Creating change in government to address the social determinants of health: How can efforts be improved?

Background The evidence base for the impact of social determinants of health has been strengthened considerably in the last decade. Increasingly, the public health field is using this as a foundation for arguments and actions to change government policies. The Health in All Policies (HiAP) approach, alongside recommendations from the 2010 Marmot Review into health inequalities in the UK (which we refer to as the ‘Fairness Agenda’), go beyond advocating for the redesign of individual policies, to shaping the government structures and processes that facilitate the implementation of these policies. In doing so, public health is drawing on recent trends in public policy towards ‘joined up government’, where greater integration is sought between government departments, agencies and actors outside of government. Methods In this paper we provide a meta-synthesis of the empirical public policy research into joined up government, drawing out characteristics associated with successful joined up initiatives. We use this thematic synthesis as a basis for comparing and contrasting emerging public health interventions concerned with joined-up action across government. Results We find that HiAP and the Fairness Agenda exhibit some of the characteristics associated with successful joined up initiatives, however they also utilise ‘change instruments’ that have been found to be ineffective. Moreover, we find that – like many joined up initiatives – there is room for improvement in the alignment between the goals of the interventions and their design. Conclusion Drawing on public policy studies, we recommend a number of strategies to increase the efficacy of current interventions. More broadly, we argue that up-stream interventions need to be ‘fit-for-purpose’, and cannot be easily replicated from one context to the next.

Micro inverter with a front-end current-fed converter

The reliability of micro inverters is an important factor as it would be necessary to reduce cost and maintenance of the small and medium scale distributed PV power conversion systems. Electrolytic capacitors and active power decouple circuits can be avoided in micro inverters with the use of medium voltage DC-link. Such a DC-link based micro inverter is proposed with a front-end dual inductor current-fed push-pull converter. The primary side power switches of the front-end converter have reduced switching losses due to multi-resonant operation. In addition, the voltage and current stresses on the diodes of the secondary diode voltage doubler rectifier are reduced due to the presence of a series resonant circuit in the front-end converter. The operation of the proposed micro inverter is explained using an in-depth analysis of the switching characteristics of the power semiconductor devices. The theoretical analysis of the proposed micro inverter is validated using simulation result.

Evaluation framework to assess orthopaedic procedures

Introduction & aims The demand for evidence of efficacy of treatments in general and orthopaedic surgical procedures in particular is ever increasing in Australia and worldwide. The aim of this study is to share the key elements of an evaluation framework recently implemented in Australia to determine the efficacy of bone-anchored prostheses. Method The proposed evaluation framework to determine the benefit and harms of bone-anchored prostheses for individuals with limb loss was extracted from a systematic review of the literature including seminal studies focusing on clinical benefits and safety of procedures involving screw-type implant (e.g., OPRA) and press-fit fixations (e.g., EEFT, ILP, OPL). [1-64] Results The literature review highlighted that a standard and replicable evaluation framework should focus on: • The clinical benefits with a systematic recording of health-related quality of life (e.g., SF-26, Q-TFA), mobility predictor (e.g., AMPRO), ambulation abilities (e.g., TUG, 6MWT), walking abilities (e.g., characteristic spatio-temporal) and actual activity level at baseline and follow-up post Stage 2 surgery, • The potential harms with systematic recording of residuum care, infection, implant stability, implant integrity, injuries (e.g., falls) after Stage 1 surgery. There was a general consensus around the instruments to monitor most of the benefits and harms. The benefits could be assessed using a wide spectrum of complementary assessments ranging from subjective patient self-reporting to objective measurements of physical activity. However, this latter was assessed using a broad range of measurements (e.g., pedometer, load cell, energy consumption). More importantly, the lack of consistent grading of infections was sufficiently noticeable to impede cross-fixation comparisons. Clearly, a more universal grading system is needed. Conclusions Investigators are encouraged to implement an evaluation framework featuring the domains and instruments proposed above using a single database to facilitate robust prospective studies about potential benefits and harms of their procedure. This work is also a milestone in the development of national and international clinical outcome registries.

Regional changes in choroidal thickness associated with accommodation

Purpose. To characterize the changes occurring in choroidal thickness (ChT) across the posterior pole during accommodation using enhanced-depth imaging optical coherence tomography (OCT). Methods. Forty participants (mean age 21 ± 2 years) had measures of ChT and ocular biometry taken during accommodation to 0, 3, and 6 diopter (D) stimuli, with the Spectralis OCT and Lenstar biometer. A Badal optometer and cold mirror system was mounted on both instruments, allowing measurement collection while subjects viewed an external fixation target at varying accommodative demands. Results. The choroid exhibited significant thinning during accommodation to the 6 D stimulus in both subfoveal (mean change, −5 ± 7 μm) and parafoveal regions (P < 0.001). The magnitude of these changes varied by parafoveal meridian, with the largest changes seen in the temporal (−9 ± 12 μm) and inferotemporal (−8 ± 8 μm) meridians (P < 0.001). Axial length increased with accommodation (mean change, +5 ± 11 μm at 3 D, +14 ± 13 μm at 6 D), and these changes were weakly negatively associated with the choroidal changes (r2 = 0.114, P < 0.05). Conclusions. A small, but significant thinning of the choroid was observed at the 6 D accommodation demand, which was greatest in the temporal and inferotemporal parafoveal choroid, and increased with increasing eccentricity from the fovea. The regional variation in the parafoveal thinning corresponds to the distribution of the nonvascular smooth muscle within the uvea, which may implicate these cells as the potential mechanism by which the choroid thins during accommodation.

