-). The modulating effect associated with Vi was not observed in MyD88(-/-) and was reduced in TLR4(-/-) mice. The presence of the Vi capsule also correlated with induction of the anti-inflammatory cytokine IL-10 in vivo, a factor that impacted on chemotaxis and the activation of immune cells in vitro.

Effect of previous cyclic axial loads on pile groups

Numerous piles are often subjected to the combination of cyclic axial and cyclic lateral loads in service, such as piled foundations for offshore platforms which may suffer swaying and rocking motions owing to wind and wave actions. In this research, centrifuge tests were conducted to investigate the effect of previous cyclic axial loads on the performance of pile groups subjected to subsequent cyclic lateral loads. Different pile installation methods were also applied to study the different behaviour of bored and jacked pile groups subjected to cyclic loads. During lateral load cycling, it is seen that cyclic axial loads to which pile groups were previously subjected could reduce the pile cap permanent lateral displacement in the first lateral load cycle but do not influence the incremental rate of permanent displacement in the following lateral load cycles. Moreover, it is found that previous cyclic axial loads could improve the pile cap cyclic lateral secant stiffness, especially for the pre-jacked pile group. When rocking motions were induced by cyclic lateral loads, pile groups subjected to cyclic axial loads before have smaller permanent settlement than those without the cyclic axial loading effect. The designers of piles that are intended to resist significant lateral loads without excessive deformations in service may wish to deploy cyclic axial preloading, accordingly.

Investigating the link between well-being and energy use; an explorative case study between passive and active domestic energy management systems

The aim of this study was to explore how the remote control of appliances/lights (active energy management system) affected household well-being, compared to in-home displays (passive energy management system). A six-week exploratory study was conducted with 14 participants divided into the following three groups: active; passive; and no equipment. The effect on well-being was measured through thematic analysis of two semi-structured interviews for each participant, administered at the start and end of the study. The well-being themes were based on existing measures of Satisfaction and Affect. The energy demand for each participant was also measured for two weeks without intervention, and then compared after four weeks with either the passive or active energy management systems. These measurements were used to complement the well-being analysis. Overall, the measure of Affect increased in the passive group but Satisfaction decreased; however, all three measures on average decreased in the active group. The measured energy demand also highlighted a disconnect between well-being and domestic energy consumption. The results point to a need for further investigation in this field; otherwise, there is a risk that nationally implemented energy management solutions may negatively affect our happiness and well-being. © 2013 Elsevier Ltd.