What stops children with a chronic illness accessing health care: A mixed methods study in children with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)

Background: Paediatric Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is relatively common and disabling with a mean time out of school of more than one academic year. NICE guidelines recommend referral to specialist services immediately if severely affected, within 3 months if moderately affected and within 6 months if mildly affected. However, the median time-to-assessment by a specialist service in the UK is 18 months. This study used a mixed-methods approach to examine factors associated with time taken to access specialist services. Methods. Time-to-assessment was analysed as a continuous "survival-time" variable in Cox regression models using data from self-completed assessment forms for children attending a regional specialist CFS/ME service between January 2006 and December 2009. Semi-structured interviews about barriers experienced in accessing healthcare for their child were conducted with nine parents of children aged < 17 years (8 individual and one parent couple). Interviews were digitally recorded and analysed using "thematic analysis". Results: 405 children were assessed between 2006 and 2009 and information on school attendance was available on 388. Only 1/125 with severe CFS/ME and 49/263 (19%) with mild to moderate CFS/ME were seen within NICE recommended timeframe. Increased fatigue was associated with shorter time to assessment (HR = 1.15; 95% CI 1.03, 1.29 per unit increase in Chalder fatigue score; P = 0.01). Time-to-assessment was not associated with disability, mood, age or gender. Parents described difficulties accessing specialist services because of their own as well as their GP's and Paediatrician's lack of knowledge. They experienced negative attitudes and beliefs towards the child's condition when they consulted GPs, Paediatricians and Child Psychiatrists. Parents struggled to communicate an invisible illness that their child and not themselves were experiencing. Conclusions: GPs, Child Psychiatrists and Paediatricians need more knowledge about CFS/ME and the appropriate referral pathways to ensure timeliness in referral to specialist services. © 2011 Webb et al; licensee BioMed Central Ltd

New Caledonian crows rapidly solve a collaborative problem without cooperative cognition

There is growing comparative evidence that the cognitive bases of cooperation are not unique to humans. However, the selective pressures that lead to the evolution of these mechanisms remain unclear. Here we show that while tool-making New Caledonian crows can produce collaborative behavior, they do not understand the causality of cooperation nor show sensitivity to inequity. Instead, the collaborative behavior produced appears to have been underpinned by the transfer of prior experience. These results suggest that a number of possible selective pressures, including tool manufacture and mobbing behaviours, have not led to the evolution of cooperative cognition in this species. They show that causal cognition can evolve in a domain specific manner-understanding the properties and flexible uses of physical tools does not necessarily enable animals to grasp that a conspecific can be used as a social tool

Demographic amplification is a predictor of invasiveness among plants

Invasive plant species threaten native biodiversity, ecosystems, agriculture, industry and human health worldwide, lending urgency to the search for predictors of plant invasiveness outside native ranges. There is much conflicting evidence about which plant characteristics best predict invasiveness. Here we use a global demographic survey for over 500 plant species to show that populations of invasive plants have better potential to recover from disturbance than non-invasives, even when measured in the native range. Invasives have high stable population growth rates in their invaded ranges, but this metric cannot be predicted based on measurements in the native ranges. Recovery from demographic disturbance is a measure of transient population amplification, linked to high levels of reproduction, and shows phylogenetic signal. Our results demonstrate that transient population dynamics and reproductive capacity can help to predict invasiveness across the plant kingdom, and should guide international policy on trade and movement of plants

The ERA System for steady-state evoked potential recording and analysis [Abstract]

Presented at the 13th National Scientific Conference and Workshops Audiological Society of Australia, Brighton Beach, Sydney, 28 April - 1 May, 1998.This is a publisher’s version of an abstract published in Australian Journal of Audiology 1998. This version is reproduced with permission from the publisher, Australian Academic Press. http://www.australianacademicpress.com.au/The ERA System is the first commercially available device designed specifically for the recording and analysis of steady-state evoked potentials. It is the result of basic and applied research carried out at the University of Melbourne over the past 20 years. The basic research that contributed to the development of this project as well as studies of a more applied nature that highlight the clinical utility of SSEP measure will now be reviewed. The automatic detection algorithm employed in the analysis of results will be explained, as well as the linear regression for threshold estimation. The hardware components and software options of the ERA System will be reviewed. In addition, some of the issues involved in the production and distribution of a commercial device for “evoked response audiometry” in both national (Australian) and international (e.g. U.S.A., E.U., Asia) markets will be discussed

How insightful is ‘insight’? New Caledonian crows do not attend to object weight during spontaneous stone dropping

It is highly difficult to pinpoint what is going through an animal’s mind when it appears to solve a problem by ‘insight’. Here, we searched for an information processing error during the emergence of seemingly insightful stone dropping in New Caledonian crows. We presented these birds with the platform apparatus, where a heavy object needs to be dropped down a tube and onto a platform in order to trigger the release of food. Our results show New Caledonian crows exhibit a weight inattention error: they do not attend to the weight of an object when innovating stone dropping. This suggests that these crows do not use an understanding of force when solving the platform task in a seemingly insightful manner. Our findings showcase the power of the signature-testing approach, where experiments search for information processing biases, errors and limits, in order to make strong inferences about the functioning of animal minds

Why do young people with CFS/ME feel anxious? A qualitative study

Young people with chronic fatigue syndrome or myalagic encephalopathy (CFS/ME) (CFS/ME) experience higher levels of psychological distress than healthy controls and young people with other chronic illnesses, and it was recently demonstrated that 38% of this population scored above the clinical cut-off on the Spence Child Anxiety Scale. Subscales of social and separation anxiety were consistently high across gender and age groups. In this study, we used qualitative methods to help us understand more about these two types of anxiety in young people with CFS/ME. Eleven young people (age 12-18) were interviewed. Interviews were self-directed by the participants and were wide ranging. The transcripts were analysed using interpretative phenomenological analysis. Five superordinate themes were identified: social loss and adjustment; introduction of uncertainty and unpredictability; the vulnerable self; individual differences; and contributions towards recovery. Many themes were identical to those described in young people coping with other chronic illnesses in adolescence. In addition, young people with CFS/ME describe experiences associated with the perceived illegitimacy of this condition, namely: feeling unable to explain their illness; bullying from peers; disbelief; and distrust from adults around them. This becomes an additional challenge for these young people. Clinicians need to be aware of these problems, and offer appropriate support

Crows’ pre-test block preferences.

<p>Crows’ pre-test block preferences.</p

Summary of crows’ post-training first choice preferences.

<p>Summary of crows’ post-training first choice preferences.</p