The ultimate edge: The case for planning media for sustaining space communities

Governments and intergovernmental organisations have long recognised that space communities – the ultimate ‘settlements at the edge’ – will exist one day and have based their first plans for these on another region ‘at the edge’, the Antarctic. United States President Eisenhower proposed to the United Nations in 1960 that the principles of the Antarctic Treaty be applied to outer space and celestial bodies (State Department, n.d.). Three years later the UN adopted the Declaration of Legal Principles Governing the Activities of States in the Exploration and Use of Outer Space and in 1967 that became the Outer Space Treaty. According to the UN Office for Outer Space Affairs, ‘the Treaty was opened for signature by the three depository Governments (the Russian Federation, the United Kingdom and the United States of America) in January 1967, and it entered into force in October 1967’ (Office for Outer Space Affairs, n.d). The status of the treaty (at time of writing) was 89 signatories and 102 parties (Office for Disarmament Affairs, n.d.). Other related instruments include the Rescue Agreement, the Liability Convention, the Registration Convention and the Moon Agreement (Office for Outer Space Affairs, n.d.-a). Jumping to the present, a newsagency reported in July 2014 (Reuters, 2014) that the British Government had shortlisted eight aerodromes in its search for a potential base for the UK’s first spaceplane flights which Ministers want to happen by 2018 (UK Space Agency, 2014). The United States already has a spaceport, in New Mexico (Cokley, Rankin, Heinrich, & McAuliffe, 2013)...

Solute induced liquid crystalline behaviour of a quaternary ammonium salt and its application to structure determination

A new liquid crystalline phase, induced by the addition of small amounts of a non-mesogenic solute (such as dimethyl sulphoxide or methyl iodide) to a quaternary ammonium salt, N-methyl-N,N,N-trioctadecylammonium iodide (MTAI), has been detected by NMR and optical microscopic studies. In some cases, there is a coexistence of nematic and smectic phases. Information on the ordering of the phases in the magnetic field of the spectrometer has been derived from NMR spectra of a dissolved molecule, C-13-enriched methyl iodide. The low order parameter of the pure thermotropic nematic phase of the salt provides first-order spectra of the dissolved oriented molecules. Analyses of spectra of cis,cis-mucononitrile exemplifies the utility of the MTAI nematic phase in the determination of structural parameters of the solute.

Two linear beetle-type scanning tunneling microscopes

Two beetle-type scanning tunneling microscopes are described. Both designs have the thermal stability of the Besocke beetle and the simplicity of the Wilms beetle. Moreover, sample holders were designed that also allow both semiconductor wafers and metal single crystals to be studied. The coarse approach is a linear motion of the beetle towards the sample using inertial slip–stick motion. Ten wires are required to control the position of the beetle and scanner and measure the tunneling current. The two beetles were built with different sized piezolegs, and the vibrational properties of both beetles were studied in detail. It was found, in agreement with previous work, that the beetle bending mode is the lowest principal eigenmode. However, in contrast to previous vibrational studies of beetle-type scanning tunneling microscopes, we found that the beetles did not have the “rattling” modes that are thought to arise from the beetle sliding or rocking between surface asperities on the raceway. The mass of our beetles is 3–4 times larger than the mass of beetles where rattling modes have been observed. We conjecture that the mass of our beetles is above a “critical beetle mass.” This is defined to be the beetle mass that attenuates the rattling modes by elastically deforming the contact region to the extent that the rattling modes cannot be identified as distinct modes in cross-coupling measurements.

Enhanced sensitivity in detection of Kerr rotation by double modulation and time averaging based on Allan variance

Experiments in spintronics necessarily involve the detection of spin polarization. The sensitivity of this detection becomes an important factor to consider when extending the low temperature studies on semiconductor spintronic devices to room temperature, where the spin signal is weaker. In pump-probe experiments, which optically inject and detect spins, the sensitivity is often improved by using a photoelastic modulator (PEM) for lock-in detection. However, spurious signals can arise if diode lasers are used as optical sources in such experiments, along with a PEM. In this work, we eliminated the spurious electromagnetic coupling of the PEM onto the probe diode laser, by the double modulation technique. We also developed a test for spurious modulated interference in the pump-probe signal, due to the PEM. Besides, an order of magnitude enhancement in the sensitivity of detection of spin polarization by Kerr rotation, to 3x10(-8) rad was obtained by using the concept of Allan variance to optimally average the time series data over a period of 416 s. With these improvements, we are able to experimentally demonstrate at room temperature, photoinduced steady-state spin polarization in bulk GaAs. Thus, the advances reported here facilitate the use of diode lasers with a PEM for sensitive pump-probe experiments. They also constitute a step toward detection of spin-injection in Si at room temperature.

