Quality Improvement: Lessons from the English National Health Services.

Based on our own experiences leading healthcare improvement in the English National Health Service (NHS), we identify seven themes that connect with the story of front-line ownership (FLO): Create investors not buyers of change - "buy-in" is too late in the change process; We need to combine both technical and cultural aspects of change - go slow to go fast and make sure that we pay attention to the human dimensions of change; Build strong ties AND weak ties - reach out to your usual suspects AND find your unusual suspects and unlikely allies; If we want innovation, we need to create psychological safety - the conditions of trust and support that make people feel safe to try new things that might fail; Build energy for change for the long haul, right from the start of your change efforts - go beyond the typical "intellectual" energy and build "social" and "spiritual" energy that create strong foundations for change; Challenge "the myth of the disinterested" - everyone is passionate about something; The leader as coach and team member - be the leadership role model that enables change.

Sustaining organizational culture change in health systems.

Purpose: The questions addressed by this review are: first, what are the guiding principles underlying efforts to stimulate sustained cultural change; second, what are the mechanisms by which these principles operate; and, finally, what are the contextual factors that influence the likelihood of these principles being effective? The paper aims to discuss these issues.

Design/methodology/approach: The authors conducted a literature review informed by rapid realist review methodology that examined how interventions interact with contexts and mechanisms to influence the sustainability of cultural change. Reference and expert panelists assisted in refining the research questions, systematically searching published and grey literature, and helping to identify interactions between interventions, mechanisms and contexts.

Regulation of alternative VEGF-A mRNA splicing is a therapeutic target for analgesia.

Vascular endothelial growth factor-A (VEGF-A) is best known as a key regulator of the formation of new blood vessels. Neutralization of VEGF-A with anti-VEGF therapy e.g.

Development of a criterion method to determine peak mechanical power output in a countermovement jump.

There is a general agreement that the most valid method of measuring peak lower-body mechanical power output (LBPP) in a countermovement jump (CMJ) is by analysis of the corresponding vertical component of the ground reaction force (VGRF)-time history of the jump. However, there is no published standard protocol. The purpose of this study was to establish a standard protocol.

VEGF-A165b is an endogenous neuroprotective splice isoform of vascular endothelial growth factor A in vivo and in vitro.

Vascular endothelial growth factor (VEGF) A is generated as two isoform families by alternative RNA splicing, represented by VEGF-A165a and VEGF-A165b. These isoforms have opposing actions on vascular permeability, angiogenesis, and vasodilatation. The proangiogenic VEGF-A165a isoform is neuroprotective in hippocampal, dorsal root ganglia, and retinal neurons, but its propermeability, vasodilatatory, and angiogenic properties limit its therapeutic usefulness.

Influence of active recovery on professional rugby union player's ability to harness postactivation potentiation.

Aim: After postactivation potentiation (PAP) has been induced, current research recommends that, on average, an 8 minute passive recovery period is applied before engaging in subsequent dynamic exercise. However, given the importance of maximizing time usage during the warm-up of elite athletes, it is likely that further exercise would be incorporated into this time frame. This study aimed to examine the effects of passive and active recovery on the ability to utilize PAP.

Effects of resisted sprint training on acceleration in professional rugby union players.

The use of weighted sled towing as a training tool to improve athlete acceleration has received considerable attention; however, its effectiveness for developing acceleration is equivocal. This study compared the effects of combined weighted sled towing and sprint training against traditional sprint training on 10 and 30 m speed in professional rugby union players (n = 20). After baseline testing of 10 and 30 m speed, participants were assigned to either the combined sled towing and sprint training (SLED) or traditional sprint training (TRAD) groups, matched for 10-m sprint times.

Ovarian VEGF(165)b expression regulates follicular development, corpus luteum function and fertility.

Angiogenesis and vascular regression are critical for the female ovulatory cycle. They enable progression and regression of follicular development, and corpora lutea formation and regression. Angiogenesis in the ovary occurs under the control of the vascular endothelial growth factor-A (VEGFA) family of proteins, which are generated as both pro-(VEGF(165)) and anti(VEGF(165)b)-angiogenic isoforms by alternative splicing.

Acute laminar shear stress reversibly increases human glomerular endothelial cell permeability via activation of endothelial nitric oxide synthase.

