“I’m just a long history of people rejecting referrals” experiences of young people who fell through the gap between child and adult mental health services

The paediatric-adult split in mental health care necessitates young people to make a transition between services when they reach the upper end of child and adolescent mental health services (CAMHS). However, we know that this transition is often poor, and not all young people who require ongoing support are able to continue care in adult mental health services (AMHS). These young people are said to have fallen through the gap between services. This research aimed to explore the reasons why young people fall through the gap between CAMHS and AMHS, and what effect his has had on them and their families. Narrative interviews were conducted with 15 young people and 15 parents, representing 19 unique transition stories. Themes were identified collaboatively using thematic analysis. Reasons for falling through the gap were grouped into systemic problems and problems with the quality of care received. Effects of alling through the gap were grouped into separate themes for young people (feeling abandoned; struggling to manage without continued care; problems with medication) and parents (emotional impact of care ending; parents taking an active role in the young person’s care). To our knowledge, this is the firt qualitative study that has focused only on the experiences of young people who have fallen through the gap between services. This research adds novel findings o existing literature regarding barriers to transition and the effectsof discontinuity of care

Capturing the impacts of end of life care on those close to the dying for use in economic evaluation

This thesis reports work to develop and score (value) a measure to capture the impact of end of life care (EoLC) on those people close to the dying. This work is conducted in response to the need to capture wider impacts of EoLC for economic evaluation where there is lack of appropriate measures. To develop the measure, twenty seven in-depth interviews were conducted with those who were recently bereaved or close to somebody receiving EoLC. Constant-comparative analysis was used to develop dimensions for the measure. Pictorial tools were used to explore who is close to those at the end-of-life and therefore could legitimately be included within the evaluation of EoLC interventions. The measure was valued using an exploratory deliberative methodology conducted with six focus groups comprising members of the public. The measure contains six dimensions: $communication$ $with$ $those$ $providing$ $care$ $services$, $practical$ $support$, $privacy$ $and$ $space$, $emotional$ $support$, $preparing$ $and$ $coping$ and $emotional$ $distress$. The communication and practical support attributes received the greatest weighting in the valuation process. On average, there were eight individuals close to those at EoL. This work significantly enhances the potential for including close-persons in economic evaluation of interventions at the end of life

“It is not a scientific number it is just a feeling”:Populating a multi-dimensional end-of-life decision framework using deliberative methods

The capability approach is potentially valuable for economic evaluation at the end of life because of its conceptualisation of wellbeing as freedom and the potential for capturing outcomes for those at end of life and those close to persons at the end of life. For decision making, however, this information needs to be integrated into current evaluation paradigms. This research explored weights for an integrated economic evaluation framework using a deliberative approach. Twelve focus groups were held (38 members of the public, 29 ‘policy makers’, 7 hospice volunteers); budget pie tasks were completed to generate weights. Constant comparison was used to analyse qualitative data, exploring principles behind individuals’ weightings. Average weights elicited from members of the general population and policy makers for the importance that should be given to close persons (versus patients) were very similar, at around 30%. A ‘sliding scale’ of weights between health gain and the capability for a good death resulted from the policy maker and volunteer groups, with increasing weight given to the capability for a good death as the trajectory got closer to death. These weights can be used in developing a more comprehensive framework for economic evaluation at end of life

Maximising the performance of sports turf.

Research was carried out on four main subject areas: playing quality of natural turf; establishment; nitrogen nutrition and stabilisation ofsand rootzones. Apparatus and test methods for determining playing quality are described and procedures for the development of standards for playing quality measures are given. A theoretical analysis of the factors governing playing quality was undertaken which showed that natural turf must be considered in terms of the plant and soil constituents and the manner in which these interact, especially in response to wear. The soil factor grouping is shown to be the most important influence on playing quality, primarily through its effect on moisture retention and throughput. A large-scale field experiment was carried out in order to investigate the effect of five different constructional techniques on playing quality and other aspects of turf performance. Constructional types included: pipe-drainage, slitdrainage, slit-drainage with a 25mm sand layer, a sand carpet and a sand profile construction. The results showed that the sand-based constructions provided the best playing quality but that potential numbers of days lost due to the presence of standing water decreased with increasing constructional sophistication. A review of playing quality of fine turf was carried out and an experiment on ball roll characteristics of five turfgrass specieswas undertaken which showed significant differencesamong species. Two experiments on the establishment of turf using different types of seed and sod were carried out, whose objective was to determine the effects of these experimental treatments on the playing quality, ground cover and water infiltration rate of playing surfaces for both football and golf. Experimental treatments included grades of mature turf, juvenile turf and seed. The most notable finding was the dramatic reduction in water infiltration rate where mature turfwas used for establishment. This was ascribed to a combination of organic and mineral matter imported along with the turf causing blockage of soil macropores and hence reducing water infiltration rate. The effect offertiliser nitrogen on the response of Lolium perenne turf grown on a PruntyMulqueen sand carpet rootzone was studied a field experiment which was subjected to football-type artificial wear treatments during two playing seasons. Measures included ground cover under wear and playing quality. In the case of ground cover and player traction responses to nitrogen showed distinct optima particularly during wear. Ball rebound resilienceand hardness showed no such response. Finally an experiment on the stabilisation ofsand rootzones for sport was carried out the objective of which was to study the effect of artificially strengthening a sand rootzone using randomly oriented tensile inclusions {Netlon mesh elements}. Three different rates of mesh elements, two different sizes and establishment using two types of turf were studied in a field experiment. Mesh element inclusion was found to increase water infiltration rate, traction and hardness. Turf treated by washing to remove adhering soil prior to laying also gave higher infiltration rates and, in addition, affected playing quality

