A comparison of parent reported outcome with experience of services

PublishedJournal ArticlePurpose - Routine outcome monitoring (ROM) is currently seen as a key driver for service improvement at individual, team and service level. The purpose this paper is to explore the relationships between a patient (parent) reported outcome measure (PROM), a practitioner reported outcome measure, and a patient (parent) reported experience measure (PREM). Design/methodology/approach - A cohort of 302 primary school-age children was recruited and followed for one year from consecutively accepted referrals to three teams within two English Child and Adolescent Mental Health Services (CAMHS). Parents completed the Strengths and Difficulties Questionnaire (a PROM) and practitioners completed the Clinician Global Assessment Scale at baseline, six and 12 months; parents completed the Experience of Services Questionnaire (a PREM) at six and 12 months. Findings - PROM and practitioner reported outcome measure data suggested poor clinical outcome in terms of symptoms, impact and levels of functioning but were accompanied by PREM evidence of high levels of satisfaction. There was an unexpectedly low correlation (o0.2) between both measures of outcome and satisfaction. Originality/value - This paper fulfils a need to explore the relationships between different outcome measures to contribute to the understanding of ROM its validity

The impact of flooding on road transport: A depth-disruption function

\ua9 2017 Transport networks underpin economic activity by enabling the movement of goods and people. During extreme weather events transport infrastructure can be directly or indirectly damaged, posing a threat to human safety, and causing significant disruption and associated economic and social impacts. Flooding, especially as a result of intense precipitation, is the predominant cause of weather-related disruption to the transport sector. Existing approaches to assess the disruptive impact of flooding on road transport fail to capture the interactions between floodwater and the transport system, typically assuming a road is fully operational or fully blocked, which is not supported by observations. In this paper we develop a relationship between depth of standing water and vehicle speed. The function that describes this relationship has been constructed by fitting a curve to video analysis supplemented by a range of quantitative data that has be extracted from existing studies and other safety literature. The proposed relationship is a good fit to the observed data, with an R-squared of 0.95. The significance of this work is that it is simple to incorporate our function into existing transport models to produce better estimates of flood induced delays and we demonstrate this with an example from the 28th June 2012 flood in Newcastle upon Tyne, UK

Searching for nests of the invasive Asian hornet (Vespa velutina) using radio-telemetry

This is the final version of the article. Available from the publisher via the DOI in this recordAsian hornets (Vespa velutina) are voracious predators of bees, and are the latest emerging threat to managed and wild pollinator populations in Europe. To prevent establishment or reduce the rate of spread of V. velutina, early detection and destruction of nests is considered the only option. Detection is difficult as their nests are well hidden and flying hornets are difficult to follow over long distances. We address this challenge by tracking individual V. velutina workers flying back to their nests using radio telemetry for the first time, finding five previously undiscovered nests, up to 1.33 km from hornet release points. Hornets can fly with 0.28 g tags if the tag:hornet ratio is less than 0.8. This method offers a step-change in options to tackle the spread of this invader, providing an efficient means of finding V. velutina nests in complex environments to manage this emerging threat to pollinators.We thank Olivier Bonnard for discussions, sourcing materials, and advice on locating foraging V. velutina workers at INRA Bordeaux-Aquitaine. We also thank members of Jersey Beekeeping Association for their assistance in catching V. velutina workers in Jersey. The work was funded by a Defra research project grant (PH0532), with additional support by the States of Jersey Department of Environment and generous philanthropic donations by the South West Beekeeping Associations’ Forum (SWBKF), Somerset Beekeeping Association, Dorset Beekeeping Association, Cornwall Beekeeping Association, West Cornwall Beekeeping Association, Devon Beekeeping Association, Bournemouth & South Dorset Beekeeping Association, and B.J. Sherriff. We are grateful to INRA Bordeaux-Aquitaine, States of Jersey Department of Environment, and Durrell Wildlife Park for their welcome and permission to use facilities at their institutions

Competition of van der Waals and chemical forces on gold-sulfur surfaces and nanoparticles

© 2017 Macmillan Publishers Limited. Chemists generally believe that covalent and ionic bonds form much stronger links between atoms than the van der Waals force does. However, this is not always so. We present cases in which van der Waals dispersive forces introduce new competitive bonding possibilities rather than just modulating traditional bonding scenarios. Although the new possibilities could arise from any soft-soft chemical interaction, we focus on bonding between gold atoms and alkyl or arylsulfur ligands, RS. Consideration of all the interactions at play in sulfur-protected gold surfaces and gold nanoparticles is necessary to understand their structural, chemical and spectroscopic properties. In turn, such knowledge opens pathways to new chemical entities and innovative nanotechnological devices. Such experimentation is complemented by modern theory, and presented here is a broad overview of computational methods appropriate to fields ranging from gas-phase chemistry to device physics and biochemistry

