The MS Symptom and Impact Diary (MSSID): psychometric evaluation of a new instrument to measure the day to day impact of multiple sclerosis

OBJECTIVES: This study aimed to develop further a diary originally devised to measure the impact of multiple sclerosis (MS) as part of a cost utility study of beta interferon, and to evaluate its reliability, validity, and responsiveness in an outpatient sample of people with MS. METHODS: The original diary was further developed using qualitative and quantitative methods to ensure that it addressed the views of people with MS. The psychometric properties of the MS Symptom and Impact Diary (MSSID) were evaluated in a sample of 77 people who completed the MSSID daily for 12 weeks. Internal and test–retest reliability, discriminant and convergent validity, and responsiveness were assessed using traditional psychometric methods. RESULTS: The MSSID formed three, internally consistent scales that measured mobility, fatigue, and the overall impact of MS. The test–retest reliability of the mobility scale was adequate for individual comparisons (ICC.0.90) and the fatigue and overall impact scales were adequate for group comparisons (ICC.0.70). The MSSID was able to distinguish between clinical groups depending on clinical course, indoor ambulation status, and relapse status. It demonstrated associations with other single point instruments in the expected direction. Compared with single point instruments, its responsiveness was similar or better, especially in detecting short term improvements in functioning. CONCLUSIONS: The MSSID may provide a useful complement to currently available instruments to measure the outcomes of MS within clinical trials. Further research is needed to explore its feasibility in the context of a randomised controlled trial and its utility for clinicians

Twilight for the energy conditions?

The tension, if not outright inconsistency, between quantum physics and general relativity is one of the great problems facing physics at the turn of the millennium. Most often, the problems arising in merging Einstein gravity and quantum physics are viewed as Planck scale issues (10^{19} GeV, 10^{-34} m, 10^{-45} s), and so safely beyond the reach of experiment. However, over the last few years it has become increasingly obvious that the difficulties are more widespread: There are already serious problems of deep and fundamental principle at the semi-classical level, and worse, certain classical systems (inspired by quantum physics, but in no sense quantum themselves) exhibit seriously pathological behaviour. One manifestation of these pathologies is in the so-called ``energy conditions'' of general relativity. Patching things up in the gravity sector opens gaping holes elsewhere; and some ``fixes'' are more radical than the problems they are supposed to cure.Comment: Honourable mention in the 2002 Gravity Research Foundation essay contest. 12 pages. Plain LaTeX 2

How accessible and acceptable are current GP referral mechanisms for IAPT for low-income patients? Lay and primary care perspectives

Background: Improving Access to Psychological Therapies (IAPT) constitutes a key element of England’s national mental health strategy. Accessing IAPT usually requires patients to self-refer on the advice of their GP. Little is known about how GPs perceive and communicate IAPT services with patients from low-income communities, nor how the notion of self-referral is understood and responded to by such patients. Aims: This paper examines how IAPT referrals are made by GPs and how these referrals are perceived and acted on by patients from low-income backgrounds Method: Findings are drawn from in-depth interviews with low-income patients experiencing mental distress (n = 80); interviews with GPs (n = 10); secondary analysis of video-recorded GP-patient consultations for mental health (n = 26). Results: GPs generally supported self-referral, perceiving it an important initial step towards patient recovery. Most patients however, perceived self-referral as an obstacle to accessing IAPT, and felt their mental health needs were being undermined. The way that IAPT was discussed and the pathway for referral appears to affect uptake of these services. Conclusions: A number of factors deter low-income patients from self-referring for IAPT. Understanding these issues is necessary in enabling the development of more effective referral and support mechanisms within primary care

Paediatric Surgery: A Core Surgical Trainee's Guide To Vascular Malformations In Children

Vascular malformations can prove to be a daunting group of conditions to the surgical trainee. Historically, difficulties in classification and nomenclature, along with a lack of a definitive responsible specialty, have lead to variability in management strategies. Here we hope to give a brief overview of vascular malformations, detailing the four most common a little further

Simulating Impacts of Extreme Weather Events on Urban Transport Infrastructure in the UK

Urban areas face many risks from future climate change and their infrastructure will be placed under more pressure due to changes in climate extremes. Using the Tyndall Centre Urban Integrated Assessment Framework, this paper describes a methodology used to assess the impacts of future climate extremes on transport infrastructure in London. Utilising high-resolution projections for future climate in the UK, alongside stochastic weather generators for downscaling, urban temperature and flooding models are used to provide information on the likelihood of future extremes. These are then coupled with spatial network models of urban transport infrastructure and, using thresholds to define the point at which systems cease to function normally, disruption to the networks can be simulated. Results are shown for both extreme heat and urban surface water flooding events and the impacts on the travelling population, in terms of both disruption time and monetary cost

Development of children's assent documents using a child-centred approach

The call for researchers to obtain childrens informed assent, prior to their participation in medical procedures and research, has increased over recent years and parallels moves to implement child-centred approaches to health care. This article describes the processes used to include children in developing a research information sheet and assent form for use in future research into childrens understandings of their surgery and hospital experiences. The process involved primary school children aged between six and 12 years. Children worked in small groups to consider information to include in these documents. Their words were collated to construct the research information sheet and assent form. Working with children resulted in documents that were more understandable for their intended audience. The article includes discussion of `language, `understandability and `readability; concepts that researchers seeking to work with children need to come to terms with if they are to obtain `informed assent

Chains of large gaps between primes

Let $p_n$ denote the $n$-th prime, and for any $k \geq 1$ and sufficiently large $X$, define the quantity $$G_k(X) := \max_{p_{n+k} \leq X} \min( p_{n+1}-p_n, \dots, p_{n+k}-p_{n+k-1} ),$$ which measures the occurrence of chains of $k$ consecutive large gaps of primes. Recently, with Green and Konyagin, the authors showed that $$G_1(X) \gg \frac{\log X \log \log X\log\log\log\log X}{\log \log \log X}$$ for sufficiently large $X$. In this note, we combine the arguments in that paper with the Maier matrix method to show that $$G_k(X) \gg \frac{1}{k^2} \frac{\log X \log \log X\log\log\log\log X}{\log \log \log X}$$ for any fixed $k$ and sufficiently large $X$. The implied constant is effective and independent of $k$.Comment: 16 pages, no figure

Exponential Divergence and Long Time Relaxation in Chaotic Quantum Dynamics

Phase space representations of the dynamics of the quantal and classical cat map are used to explore quantum--classical correspondence in a K-system: as $\hbar \to 0$, the classical chaotic behavior is shown to emerge smoothly and exactly. The quantum dynamics near the classical limit displays both exponential separation of adjacent distributions and long time relaxation, two characteristic features of classical chaotic motion.Comment: 10 pages, ReVTeX, to appear in Phys. Rev. Lett. 13 figures NOT included. Available either as LARGE (uuencoded gzipped) postscript files or hard-copies from [email protected]