Interdisciplinary Approaches Suggested for Children With Multiple Hospital Referrals Presenting With Non-specific Conditions

Aims: To describe the care patterns of patients with repeated referrals to both mental and somatic specialist healthcare, and to study their diagnostic processes. Methods: In a previous register study patients aged 6–12 years referred to Haukeland University Hospital from 2013 to 2015, we found 922 children with at least three referrals including both somatic and mental health services. Of these, more than one in four (250) were randomly selected and observed from their first hospital episode ever and further after inclusion followed during their next three referrals or until July 2017. Data on referral patterns and diagnostics were collected from patient hospital records. Results: Mean number of referrals was 6.5 prior to inclusion and 4.2 in the follow-up period. At the end of the study period 15% of patients still had a non-specific diagnosis. During the follow-up period, more than half of the children were again referred across the border between somatic and mental healthcare. Conclusion: Very complex care patterns were found for these patients, who were repeatedly being referred and “crossing over” between mental and somatic healthcare. This indicates a need for more interdisciplinary-based approaches both within specialist care and between different care levels to broaden the perspective and achieve shorter time lag before reaching a diagnostic conclusion.publishedVersio

Marrying ‘universal’ neurodiversity and Universal Design for Learning to enhance inclusive pedagogy: A case study from the primary school geography classroom

In this article, we take forward some of the ideas presented in an earlier Impact piece (Griffiths, 2020), which presented the case for using ‘neurodiversity’ as a framework for looking beyond the (SEND) labels that some learners attract, to build a more individually responsive and flexible repertoire of teaching approaches. We recap some key points about what the term ‘neurodiversity’ can mean and look at how it might be applied as a theoretical underpinning for a ‘Universal Design for Learning’ (UDL) approach to inclusive lesson planning and teaching (Meyer et al., 2014). To illustrate this, we offer the example of a UDL-based primary school geography lesson. We hope to show how the approaches used in this case study example might be more widely applied to inclusive teaching and learning

The agronomic performance and nutritional content of oat and barley varieties grown in a northern maritime environment depends on variety and growing conditions

Funding for this research came from the Scottish Government's Rural and Environment Science and Analytical Services Division (RESAS) through their support for this Strategic Partnership project. We are also grateful to Ingvar Andersson at Lantmännen SW Seed AB for supplying seed of the Scandinavian varieties for the trials each year and to the seed merchant William Shearer (Kirkwall) for importing it. We are indebted to Grietje Holtrop from Biomathematics and Statistics Scotland for her help with statistical analysis. Andy Beer (The Royal Zoological Society, Edinburgh) performed all NIRS analysis and Gill Campbell (Rowett Institute of Nutrition and Health) performed the mineral content analysis. The Centre for Sustainable Cropping platform is supported through Scottish Government Underpinning Capacity funding. The Agronomy Institute acknowledges support from the Northern Periphery and Arctic Programme's Northern Cereals project in preparing this publication.Peer reviewedPostprin

Genotype and environment affect the grain quality and yield of winter oats (Avena sativa L.)

The extent to which the quality and yield of plant varieties are influenced by the environment is important for their successful uptake by end users particularly as climatic fluctuations are resulting in environments that are highly variable from one growing season to another. The genotype-by-environment interaction (GEI) of milling quality and yield was studied using four winter oat varieties in multi-locational trials over 4 years in the U.K. Significant differences across the 22 environments were found between physical grain quality and composition as well as grain yield, with the environment having a significant effect on all of the traits measured. Grain yield was closely related to grain number m−2 whereas milling quality traits were related to grain size attributes. Considerable genotype by environment interaction was obtained for all grain quality traits and stability analysis revealed that the variety Mascani was the least sensitive to the environment for all milling quality traits measured whereas the variety Balado was the most sensitive. Examination of environmental conditions at specific within-year stages of crop development indicated that both temperature and rainfall during grain development were correlated with grain yield and β-glucan content and with the ease of removing the hull (hullability)

