The Care Programme Approach and the end of indefinitely renewable Leave of Absence in Scotland

ObjectiveTo consider the relationship between the restriction of leave of absence (LOA) to 12 months, the introduction of community care orders (CCOs) and the implementation of the Care Programme Approach (CPA).DesignMultiple methods were employed: scrutiny of Mental Welfare Commission for Scotland (MWC) records; questionnaire to consultant psychiatrists and mental health officers (MHOs) regarding attitudes; survey of psychiatrists in respect of outcomes for named patients.SettingScotlandSubjectsTwo hundred and sixty six patients who were affected by the changes introduced by the Mental Health (Patients in the Community) Act 1995.ResultsInformation was available for 195 (73%) patients in relation to CPA. Of these 113 (58%) were included on CPA and for 63/113 (56%) (63/195 (32%)) CPA was considered to have enhanced patient care.Where CPA was considered useful it was because it was seen as bringing people together, enhancing the patient’s role in treatment and managing difficult situations. Negative comments regarding CPA were that it was unnecessary as the patient’s needs were straightforward, it duplicated current practices or it was too bureaucratic.ConclusionsDespite concerns expressed by professionals about the restriction to LOA and the guidance that patients should be on CPA, for only a minority of patients was CPA described as enhancing care. Questions are raised about the low use of CCOs and CPA by psychiatrists for patients who reached the new limits of LOA

Chronic Cough, Reflux, Postnasal Drip Syndrome, and the Otolaryngologist

Objectives. Chronic cough is a multifactorial symptom that requires multidisciplinary approach. Over the last years, general practitioners refer increasingly more chronic cough patients directly to the otolaryngologist. The aim of this paper is to highlight the issues in diagnosis and management of chronic cough patients from the otolaryngologist perspective. Design. Literature review. Results. Gastroesophageal reflux and postnasal drip syndrome remain one of the most common causes of chronic cough. Better diagnostic modalities, noninvasive tests, and high technology radiological and endoscopic innovations have made diagnosis of these difficult-to-treat patients relatively easier. Multidisciplinary assessment has also meant that at least some of these cases can be dealt with confidently in one stop clinics. Conclusions. As the number of referrals of chronic cough patients to an Ear Nose Throat Clinic increases, the otolaryngologist plays a pivotal role in managing these difficult cases

Evaluation of Flying Start NHS

Introduction In January 2006 “Flying Start NHS”, a national web-based educational resource to support the transition from student to qualified practitioner for all newly qualified nurses, midwives and allied health professionals (NMAHP) joining NHS Scotland was launched. This report brings together the findings from a two-year evaluation which focussed on the impact and effectiveness of Flying Start NHS in supporting the recruitment, confidence and skills development of newly qualified nurses, midwives and allied health professionals within NHS Scotland. The evaluation was carried out be a research team from the University of the West of Scotland, the University of Stirling, and the University of Dundee

A new automated method for high‐throughput carbon and hydrogen isotope analysis of gaseous and dissolved methane at atmospheric concentrations

Rationale The dual isotope ratio analysis, carbon (δ13C value) and hydrogen (δ2H value), of methane (CH4) is a valuable tracer tool within a range of areas of scientific investigation, not least wetland ecology, microbiology, CH4 source identification and the tracing of geological leakages of thermogenic CH4 in groundwater. Traditional methods of collecting, purification, separating and analysing CH4 for δ13C and δ2H determination are, however, very time consuming, involving offline manual extractions. Methods Here we describe a new gas chromatography, pyrolysis/combustion, isotope ratio mass spectrometry (IRMS) system for the automated analysis of either dissolved or gaseous CH4 down to ambient atmospheric concentrations (2.0 ppm). Sample introduction is via a traditional XYZ autosampler, allowing either helium (He) purging of gas or sparging of water from a range of suitable, airtight bottles. Results The system routinely achieves precision of <0.3‰ for δ13C values and <3.0‰ for δ2H values, based on long‐term replicate analysis of an in‐house CH4/He mix standard (BGS‐1), corrected to two externally calibrated reference gases at near atmospheric concentrations of methane. Depending upon CH4 concentration and therefore bottle size, the system runs between 21 (140‐mL bottle) and 200 samples (12‐mL exetainer) in an unattended run overnight. Conclusions This represents the first commercially available IRMS system for dual δ13C and δ2H analysis of methane at atmospheric concentrations and a step forward for the routine (and high‐volume) analysis of CH4 in environmental studies

Child and parental sleep in young children with epilepsy: A population-based case-control study

