How to measure the need for transition to adult services among young people with Attention Deficit Hyperactivity Disorder(ADHD): a comparison of surveillance versus case note review methods

This is the author accepted manuscript. The final version is available from BioMed Central via the DOI in this recordBackground: Health services have not provided adequate support for young people with long term health conditions to transfer from child to adult services. National Institute of Health and Care (NICE) guidance on transition has been issued to address these gaps. However, data are often sparse about the number of young adults who might need to transition. Using Attention Deficit Hyperactivity Disorder (ADHD) as an exemplar, this study used an existing surveillance system and a case note review to capture the incidence of the transition process, and compared and contrasted the findings. Methods: The Child and Adolescent Psychiatry Surveillance System (CAPSS) was used to estimate the incident transition of young people with Attention Deficit Hyperactivity Disorder (ADHD) from child to adult services. This involves consultant child and adolescent psychiatrists from the United Kingdom (UK) and Republic of Ireland (ROI) reporting relevant young people as they are seen in clinics. In parallel, a case note review was conducted using the Maudsley Biomedical Research Centre (BRC) Clinical Records Interactive Search (CRIS). The study period ran for twelve months with a nine month follow up to see how the transition proceeded. Results: CRIS identified 76 cases in the study period, compared to 18 identified using surveillance via CAPSS. Methodological issues were experienced using both methods. Surveillance issues; eligibility criteria confusion, reporting errors, incomplete questionnaires, difficulties contacting clinicians, and surveillance systems do not cover non-doctors and psychiatrists who are not consultants. Case note review issues using CRIS included the need for researchers to interpret clinical notes, the availability and completeness of data in the notes, and data limited to the catchment of one particular mental health trust. Conclusions: Both methods demonstrate strengths and weaknesses; the combination of both methods in the absence of strong routinely collected data, allowed a more robust estimate of the level of need for service planning and commissioning.National Institute for Health Researc

How random is your heart beat?

We measure the content of random uncorrelated noise in heart rate variability using a general method of noise level estimation using a coarse grained entropy. We show that usually - except for atrial fibrillation - the level of such noise is within 5 - 15% of the variance of the data and that the variability due to the linearly correlated processes is dominant in all cases analysed but atrial fibrillation. The nonlinear deterministic content of heart rate variability remains significant and may not be ignored.Comment: see http://urbanowicz.org.p

Transition between child and adult services for young people with ADHD: findings from a British national surveillance study

This is the author accepted manuscript. The final version is available from Cambridge University Press via the DOI in this record.Data Availability: Data is currently stored securely by the University of Exeter Medical School, under embargo until the end of the CATCh-uS project (2019).Background: Optimal transition involves continuity, joint care, planning meetings and information transfer. To plan services, commissioners and service providers need data on how many people require that service. Although Attention-Deficit/Hyperactivity Disorder (ADHD) frequently persists into adulthood, evidence is limited on transitions between child and adult services. Aims: To estimate the national incidence of young people taking medication for ADHD that require and complete transition, and describe the proportion that experienced optimal transition. Methods: Surveillance over twelve months using the British Paediatric Surveillance Unit and the Child and Adolescent Psychiatry Surveillance System, including baseline notification and follow up questionnaires. Results: Questionnaire response was 79% at baseline and 82% at follow up. For cases aged 17-19, incident rate (range adjusted for non-response) of transition need was 202-511 per 100,000 people aged 17-19 per year, with successful transition of 38-96 per 100,000 people aged 17-19 per year. Cases were mostly male (77%) with a comorbid condition (62%). Half were referred to specialist adult ADHD and 25% to general adult mental health services; 64% had referral accepted but only 22% attended a first appointment. Only 6% met optimal transition criteria. Conclusions: As inclusion criteria required eligible cases to be on medication, these estimates will represent the lower limit of the need for transition. Two critical points were apparent; referral acceptance and first appointment attendance. The low rate of successful transition and limited guideline adherence indicates significant need for commissioners and service providers to improve service transition experiences.National Institute for Health Research (NIHR