Implementing within‐cross genomic prediction to reduce oat breeding costs

A barrier to the adoption of genomic prediction in small breeding programs is the initial cost of genotyping material. Although decreasing, marker costs are usually higher than field trial costs. In this study we demonstrate the utility of stratifying a narrow‐base biparental oat population genotyped with a modest number of markers to employ genomic prediction at early and later generations. We also show that early generation genotyping data can reduce the number of lines for later phenotyping based on selections of siblings to progress. Using sets of small families selected at an early generation could enable the use of genomic prediction for adaptation to multiple target environments at an early stage in the breeding program. In addition, we demonstrate that mixed marker data can be effectively integrated to combine cheap dominant marker data (including legacy data) with more expensive but higher density codominant marker data in order to make within generation and between lineage predictions based on genotypic information. Taken together, our results indicate that small programs can test and initiate genomic predictions using sets of stratified, narrow‐base populations and incorporating low density legacy genotyping data. This can then be scaled to include higher density markers and a broadened population base

Determining the level of social distancing necessary to avoid future COVID-19 epidemic waves : a modelling study for North East London

Determining the level of social distancing, quantified here as the reduction in daily number of social contacts per person, i.e. the daily contact rate, needed to maintain control of the COVID-19 epidemic and not exceed acute bed capacity in case of future epidemic waves, is important for future planning of relaxing of strict social distancing measures. This work uses mathematical modelling to simulate the levels of COVID-19 in North East London (NEL) and inform the level of social distancing necessary to protect the public and the healthcare demand from future COVID-19 waves. We used a Susceptible-Exposed-Infected-Removed (SEIR) model describing the transmission of SARS-CoV-2 in NEL, calibrated to data on hospitalised patients with confirmed COVID-19, hospital discharges and in-hospital deaths in NEL during the first epidemic wave. To account for the uncertainty in both the infectiousness period and the proportion of symptomatic infection, we simulated nine scenarios for different combinations of infectiousness period (1, 3 and 5 days) and proportion of symptomatic infection (70%, 50% and 25% of all infections). Across all scenarios, the calibrated model was used to assess the risk of occurrence and predict the strength and timing of a second COVID-19 wave under varying levels of daily contact rate from July 04, 2020. Specifically, the daily contact rate required to suppress the epidemic and prevent a resurgence of COVID-19 cases, and the daily contact rate required to stay within the acute bed capacity of the NEL system without any additional intervention measures after July 2020, were determined across the nine different scenarios. Our results caution against a full relaxing of the lockdown later in 2020, predicting that a return to pre-COVID-19 levels of social contact from July 04, 2020, would induce a second wave up to eight times the original wave. With different levels of ongoing social distancing, future resurgence can be avoided, or the strength of the resurgence can be mitigated. Keeping the daily contact rate lower than 5 or 6, depending on scenarios, can prevent an increase in the number of COVID-19 cases, could keep the effective reproduction number Re below 1 and a secondary COVID-19 wave may be avoided in NEL. A daily contact rate between 6 and 7, across scenarios, is likely to increase Re above 1 and result in a secondary COVID-19 wave with significantly increased COVID-19 cases and associated deaths, but with demand for hospital-based care remaining within the bed capacity of the NEL health and care system. In contrast, an increase in daily contact rate above 8 to 9, depending on scenarios, will likely exceed the acute bed capacity in NEL and may potentially require additional lockdowns. This scenario is associated with significantly increased COVID-19 cases and deaths, and acute COVID-19 care demand is likely to require significant scaling down of the usual operation of the health and care system and should be avoided. Our findings suggest that to avoid future COVID-19 waves and to stay within the acute bed capacity of the NEL health and care system, maintaining social distancing in NEL is advised with a view to limiting the average number of social interactions in the population. Increasing the level of social interaction beyond the limits described in this work could result in future COVID-19 waves that will likely exceed the acute bed capacity in the system, and depending on the strength of the resurgence may require additional lockdown measures

EMAS recommendations for conditions in the workplace for menopausal women

Women form a large part of many workforces throughout Europe. Many will be working throughout their menopausal years. Whilst the menopause may cause no significant problems for some, for others it is known to present considerable difficulties in both their personal and working lives. During the menopausal transition women report that fatigue and difficulties with memory and concentration can have a negative impact on their working lives. Furthermore, hot flushes can be a source of embarrassment and distress. Some consider that these symptoms can impact on their performance. Greater awareness among employers, together with sensitive and flexible management can be helpful for women at this time. Particular strategies might include: fostering a culture whereby employees feel comfortable disclosing health problems, allowing flexible working, reducing sources of work-related stress, providing easy access to cold drinking water and toilets, and reviewing workplace temperature and ventilation