Objective: To determine the prevalence of parent‐reported sleep problems in young children with epilepsy and their parents, and to compare findings with those in a non–epilepsy‐related neurodisability (neurodevelopmental/neurological difficulties) group. Method: Parents of young children (1–7 years) with epilepsy (n = 48 [91% ascertainment]) completed the Child Sleep Habits Questionnaire (CSHQ). Parents (mothers and fathers) also completed the Pittsburgh Sleep Quality Index (PSQI) and the Iowa Fatigue Scale (IFS) in relation to their own functioning. The responses of parents of children with epilepsy were compared with parents of developmental‐, age‐, and gender‐matched children with nonepilepsy‐related neurodisability (n = 48). Results: There was not a significant difference in the proportion of children with epilepsy and the children with neurodisability scoring in the at‐risk range on the CSHQ (81% vs. 71% respectively) (p = 0.232). 62% of mothers and 44% of fathers of children with epilepsy had ‘poor quality sleep’ on the PSQI; there was not a significant difference between mothers of children with epilepsy and those of children with neurodisability (p = 0.526) or IFS (p = 0.245) total scores. However, mothers of children with epilepsy had significantly more difficulties on the productivity subscale of the IFS (p = 0.004). There were no significant differences between fathers’ scores on either measure. In the epilepsy group, child behavioral problems (p = 0.001) were independently associated with child sleep difficulties and maternal mental health problems were associated with parental sleep difficulties (p = 0.04) and fatigue (p = 0.018). Significance: Young children with epilepsy and their parents have a high rate of sleep difficulties. There is a need to develop effective interventions for this population, taking into consideration of the role of child behavioral problems and parental mental health difficulties

The Ursinus Weekly, January 11, 1965

Football players receive awards at banquet: Tony Motto gets All-ECAC • Ursinus to send delegation to Model UN • Weekly names Sam Walker sports editor • Faculty Forum to present concert, lecture recital: 20th century American music, subject • Three placed in teaching positions • Pre-meds to hear two Sacred Heart pathologists • World\u27s Fair invites college talent to perform • Pi Nu Epsilon, music fraternity, initiates eight • Norristown man named to vacancy in Treas. Office • Good band, decorations add to great TG dance • The best TV show in the world • Editorial: Our large small college • Bob Dylan: Alone and indifferent • J. D. Salinger writes for The Ursinus Weekly • Anthem, a warning to society • The Doanes report on teaching in the South • Bears drop two, F&M-Swarthmore; Troster\u27s thirty points rock PMC • Matmen drop opener to Del. • Soccer team puts three on All-MAC • Y Commission sponsors film on discrimination • Greek gleanings • Letters to the editor • Kaffee Klatsch debates Negro block bustinghttps://digitalcommons.ursinus.edu/weekly/1238/thumbnail.jp

Fruit development of the diploid kiwifruit, Actinidia chinensis 'Hort16A'

<p>Abstract</p> <p>Background</p> <p>With the advent of high throughput genomic tools, it is now possible to undertake detailed molecular studies of individual species outside traditional model organisms. Combined with a good understanding of physiological processes, these tools allow researchers to explore natural diversity, giving a better understanding of biological mechanisms. Here a detailed study of fruit development from anthesis through to fruit senescence is presented for a non-model organism, kiwifruit, <it>Actinidia chinensis </it>('Hort16A').</p> <p>Results</p> <p>Consistent with previous studies, it was found that many aspects of fruit morphology, growth and development are similar to those of the model fruit tomato, except for a striking difference in fruit ripening progression. The early stages of fruit ripening occur as the fruit is still growing, and many ripening events are not associated with autocatalytic ethylene production (historically associated with respiratory climacteric). Autocatalytic ethylene is produced late in the ripening process as the fruit begins to senesce.</p> <p>Conclusion</p> <p>By aligning <it>A. chinensis </it>fruit development to a phenological scale, this study provides a reference framework for subsequent physiological and genomic studies, and will allow cross comparison across fruit species, leading to a greater understanding of the diversity of fruits found across the plant kingdom.</p