Dynamical Effect of the Turbulence of IGM on the Baryon Fraction Distribution

We investigate the dynamical effect of the turbulence in baryonic intergalactic medium (IGM) on the baryon fraction distribution. In the fully developed nonlinear regime, the IGM will evolve into the state of turbulence, containing strong and curved shocks, vorticity and complex structures. Turbulence would lead to the density and velocity fields of the IGM to be different from those of underlying collisionless dark matter. Consequently, the baryon fraction f_b will deviate from its cosmic mean . We study these phenomena with simulation samples produced by the weighted essentially non-oscillatory (WENO) hybrid cosmological hydrodynamic/N-body code, which is effective of capturing shocks and complex structures. We find that the distribution of baryon fraction is highly nonuniform on scales from hundreds kpc to a few of Mpc, and f_b varies from as low as 1% to a few times of the cosmic mean. We further show that the turbulence pressure in the IGM is weakly scale-dependent and comparable to the gravitational energy density of halos with mass around 10^11 h-1 M\odot . The baryon fraction in halos with mass equal to or smaller than 10^11 h^-1 M\odot should be substantially lower than f_b^cosmic. Numerical results show that f_b is decreasing from 0.8 f_b^cosmic at halo mass scales around 10^12 h^-1 M\odot to 0.3f_b^cosmic at 10^11 h^-1 M\odot and shows further decrease when halo mass is less than 10^11 h^-1 M\odot. The strong mass dependence of f_b is similar to the observed results. Although the simulated f_b in halos are higher than the observed value by a factor of 2, the turbulence of the IGM should be an important dynamical reason leading to the remarkable missing of baryonic matter in halos with mass \leq 10^12 h^-1 M\odot.Comment: Accepted for publication in MNRAS, 12 pages, 10 figure

Determining the equation of state of dark energy from angular size of compact radio sources and X-ray gas mass fraction of galaxy clusters

Using recent measurements of angular size of high-z milliarcsecond compact radio sources compiled by Gurvits, Kellermann and Frey (1999) and X-ray gas mass fraction of galaxy clusters published by Allen et al. (2002,2003), we explore their bounds on the equation of state, omega_x = p_x/rho_x, of the dark energy, whose existence has been congruously suggested by various cosmological observations. We relaxe the usual constraint omega_x >= -1, and find that combining the two databases yields a nontrivial lower bound on omega_x. Under the assumption of a flat universe, we obtain a bound -2.22 < omega_x < -0.62 at 95.4% confidence level. The 95.4% confidence bound goes to -1 =< omega_x < -0.60 when the constraint omega_x >= -1 is imposed.Comment: 10 pages, 4 figures, accepted for publication in A&

Physical pretreatment of biogenic-rich trommel fines for fast pyrolysis

Energy from Waste (EfW) technologies such as fluidized bed fast pyrolysis, are beneficial for both energy generation and waste management. Such technologies, however face significant challenges due to the heterogeneous nature, particularly the high ash contents of some municipal solid waste types e.g. trommel fines. A study of the physical/mechanical and thermal characteristics of these complex wastes is important for two main reasons; (a) to inform the design and operation of pyrolysis systems to handle the characteristics of such waste; (b) to control/modify the characteristics of the waste to fit with existing EFW technologies via appropriate feedstock preparation methods. In this study, the preparation and detailed characterisation of a sample of biogenic-rich trommel fines has been carried out with a view to making the feedstock suitable for fast pyrolysis based on an existing fluidized bed reactor. Results indicate that control of feed particle size was very important to prevent problems of dust entrainment in the fluidizing gas as well as to prevent feeder hardware problems caused by large stones and aggregates. After physical separation and size reduction, nearly 70. wt% of the trommel fines was obtained within the size range suitable for energy recovery using the existing fast pyrolysis system. This pyrolyzable fraction could account for about 83% of the energy content of the 'as received' trommel fines sample. Therefore there was no significant differences in the thermochemical properties of the raw and pre-treated feedstocks, indicating that suitably prepared trommel fines samples can be used for energy recovery, with significant reduction in mass and volume of the original waste. Consequently, this can lead to more than 90% reduction in the present costs of disposal of trommel fines in landfills. In addition, the recovered plastics and textile materials could be used as refuse derived fuel

Equilibrium configuration of a bounded inextensible membrane subject to solar radiation pressure