Improving SEA procedures within Italian regions: Towards a more effective evaluation of urban sustainability

Sustainable urban development, a major issue at global scale, will become more relevant according to population growth predictions in developed and developing countries. Societal and international recognition of sustainability concerns led to the development of specific tools and procedures, known as sustainability assessments/appraisals (SA). Their effectiveness however, considering that global quality life indicators have worsened since their introduction, has promoted a re-thinking of SA instruments. More precisely, Strategic Environmental Assessment (SEA), – a tool introduced in the European context to evaluate policies, plans, and programmes (PPPs), – is being reconsidered because of several features that seem to limit its effectiveness. Over time, SEA has evolved in response to external and internal factors dealing with technical, procedural, planning and governance systems thus involving a shift of paradigm from EIA-based SEAs (first generation protocols) towards more integrated approaches (second generation ones). Changes affecting SEA are formalised through legislation in each Member State, to guide institutions at regional and local level. Defining SEA effectiveness is quite difficult. Its’ capacity-building process appears quite far from its conclusion, even if any definitive version can be conceptualized. In this paper, we consider some European nations with different planning systems and SA traditions. After the identification of some analytical criteria, a multi-dimensional cluster analysis is developed on some case studies, to outline current weaknesses.

Improving SEA prodedures within Italian regions: Towards a more effective evaluation of urban sustainability

Sustainable urban development, a major issue at global scale, will become more relevant according to population growth predictions in developed and developing countries. Societal and international recognition of sustainability concerns led to the development of specific tools and procedures, known as sustainability assessments/appraisals (SA). Their effectiveness however, considering that global quality life indicators have worsened since their introduction, has promoted a re-thinking of SA instruments. More precisely, Strategic Environmental Assessment (SEA), – a tool introduced in the European context to evaluate policies, plans, and programmes (PPPs), – is being reconsidered because of several features that seem to limit its effectiveness. Over time, SEA has evolved in response to external and internal factors dealing with technical, procedural, planning and governance systems thus involving a shift of paradigm from EIA-based SEAs (first generation protocols) towards more integrated approaches (second generation ones). Changes affecting SEA are formalised through legislation in each Member State, to guide institutions at regional and local level. Defining SEA effectiveness is quite difficult. Its’ capacity-building process appears quite far from its conclusion, even if any definitive version can be conceptualized. In this paper, we consider some European nations with different planning systems and SA traditions. After the identification of some analytical criteria, a multi-dimensional cluster analysis is developed on some case studies, to outline current weaknesses.

Submission to the External Independent Review of the United Nations Response to Allegations of Sexual Exploitation and Abuse and Other Serious Crimes by Members of Foreign Military Forces Not Under United Nations Command in the Central African Republic

In 2015 the UN Secretary-General established an External Independent Review to review how the United Nations has responded to allegations of child sexual exploitation and child sexual abuse, and to make recommendations concerning how the United Nations should respond to allegations in the future. This submission to the Review Panel draws on literature regarding children's rights, the nature of child sexual abuse, international instruments and policy, the nature of institutional child sexual abuse, and the CAR case itself. It makes recommendations for reform of UN protocols and procedures to better prevent child sexual abuse, and to improve responses to future occurrences.

Ion beam processing of oriented CuO films deposited on (100) YSZ by laser ablation

A systematic study of Ar ion implantation in cupric oxide films has been reported. Oriented CuO films were deposited by pulsed excimer laser ablation technique on (1 0 0) YSZ substrates. X-ray diffraction (XRD) spectra showed the highly oriented nature of the deposited CuO films. The films were subjected to ion bombardment for studies of damage formation, Implantations were carried out using 100 keV Arf over a dose range between 5 x 10(12) and 5 x 10(15) ions/cm(2). The as-deposited and ion beam processed samples were characterized by XRD technique and resistance versus temperature (R-T) measurements. The activation energies for electrical conduction were found from In [R] versus 1/T curves. Defects play an important role in the conduction mechanism in the implanted samples. The conductivity of the film increases, and the corresponding activation energy decreases with respect to the dose value.

Programmable digital signal averager.

A high speed digital signal averager with programmable features for the sampling period, for the number of channels and for the number of sweeps is described. The system implements a stable averaging algorithm (Deadroff and Trimble 1968) to provide a stable, calibrated display. The performance of the instrument has been evaluated for the reduction of random noise and for comb-filter action. Special uses of the instrument as a box-car integrator and as a transient recorder are also indicated.

Rotating crystal ESR cavity for angular variation studies at room temperature

We describe an X-band ESR cavity for angular variation studies on single crystals at room temperature. The cavity was found to have a high Q over wide rotation angles. Review of Scientific Instruments is copyrighted by The American Institute of Physics.

An NMR study of the interaction of cytosine arabinoside and lysozyme

Abstract is not available.