Real People, Real Lives: a small scale pilot project exploring case studies of the transition experiences of young people with long term conditions and disabilities who have recently moved from children's to adult serrvices in Cheshire and Merseyside

Aims The aim of this pilot project was to carry out Case Studies which will explore the different transition pathways and experiences of young people representing the following groups: • Young people who have common long – term conditions such as Diabetes and Epilepsy which are predominantly self-managed at home, with oversight from centres with specialist expertise. • Young People who have long term conditions which require intermittent or regular hospital-based intensive support such as those who are technology dependant or require frequent admissions for acute or specialist care. • Young people who have disabilities and complex needs. • Young people who are receiving support from Child and Adolescent Mental Health Services. The intended outcomes were to provide the local Strategic Clinical Network Special Interest Group with insight into how strategies to improve the experience of transition could be informed by the lived experiences of: • Young Service Users who had recently undergone transition from children’s to adult services • The viewpoints of their parents and carers • The perspectives of lead professionals involved in planning, coordinating and supporting the transition process. Methods Six Case Studies were constructed following face-to-face semi-structured interviews with young people, parents and carers representing the above groups. The young people involved had experienced the transition from children’s to adult services during the previous six months to three years. Where it was possible to identify and access a lead professional who was involved in planning and co-ordinating the transition their perspective was also sought through separate face to face and telephone interviews before inclusion within the appropriate case study. Results The Case Studies demonstrate that parents have a good understanding of what Transition means, and have endeavoured to explain this to their children. Some parents and carers were aware of policy guidance and expectations, for example the recommendation that planning should start during the early teenage years. This is not necessarily what they have experienced themselves. There were some examples of good practice and transitions support where knowledgeable and experienced practitioners were able to plan holistically to work across boundaries and overcome barriers to assure the best possible outcomes for young people. Other young people and their parents were not able to identify someone who had taken lead responsibility for co-ordinating their transition to adult services. Emerging themes included : • Variable Transition Plans and experiences • Young people still “getting lost” in transition • Variable involvement of young people and families in decision-making • The influence of different traditions, levels of practitioner confidence and models of service provision • Training needs and developing expertise and best practice in transition support • Fearful young people and “battle-weary” parents • The positive and negative impact of transition experiences • Loss of services • Key messages from families • Communication, planning and process • Improving services and support Conclusions 1. Transition services across the region include some areas of good or developing practice as well as some examples of inadequate transition planning and services to meet the needs of young people who have long term conditions, special educational needs or disabilities. 2. It is not currently possible to conclude that all transition experiences in the region universally meet sector standards and best practice guidance. 3. Families would like those in charge of commissioning services and making financial decisions to hear their stories and understand the challenges they face. 4. The Strategic Clinical Network is in a privileged position to make some transformational changes to benefit young people, parents and carers – to achieve this they may need to be courageous in re-thinking delivery models and the relationship between services designed to meet the needs of children and adults. This is likely to involve working in partnership with other Strategic Clinical Networks and Clinical Commissioning Groups. 5. There are some good examples of effective practice, but transition planning often starts late and may be vague and fragmented, have gaps or fail to adequately involve young people parents and carers in decisions. 6. Transition outcomes for young people and families can be positive, however the researchers found several examples of diminished service provision to the detriment of service users. 7. Where transition planning has worked well this has been because there has been a dedicated Key Worker, named lead professional or Transition Team who have developed expertise; are able to coordinate regular meetings and bring together multi-disciplinary/ multi-agency teams; effectively involve service providers and users and develop creative solutions to overcome barriers in order to meet the individual needs of young people and their families. 8. The planning process needs an approach which bridges divisions between children’s and adult services; health, social care and education; hospital and community settings; geographical boundaries - service provision needs to develop to match this approach. 9. Training, resources, and pathways need to be developed for both practitioners and families involved in developing and implementing Transition Plans. 10. New models of care provision and new ways of working will be essential to success; new technologies could contribute to solutions

Capturing whole person care

Biochemical blood levels are one international renal outcome measure. These quantitative data (such as phosphate levels) reflect, in part, dietary intervention and compliance to medical regimens, for example dialysis prescriptions and phosphate binding medication. The numbers demonstrate intervention efficacy, the cornerstone of evidence-based practice (EBP) (Greenhalgh et al., 2014). However, such data misses opportunities to capture the quality of the whole care provided, something that really matters to patients

CAFF CBMP Report No.13 - A Strategy for Facilitating and Promoting Community-Based Monitoring Approaches in Arctic Biodiversity Monitoring

Arctic Council's CAFF Working Group Circumpolar Biodiversity Monitoring Program Report No.13 - A Strategy for Facilitating and Promoting Community-Based Monitoring Approaches in Arctic Biodiversity Monitorin

Long term dietary supplementation with microalgae increases plasma docosahexaenoic acid in milk and plasma but does not affect plasma 13, 14-dihydro-15-keto PGF2α concentration in dairy cows