Reference to index of Diploma of degree of Associate of Arts, awarded to Mary Friend Whitney Canaway of Hobart, by Tasmanian Council of Education, Oct. 17 1878

1878, Oct. 17, Diploma of degree of Associate of Arts, awarded to Mary Friend Whitney Canaway of Hobart, by Tasmanian Council of Education. - Private Deposit R.1

How does age affect the relationship between weight and health utility during the middle years of childhood?

Purpose: The limited literature examining weight status and preference-based health-related quality of life (HRQL) in young children is equivocal. This study aims to examine how the association between weight status and preference-based HRQL changes as children develop between the ages of 6 and 10 years old. Methods: The Child Health Utility 9D (CHU-9D) was used to determine preference-based HRQL. Height and weight data were also collected and used to calculate z-BMI adjusted for age and gender. 1467 children were recruited from 54 schools across the West Midlands. Data were collected at four time points over 5 years. Impact of weight on dimensions of HRQL was assessed via the distribution of responses to CHU-9D dimensions by weight status. Multi-level regression analysis controlling for ethnicity, deprivation and other relevant co-variates was conducted to examine the relationship between weight and HRQL. Results: There was no evidence to suggest that the weight status impacted upon the distribution of responses to CHU-9D dimensions. Correspondingly, the multi-level regression analysis found no statistically significant differences in CHU-9D scores between underweight, healthy weight, overweight and obese children. Conclusions: The evidence surrounding the link between preference-based HRQL and weight status in children is limited. This study found no association between weight status and HRQL as measured by the CHU-9D in children between the ages of 5 and 10 years in the UK. Given this, it is recommended that future studies aiming to prevent obesity in children in their middle years do not rely solely on preference-based measures for economic evaluation, and instead focus on capturing clinical or wellbeing outcomes

Is an enhanced behaviour change intervention cost-effective compared with physiotherapy for patients with chronic low back pain? : Results from a multicentre trial in Israel

Objective To assess the cost-effectiveness of an enhanced transtheoretical model of behaviour change in conjunction with physiotherapy compared with standard care (physiotherapy) in patients with chronic lower back pain (CLBP). Design Cost-utility and cost-effectiveness analyses alongside a multicentre controlled trial from a healthcare perspective with a 1-year time horizon. Setting The trial was conducted in eight centres within the Sharon district in Israel. Participants 220 participants aged between 25 and 55 years who suffered from CLBP for a minimum of 3 months were recruited. Interventions The intervention used a model of behaviour change that sought to increase the adherence and implementation of physical activity in conjunction with physiotherapy. The control arm received standard care in the form of physiotherapy. Primary and secondary measures The primary outcome was the incremental cost per quality-adjusted life year (QALY) of the intervention arm compared with standard care. The secondary outcome was the incremental cost per Roland-Morris Disability Questionnaire point. Results The cost per QALY point estimate was 10 645 New Israeli shekels (NIS) (£1737.11). There was an 88% chance the intervention was cost-effective at NIS50 000 per QALY threshold. Excluding training costs, the intervention dominated the control arm, resulting in fewer physiotherapy and physician visits while improving outcomes. Conclusions The enhanced transtheoretical model intervention appears to be a very cost-effective intervention leading to improved outcomes for low cost. Given limitations within this study, there is justification for examining the intervention within a larger, long-term randomised controlled trial

Interspecific comparisons of C\u3csub\u3e3\u3c/sub\u3e turfgrass for tennis use: I. Wear tolerance and carrying capacity under actual match play