CO‑ADMINISTRATION OF FVIII WITH IVIG REDUCES IMMUNE RESPONSE TO FVIII IN HEMOPHILIA A MICE

Hemophilia A is an X-linked recessive congenital bleeding disorder. Exogenous infusion of FVIII is the treatment of choice, and the development of immunoglobulins against FVIII (inhibitors) remains the major challenge in clinical management of the disease. Here, we investigated the effect of co-administration of FVIII with intravenous immunoglobulin (IVIG) on the development of inhibitors in previously untreated hemophilia A mice. A group of hemophilia A mice (C57BL/6FVIII−/−) received weekly injections of recombinant human FVIII (rFVIII) for twelve consecutive weeks while a second group received co-injections of rFVIII + IVIG. An in-house enzyme-linked immunosorbent assay (ELISA) was designed to detect antibodies to rFVIII. Every mouse in the first group developed antibodies to rFVIII. In contrast, mice treated with rFVIII + IVIG showed significantly lower antibody titers. Interestingly, when co-administration of IVIG was discontinued after 12 weeks in some mice (rFVIII continued), these mice experienced an increase in antibody titer. In contrast, mice that continued to receive rFVIII + IVIG retained significantly lower titers. In conclusion, prophylactic rFVIII co-administration with IVIG modulated the immune response to FVIII and resulted in decreased anti-FVIII antibody titer. These findings suggest that co-injection therapy with IVIG could potentially be effective in the management of hemophilia A patients at risk of inhibitor development

The information needs of people living with ankylosing spondylitis: a questionnaire survey

&lt;p&gt;BACKGROUND:Today, health care is patient-centred with patients more involved in medical decision making and taking an active role in managing their disease. It is important that patients are appropriately informed about their condition and that their health care needs are met. We examine the information utilisation, sources and needs of people with ankylosing spondylitis (AS).&lt;/p&gt; &lt;p&gt;METHODS: Participants in an existing AS cohort study were asked to complete a postal or online questionnaire containing closed and open-ended questions, regarding their information access and needs. Participants were stratified by age and descriptive statistics were performed using STATA 11, while thematic analysis was performed on open-ended question narratives. Qualitative data was handled in Microsoft Access and explored for emerging themes and patterns of experiences.&lt;/p&gt; &lt;p&gt;RESULTS: Despite 73% of respondents having internet access, only 49% used the internet to access information regarding AS. Even then, this was only infrequently. Only 50% of respondents reported accessing written information about AS, which was obtained mainly in specialist clinics. Women were more likely than men to access information (63% (women) 46% (men)) regardless of the source, while younger patients were more likely to use online sources. The main source of non-written information was the rheumatologist. Overall, the respondents felt there was sufficient information available, but there was a perception that the tone was often too negative. The majority (95%) of people would like to receive a regular newsletter about AS, containing positive practical and local information. Suggestions were also made for more information about AS to be made available to non-specialist medical professionals and the general public.&lt;/p&gt; &lt;p&gt;CONCLUSIONS: There appears to be sufficient information available for people with AS in the UK and this is mostly accessed by younger AS patients. Many patients, particularly men, choose not to access AS information and concerns were raised about its negative tone. Patients still rely on written and verbal information from their specialists. Future initiatives should focus on the delivery of more positive information, targeting younger participants in particular and increasing the awareness in the general population and wider non-specialist medical community.&lt;/p&gt

A randomised controlled trial and cost-effectiveness evaluation of "booster" interventions to sustain increases in physical activity in middle-aged adults in deprived urban neighbourhoods

Background: Systematic reviews have identified a range of brief interventions which increase physical activity in previously sedentary people. There is an absence of evidence about whether follow up beyond three months can maintain long term physical activity. This study assesses whether it is worth providing motivational interviews, three months after giving initial advice, to those who have become more active. Methods/Design: Study candidates (n = 1500) will initially be given an interactive DVD and receive two telephone follow ups at monthly intervals checking on receipt and use of the DVD. Only those that have increased their physical activity after three months (n = 600) will be randomised into the study. These participants will receive either a "mini booster" (n = 200), "full booster" (n = 200) or no booster (n = 200). The "mini booster" consists of two telephone calls one month apart to discuss physical activity and maintenance strategies. The "full booster" consists of a face-to-face meeting with the facilitator at the same intervals. The purpose of these booster sessions is to help the individual maintain their increase in physical activity. Differences in physical activity, quality of life and costs associated with the booster interventions, will be measured three and nine months from randomisation. The research will be conducted in 20 of the most deprived neighbourhoods in Sheffield, which have large, ethnically diverse populations, high levels of economic deprivation, low levels of physical activity, poorer health and shorter life expectancy. Participants will be recruited through general practices and community groups, as well as by postal invitation, to ensure the participation of minority ethnic groups and those with lower levels of literacy. Sheffield City Council and Primary Care Trust fund a range of facilities and activities to promote physical activity and variations in access to these between neighbourhoods will make it possible to examine whether the effectiveness of the intervention is modified by access to community facilities. A one-year integrated feasibility study will confirm that recruitment targets are achievable based on a 10% sample.Discussion: The choice of study population, study interventions, brief intervention preceding the study, and outcome measure are discussed