The equilibrium shape of a thin inextensible membrane subject to solar radiation pressure under given boundary constraints is studied. The membrane is assumed to be insusceptible to elastic deformation and to have negligible bending resistance, and its steady-state shape is therefore described by a developable surface (i.e., a surface of zero Gaussian curvature), resulting from an equilibrium between radiation pressure and membrane tension forces. A quantitative understanding of the mechanics of such membranes is essential in characterizing the dynamics of solar sail spacecraft that use sail wing tip displacement as an attitude control mode. The analysis in this paper develops a theoretical foundation for the billowed wing shape. Under reasonable simplifying assumptions, the key result is that solar radiation pressure and a given wing tip displacement yield a billowed solar sail wing with the shape of a generalized cylinder (i.e., a developable ruled surface, whose rulings are all parallel, rather than a general developable with variable ruling directions). The base curve geometry for the solar sail is also determined as the solution to a boundary value problem. The results presented herein allow the shape of the billowed membrane to be computed to any desired precision, for any given tip displacement

Cosmological limit on the neutrino mass

We have performed a careful analysis of constraints on the neutrino mass from current cosmological data. Combining data from the cosmic microwave background and the 2dF galaxy survey yields an upper limit on the sum of the three neutrino mass eigenstates of \sum m_nu < 3 eV (95% conf.), without including additional priors. Including data from SNIa observations, Big Bang nucleosynthesis, and HST Hubble key project data on H_0 tightens the limit to \sum m_nu < 2.5 eV (95% conf.). We also perform a Fisher matrix analysis which illustrates the cosmological parameter degeneracies affecting the determination of \sum m_nu.Comment: 6 pages, 2 figures, uses Revtex

Simulating the Soft X-ray excess in clusters of galaxies

The detection of excess of soft X-ray or Extreme Ultraviolet (EUV) radiation, above the thermal contribution from the hot intracluster medium (ICM), has been a controversial subject ever since the initial discovery of this phenomenon. We use a large--scale hydrodynamical simulation of a concordance $\Lambda$CDM model, to investigate the possible thermal origin for such an excess in a set of 20 simulated clusters having temperatures in the range 1--7 keV. Simulated clusters are analysed by mimicking the observational procedure applied to ROSAT--PSPC data, which for the first time showed evidences for the soft X-ray excess. For cluster--centric distances $0.4< R/R_{\rm vir}< 0.7$ we detect a significant excess in most of the simulated clusters, whose relative amount changes from cluster to cluster and, for the same cluster, by changing the projection direction. In about 30 per cent of the cases, the soft X-ray flux is measured to be at least 50 per cent larger than predicted by the one--temperature plasma model. We find that this excess is generated in most cases within the cluster virialized regions. It is mainly contributed by low--entropy and high--density gas associated with merging sub--halos, rather than to diffuse warm gas. Only in a few cases the excess arises from fore/background groups observed in projection, while no evidence is found for a significant contribution from gas lying within large--scale filaments. We compute the distribution of the relative soft excess, as a function of the cluster--centric distance, and compare it with the observational result by Bonamente et al. (2003) for the Coma cluster. Similar to observations, we find that the relative excess increases with the distance from the cluster center, with no significant excess detected for $R<0.4R_{\rm vir}$. (abridged)Comment: 10 pages, to appear in A&

Multifractal and entropy analysis of resting-state electroencephalography reveals spatial organization in local dynamic functional connectivity

Functional connectivity of the brain fluctuates even in resting-state condition. It has been reported recently that fluctuations of global functional network topology and those of individual connections between brain regions expressed multifractal scaling. To expand on these findings, in this study we investigated if multifractality was indeed an inherent property of dynamic functional connectivity (DFC) on the regional level as well. Furthermore, we explored if local DFC showed region-specific differences in its multifractal and entropy-related features. DFC analyses were performed on 62-channel, resting-state electroencephalography recordings of twelve young, healthy subjects. Surrogate data testing verified the true multifractal nature of regional DFC that could be attributed to the presumed nonlinear nature of the underlying processes. Moreover, we found a characteristic spatial distribution of local connectivity dynamics, in that frontal and occipital regions showed stronger long-range correlation and higher degree of multifractality, whereas the highest values of entropy were found over the central and temporal regions. The revealed topology reflected well the underlying resting-state network organization of the brain. The presented results and the proposed analysis framework could improve our understanding on how resting-state brain activity is spatio-temporally organized and may provide potential biomarkers for future clinical research