Assessing the impact of nitrogen supplementation in oats across multiple growth locations and years with targeted phenotyping and high-resolution metabolite profiling approaches

Oats (Avena sativa L.) are a healthy food, being high in dietary fibre (e.g. β-glucans), antioxidants, minerals, and vitamins. Understanding the effect of variety and crop management on nutritional quality is important. The response of four oat varieties to increased nitrogen levels was investigated across multiple locations and years with respect to yield, grain quality and metabolites (assessed via GC- and LC- MS). A novel high-resolution UHPLC-PDA-MS/MS method was developed, providing improved metabolite enrichment, resolution, and identification. The combined phenotyping approach revealed that, amino acid levels were increased by nitrogen supplementation, as were total protein and nitrogen containing lipid levels, whereas health-beneficial avenanthramides were decreased. Although nitrogen addition significantly increased grain yield and β-glucan content, supporting increasing the total nitrogen levels recommended within agricultural guidelines, oat varietal choice as well as negative impacts upon health beneficial secondary metabolites and the environmental burdens associated with nitrogen fertilisation, require further consideration

Making Musical Works in Renaissance Spain

Producción CientíficaWhy is it that Renaissance musicians (in Spain in this case) could identify as the same work compositions that today might be seen as different? Wherein was the commonality? Current ontologies of music, deeply rooted in modern theories and aesthetics revolve around the notion of musical masterpieces that exist as static monuments of musical art. Not only inadequate from a historical point of view, such a conceptualisation impacts heavily on the way we perform music, how we study it and how we think about it today. Scholars such as Treitler and Strohm have proposed substituting composition over practice to highlight the act of performance over prior creation as a way of shifting the focus in the development of contemporary historiography. In parallel with recent studies on contrapuntal improvisation they have stressed the need to incorporate oral traditions within music history and to stimulate reconsideration conceptualisation of “making musical works” in the Renaissance, and the very nature of the works themselves. Starting with the notion of the Renaissance “musical work” as a group of fluid, dynamic multiplicities, this book explores varied approaches to the “musical work.” It includes lexicological analyses of Renaissance musical terminology, source studies that identify the changing practices and identities of specific works, and broader questions such as interrelationships between music, architecture and rhetoric, o between space and work. The book is further enriched by a study of the 15,000 musical works that resided in the library of Ferdinand Columbus, that survive as indices, never studied or published.Departamento de Música y Expresión MusicalEste trabajo forma parte del proyecto de investigación “La obra musical renacentista: fundamentos, repertorios y prácticas” HAR 2015-70181-P (MINECO/FEDER, UE

Plataforma virtual de entrenamiento: Fit Train Perú

El presente modelo de negocio consiste en la creación de una plataforma virtual de entrenamiento dedicada a las personas que deseen incorporar la actividad física a su rutina diaria. Este servicio consta de clases grabadas y en vivo de las disciplinas que despiertan más interés en los usuarios, como rutinas de cardio, fuerza, Body Combat, yoga, pilates y ejercicios de alta intensidad. El segmento de clientes a los que está dirigido este emprendimiento pertenecen a todos los peruanos del NSE A y B, entre 18 a 55 años. De esta manera, Fit Train Perú ofrece dos tipos de membresías al público objetivo. La membresía básica consta de clases grabadas y la Premium que son clases en vivo. El objetivo principal de Fit Train Perú es incentivar la práctica del ejercicio físico en las personas, con el fin de que mejoren su salud y calidad de vida a largo plazo.The present business model consists in the creation of a virtual entertainment platform that’s dedicated to the people that wish to incorporate physical activity to their daily schedule. This service has recorded classes and live classes from disciplines that spark the most interest in users, such as cardio routines, strength, body combat, yoga, Pilates and high intensity exercises. The segment of clients that this entrepreneurship aims for is Peruvians from social economic level A and B between 18 and 55 years old. Fit Train Peru offers two types of memberships to the target audiences. The basic membership consists of recorded classes and the premium membership has live classes. The main objective of Fit Train Peru is to incentivize the practice of physical exercise in people, with the aim of improving their health and quality of life in the long term.Trabajo de investigació