Dynamical consequences of a constraint on the Langevin thermostat in molecular cluster simulation

© 2014 Taylor and Francis. We investigate some unusual behaviour observed while performing molecular dynamics simulations of small molecular clusters using a constrained Langevin thermostat. Atoms appear to be thermalised to different temperatures that depend on their mass and on the total number of particles in the system. The deviation from the zeroth law of thermodynamics can be considerable for small systems of heavy and light particles. We trace this behaviour to the absence of thermal noise acting on the centre of mass of the system. This is demonstrated by solving the stochastic dynamics for the constrained thermostat and comparing the results with simulation data. By removing the constraint, the Langevin thermostat may be restored to its intended behaviour. We also investigate a Langevin thermostat constrained to have zero total force acting on its centre of mass, and find similar deficiencies

Implementation of routine outcome measurement in child and adolescent mental health services in the United Kingdom: a critical perspective

The aim of this commentary is to provide an overview of clinical outcome measures that are currently recommended for use in UK Child and Adolescent Mental Health Services (CAMHS), focusing on measures that are applicable across a wide range of conditions with established validity and reliability, or innovative in their design. We also provide an overview of the barriers and drivers to the use of Routine Outcome Measurement (ROM) in clinical practice

Access to primary care for socio-economically disadvantaged older people in rural areas: a qualitative study

Objective: We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas. Methods: Using a community recruitment strategy, fifteen people over 65 years, living in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access. Findings: Older people’s experience can be understood within the context of a patient perceived set of unwritten rules or social contract – an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes Health professionals’ described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system. Conclusion: Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service

HL-1 cells express an inwardly rectifying K+ current activated via muscarinic receptors comparable to that in mouse atrial myocytes

An inwardly rectifying K^+ current is present in atrial cardiac myocytes that is activated by acetylcholine (I_{KACh}). Physiologically, activation of the current in the SA node is important in slowing the heart rate with increased parasympathetic tone. It is a paradigm for the direct regulation of signaling effectors by the Gβγ G-protein subunit. Many questions have been addressed in heterologous expression systems with less focus on the behaviour in native myocytes partly because of the technical difficulties in undertaking comparable studies in native cells. In this study, we characterise a potassium current in the atrial-derived cell line HL-1. Using an electrophysiological approach, we compare the characteristics of the potassium current with those in native atrial cells and in a HEK cell line expressing the cloned Kir3.1/3.4 channel. The potassium current recorded in HL-1 is inwardly rectifying and activated by the muscarinic agonist carbachol. Carbachol-activated currents were inhibited by pertussis toxin and tertiapin-Q. The basal current was time-dependently increased when GTP was substituted in the patch-clamp pipette by the non-hydrolysable analogue GTPγS. We compared the kinetics of current modulation in HL-1 with those of freshly isolated atrial mouse cardiomyocytes. The current activation and deactivation kinetics in HL-1 cells are comparable to those measured in atrial cardiomyocytes. Using immunofluorescence, we found GIRK4 at the membrane in HL-1 cells. Real-time RT-PCR confirms the presence of mRNA for the main G-protein subunits, as well as for M2 muscarinic and A1 adenosine receptors. The data suggest HL-1 cells are a good model to study IKAch

Safety and efficacy of antenatal milk expressing for women with diabetes in pregnancy: protocol for a randomised controlled trial

Many maternity providers recommend that women with diabetes in pregnancy express and store breast milk in late pregnancy so breast milk is available after birth, given (1) infants of these women are at increased risk of hypoglycaemia in the first 24 h of life; and (2) the delay in lactogenesis II compared with women without diabetes that increases their infant\u27s risk of receiving infant formula. The Diabetes and Antenatal Milk Expressing (DAME) trial will establish whether advising women with diabetes in pregnancy (pre-existing or gestational) to express breast milk from 36 weeks gestation increases the proportion of infants who require admission to special or neonatal intensive care units (SCN/NICU) compared with infants of women receiving standard care. Secondary outcomes include birth gestation, breastfeeding outcomes and economic impact