Previous studies in the evaluation of wear tolerance have been conducted using wear simulators. Research to investigate wear tolerance of C3 turfgrasses under actual playing conditions and their carrying capacity is limited. Three grass tennis courts (replicates) maintained as official size (single) courts were constructed. Eight species and cultivars were randomized within the three courts (blocks): (1) ‘Keeneland’ Kentucky bluegrass (KB, Poa pratensis L.), (2) ‘Rubix’ KB, (3) ‘Villa’ velvet bentgrass (VBG, Agrostis canina L.), (4) ‘Puritan’ colonial bentgrass (CL, Agrostis capillaris L.), (5) ‘007’ creeping bentgrass (CB, Agrostis stolonifera L.), (6) fine fescue (FF, Festuca spp.) mixture, (7) ‘Karma’ perennial ryegrass (PR, Lolium perenne L.), and (8) ‘Wicked’ PR. Injury at the baseline was measured by counting healthy grass on four dates in 2017 and 2019 using an intersect grid. Carrying capacity at the baseline was derived as hours of play to sustain 90, 80, 70, and 60% grass cover. After 6 wk of actual tennis play involving \u3e120 participating players in 2017 and 2019, KB and PR were superior to other C3 turfgrass for wear tolerance and carrying capacity. These two species exhibited four times the carrying capacity of FF species and nearly 60% more carrying capacity than bentgrass (BG) species. Species of BG afforded higher shoot density and better traction than KB and PR, with VBG exhibiting the best traction, and FF and PR exhibiting the poorest traction. In 2017, greater cell wall content increased wear tolerance and carrying capacity. Velvet bentgrass was as good as KB and PR in overall wear tolerance and carrying capacity under actual match play

Redesigning Sciences Courses based on A Local Senior High School in Iloilo, Philippines’ Student Performances and Perspectives towards Hybrid Learning Approach

This study aimed to examine learners' perspectives on the hybrid learning approach, using printed modules and social media as learning materials to redesign science courses and improve their performances. This study involved 37 students from Tacuyong Sur National High School, 20 from the Grade 9 class and 17 from the Grade 12 Technical Vocational Livelihood (TVL) class in the fourth quarter of the school year 2021-2022. The 5-items multiple-choice test assesses student performance. A survey question determined learners' perspectives on hybrid learning after revising the delivery mode for science courses. Student performances based on their pre-test/post-test revealed the benefits and problems connected with the hybrid learning approach. Program for statistical analysis of sampled data (PSPP) interpreted the survey and student performance. Hybrid learning survey results revealed a practical approach to improve science learners' performances during the COVID-19 pandemic. Data results through teacher-technology innovation demonstrated the effectiveness of hybrid learning techniques to help teachers and curriculum planners redesign course subjects that improve science student performances

Supporting good practice in the provision of services to people with comorbid mental health and alcohol and other drug problems in Australia: describing key elements of good service models

<p>Abstract</p> <p>Background</p> <p>The co-occurrence of mental illness and substance use problems (referred to as "comorbidity" in this paper) is common, and is often reported by service providers as the expectation rather than the exception. Despite this, many different treatment service models are being used in the alcohol and other drugs (AOD) and mental health (MH) sectors to treat this complex client group. While there is abundant literature in the area of comorbidity treatment, no agreed overarching framework to describe the range of service delivery models is apparent internationally or at the national level. The aims of the current research were to identify and describe elements of good practice in current service models of treatment of comorbidity in Australia. The focus of the research was on models of service delivery. The research did not aim to measure the client outcomes achieved by individual treatment services, but sought to identify elements of good practice in services.</p> <p>Methods</p> <p>Australian treatment services were identified to take part in the study through a process of expert consultation. The intent was to look for similarities in the delivery models being implemented across a diverse set of services that were perceived to be providing good quality treatment for people with comorbidity problems.</p> <p>Results</p> <p>A survey was designed based on a concept map of service delivery devised from a literature review. Seventeen Australian treatment services participated in the survey, which explored the context in which services operate, inputs such as organisational philosophy and service structure, policies and procedures that guide the way in which treatment is delivered by the service, practices that reflect the way treatment is provided to clients, and client impacts.</p> <p>Conclusions</p> <p>The treatment of people with comorbidity of mental health and substance use disorders presents complex problems that require strong but flexible service models. While the treatment services included in this study reflected the diversity of settings and approaches described in the literature, the research found that they shared a range of common characteristics. These referred to: service linkages; workforce; policies, procedures and practices; and treatment.</p