Laminar shear stress is a key determinant of systemic vascular behavior, including through activation of endothelial nitric oxide synthase (eNOS), but little is known of its role in the glomerulus. We confirmed eNOS expression by glomerular endothelial cells (GEnC) in tissue sections and examined effects of acute exposure (up to 24 h) to physiologically relevant levels of laminar shear stress (10-20 dyn/cm(2)) in conditionally immortalized human GEnC. Laminar shear stress caused an orientation of GEnC and stress fibers parallel to the direction of flow and induced Akt and eNOS phosphorylation along with NO production.

Exploring the differential diagnosis of hemorrhagic vesicopustules in a newborn.

Hemorrhagic vesicles in a newborn present a challenging differential diagnosis including both infectious and neoplastic disorders. Patients should be evaluated in an efficient manner to arrive at the correct diagnosis as quickly as possible. We present here an interesting case that outlines the methodical workup that ultimately revealed the diagnosis of congenital Langerhans cell histiocytosis.

Comparing Point of Care International Normalised Ratio testing with laboratory testing methods in a cardiac inpatient population.

Aims And Objective: To compare agreement between International Normalised Ratio results from Point of Care testing with laboratory testing for cardiac inpatients receiving warfarin sodium.

Background: Availability of point of care technology for International Normalised Ratio testing offers considerable benefits to patients and health care staff across a range of context.

Design: Prospective comparison study.

Overexpression of VEGF165b in podocytes reduces glomerular permeability.

The observation that therapeutic agents targeting vascular endothelial growth factor-A (VEGF-A) associate with renal toxicity suggests that VEGF plays a role in the maintenance of the glomerular filtration barrier. Alternative mRNA splicing produces the VEGF(xxx)b family, which consists of antiangiogenic peptides that reduce permeability and inhibit tumor growth; the contribution of these peptides to normal glomerular function is unknown. Here, we established and characterized heterozygous and homozygous transgenic mice that overexpress VEGF(165)b specifically in podocytes.

VEGF-A165b is cytoprotective and antiangiogenic in the retina.

Purpose: A number of key ocular diseases, including diabetic retinopathy and age-related macular degeneration, are characterized by localized areas of epithelial or endothelial damage, which can ultimately result in the growth of fragile new blood vessels, vitreous hemorrhage, and retinal detachment. VEGF-A(165), the principal neovascular agent in ocular angiogenic conditions, is formed by proximal splice site selection in its terminal exon 8. Alternative splicing of this exon results in an antiangiogenic isoform, VEGF-A(165)b, which is downregulated in diabetic retinopathy.

Influence of postactivation potentiation on sprinting performance in professional rugby players.

After a bout of high-intensity exercise of short duration (preload stimulus), the muscle is in both a fatigued and potentiated (referred to as postactivation potentiation [PAP]) state. Consequently, subsequent muscle performance depends on the balance of these 2 factors. Although research has shown PAP to be an effective method of increasing power during both the squat jumps, little data exist on its effect on more functional activities such as sprinting.

Optimal loading for the development of peak power output in professional rugby players.

The ability to develop high levels of muscular power is considered an essential component of success in many sporting activities; however, the optimal load for the development of peak power during training remains controversial. Our aim in the present study was to determine the optimal load required to observe peak power output during the ballistic bench throw (BBT) and squat jump (SJ) in professional rugby players. Forty-seven, professional, male, rugby players of (mean +/- SD) mass 101.

Complex training in professional rugby players: influence of recovery time on upper-body power output.

After a bout of heavy resistance training (HRT), skeletal muscle is in both a fatigued and potentiated state. Subsequent muscle performance depends on the balance between these 2 factors. To date, there is no uniform agreement about the recovery time required between the HRT and subsequent muscle performance to gain performance benefits in the upper body.

Molecular diversity of VEGF-A as a regulator of its biological activity.

The vascular endothelial growth factor (VEGF) family of proteins regulates blood flow, growth, and function in both normal physiology and disease processes. VEGF-A is alternatively spliced to form multiple isoforms, in two subfamilies, that have specific, novel functions. Alternative splicing of exons 5-7 of the VEGF gene generates forms with differing bioavailability and activities, whereas alternative splice-site selection in exon 8 generates proangiogenic, termed VEGF(xxx), or antiangiogenic proteins, termed VEGF(xxx)b.