The aims of the study were to determine the long-term effects of dietary supplementation with microalgae (SCIM) on milk and blood fatty acid (FA) composition and reproductive hormones in early lactation dairy cows. Sixty Holstein–Friesian dairy cows (30 per treatment) were unsupplemented (Control) or supplemented with 100 g of SCIM (Schizochytrium limacinum sp.) per cow per day from 25 ± 0.5 d post-partum for 98 d. Intake and milk yield were recorded daily, with milk samples collected at weeks 0, 1, 2, 4, 8 and 14, and blood samples collected from 12 representative pairs per treatment at weeks 0, 2, 4, 8, and 14 for subsequent analysis of FA, β-hydroxybutyrate, non-esterified fatty acids and glucose. At 33 ± 0.9 d postpartum the oestrus cycle of 24 cows (12 per treatment) were synchronized and plasma 13,14-dihydro-15-keto PGF2α (PGFM) concentrations determined following an oxytocin challenge. Data were analysed by repeated measures analysis of variance. There was no effect of treatment on dry matter intake, milk yield or milk fat content, with mean values across treatments of 22.1 and 40.6, and 37.2 g/kg respectively. Milk fat concentration of C22:6 n-3 increased rapidly in cows receiving SCIM, reaching a maximum of 0.38 g/100 g FA by week 14. Similarly, blood concentration of C22:6 n-3 increased to 1.6 g/100 g FA by week 14 in cows fed SCIM. There was no effect of treatment on plasma metabolites, but plasma glucose was lower in cows fed SCIM compared to the Control at week 2, and higher in week 8. There was no effect of treatment on peak plasma PGFM concentration or area under the curve. It is concluded that feeding SCIM rapidly increases blood and milk concentrations of C22:6 n-3 which are maintained over time, but does not improve plasma PGFM in dairy cows

Review of remote monitoring systems for the delivery of sustainable and resilient water infrastructure

Purpose This paper aims to present a literature review of remote monitoring systems for water infrastructure in the Global South. Design/methodology/approach Following initial scoping searches, further examination was made of key remote monitoring technologies for water infrastructure in the Global South. A standard literature search methodology was adopted to examine these monitoring technologies and their respective deployments. This hierarchical approach prioritised “peer-reviewed” articles, followed by “scholarly” publications, then “credible” information sources and, finally, “other” relevant materials. The first two search phases were conducted using academic search services (e.g. Scopus and Google Scholar). In the third and fourth phases, Web searches were carried out on various stakeholders, including manufacturers, governmental agencies and non-governmental organisations/charities associated with Water, Sanitation and Hygiene (WASH) in the Global South. Findings This exercise expands the number of monitoring technologies considered in comparison to earlier review publications. Similarly, preceding reviews have largely focused upon monitoring applications in sub-Saharan Africa (SSA). This paper explores opportunities in other geographical regions and highlights India as a significant potential market for these tools. Research limitations/implications This review predominantly focuses upon information/data currently available in the public domain. Practical implications Remote monitoring technologies enable the rapid detection of broken water pumps. Broken water infrastructure significantly impacts many vulnerable communities, often leading to the use of less protected water sources and increased exposure to water-related diseases. Further to these public health impacts, there are additional economic disadvantages for these user communities. Originality/value This literature review has sought to address some key technological omissions and to widen the geographical scope associated with previous investigations

Measuring and benchmarking the productivity of excavators in infrastructure projects: A deep neural network approach

Inefficiencies in the management of earthmoving equipment greatly contribute to the productivity gap of infrastructure projects. This paper develops and tests a Deep Neural Network (DNN) model for estimating the productivity of excavators and establishing a productivity measure for their benchmark. After investigating current practices for measuring the productivity of earthwork equipment during 13 interviews with selected industry experts, the DNN model was developed and tested in one of the ‘High Speed rail second phase’ (HS2) sites. The accuracy of prediction achieved by the DNN model was evaluated using the coefficient of determination (R2) and the Weighted Absolute Percentage Error (WAPE) resulting in 0.87 and 69.64%, respectively. This is an adequate level of accuracy when compared to other similar studies. However, according to the WAPE method, the accuracy is still 10.36% below the threshold (i.e. 80%) expected by the industry experts. An inspection of the prediction results over the testing period (21 days) revealed better precision in days with high excavation volumes compared to days with low excavation volumes. This was attributed to the likely involvement of manual work (i.e. archaeologists in the case of the selected site) alongside some of the excavators, which caused gaps in telematics data. This indicates that the accuracy attained is adequate, but the proposed approach is more accurate in a highly mechanised environment (i.e. excavation work with equipment predominantly and limited manual interventions) compared to a mixed mechanised-manual working environment. A bottom-up benchmark measure (i.e. excavation rate) that can be used to measure and benchmark the excavation performance of an individual or a group of equipment, through a work area, to a whole site was also proposed and discussed