Autism Spectrum Disorder (ASD): Improving Community Services Recommendations Report from the ASD Special Interest Group

Executive Summary and Key Recommendations In 2011, the National Institute for Health and Care Excellence (NICE) published guidelines for the recognition, referral and diagnosis of children and young people on the autistic spectrum1. NICE recommended that each local area establish co-ordinated multidisciplinary and multi-agency referral, assessment and diagnostic pathways (hereafter referred to as the “pathway”) for children with a suspected ASD. In February 2014, the Cheshire and Merseyside Strategic Clinical Network (CMSCN) established an Autistic Spectrum Disorder (ASD) Special Interest Group (SIG) to review community services for children with ASD and their families in the Cheshire and Merseyside region. The aim of the SIG was to: 1. Identify and map current multi-agency pathways from diagnosis to transition for Children and Young People (CYP) with Autistic Spectrum Disorder (ASD) 2. Review existing Parent Support Programmes for CYP aged 11-15 years with ASD 3. Develop a process to allow measurement of CYP and family experience The SIGs programme of work was originally intended to run until March 2016. However, ongoing changes to national service improvement policy and the adaptation of Strategic Clinical Network (SCN) priorities meant the SIGs work programme was condensed to one year with an aim to complete by March 2015. As a result, work on aims 2 and 3 were “paused” with acknowledgement and scope for wider stakeholders to explore these issues further. Key Findings There was considerable variation in the availability and quality of referral pathways within the Cheshire and Merseyside region and it was difficult to establish to what extent some referral pathways were meeting NICE guideline recommendations. Parents reported poor access to services and frustration and confusion with the referral pathway. With a few exceptions, the voluntary sector was largely disengaged from the process. Those that gave a reason for not engaging with the process cited a feeling of repeated broken policy promises and raised expectations that were not subsequently met. There was variable but significant pressure on resources and some areas were unable to meet parent expectations or to meet the NICE recommendation. There was considerable expertise in ASD and a passion across all voluntary, health, education and social care agencies to improve services for children with ASD and their families. v Key Outcomes A standard blueprint referral pathway template that maps onto NICE guidelines recommendation. A parent and carer information leaflet which can be used at point of referral. An initial assessment of parent’s priorities during the referral pathway with the aim of informing the development of a tool for measuring parents’ experience. Key Recommendations Clinical Commissioning Groups (CCGs) to refer to NICE guidance and ensure that there is a suitable ASD pathway in place for referral, assessment and diagnosis of children with a suspected ASD in their area. CCGs to consider workforce and training needs review, to ensure there is sufficient experience and expertise to meet NICE guidelines. CCGs that are due to review or renew their ASD pathway or are developing new process, give consideration to using the blueprint pathway template. CCGs to tailor the blueprint pathway template to local needs following a detailed analysis of current local services and gaps. CCGs to give consideration to the results of the parent survey when developing their pathway and when developing tools to measures parent experience. CCGs to consider developing and expanding on patient and public involvement (PPI) within their catchment area where possible, taking into account families under pressure may need additional support to engage in PPI processes. CCGs to consider using the parent information leaflet to provide preliminary information and signposting to support for parents at the point of referral

Pengaruh Social Media Influencer Terhadap Perilaku Konsumtif di Era Ekonomi Digital

This study aims to determine the correlation between consumptive behavior at using e-commerce in this digital era and social media influencers. The background of this study is the rapid growth of e-commerce in Indonesia. Quantitative descriptive method was being used to found the causal relationship among dependent and independent variable for the e-commerce users in this digital era. The data collection technique was carried out with the study of literature by collecting information from various sources relevant to the research object. The results showed that in 2018 there were 72.83% of businesses selling via the internet with an online shopper which increased from year to year, where the number reached 11.9% of the total population in Indonesia. The results of other studies indicate that the level of public trust in social media in 2018 is 51%, based on public behavior from information written by journalists, global report platforms, and social media influencers. The information is in the form of news, educational activities, communication, and trading activities. From these results, there is a correlation between the high of consumptive behavior in the use of e-commerce and social media influencers who are influenced by the credibility of the influencers, thereby increasing consumptive behavior in the digital era.

Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience

Aim Organ-preserving local excision by transanal endoscopic microsurgery (TEM) for early rectal cancer offers significantly lower morbidity as compared to formal rectal cancer resection with acceptable outcomes. This study presents our 6-year experience of TEM for rectal lesions referred to a specialist early rectal cancer centre in the UK. Method Data were collected for all patients referred for TEM of suspected early rectal cancer to a regional specialist early rectal cancer multidisciplinary team (MDT) over a 6-year period. Results One hundred and forty-one patients who underwent full-thickness TEM for suspected or confirmed early rectal cancer were included. Thirty patients were referred for TEM following incomplete endoscopic polypectomy. Final pathology was benign in 77 (54.6%) cases and malignant in 64 (45.4%). Of the 61 confirmed adenocarcinomas, TEM resections were pT0 in 17 (27.9%), pT1 in 32 (51.7%), pT2 in 11 (18.0%) and pT3 in 1 (1.6%). Thirty-eight of 61 patients (62.3%) had one or more poor histological prognostic features and these patients were offered further treatment. Twenty-three of 61 (37.7%) patients with rectal adenocarcinoma required no further treatment following TEM. Forty-three cases of rectal adenocarcinoma were available for establishing recurrence rates. Two of 43 patients (4.7%) developed a recurrence at a median follow-up of 28.7 months (12.1–66.5 months). The overall estimated 5-year overall survival rate was 87.9% and the disease-free survival rate was 82.9%. Conclusion Acceptable outcomes are possible for TEM surgery with appropriate patient selection, effective technique, expert histopathology, appropriate referral for adjuvant treatment and meticulous follow-up. This can be achieved through an early rectal cancer MDT in a dedicated specialist regional centre

LIFE in a ZOO: Henri Lefebvre and the (social) production of (abstract) space in Liverpool

Building on recent critical contributions towards conceptualising neighbourhood change as socially produced and politically ‘performed’, this paper takes a closer look at the work of Henri Lefebvre to understand the production of urban space as a deeply political process. A common critical characterisation of neighbourhood change—occurring through a grand Lefebvrean struggle between ‘abstract space-makers’ and ‘social space-makers’—is critically examined through an in-depth historical case study of the Granby neighbourhood in Liverpool. Here, these forces are embodied respectively in technocratic state-led comprehensive redevelopment, notably Housing Market Renewal and its LIFE and ZOO zoning models; and in alternative community-led rehabilitation projects such as the Turner Prize-winning Granby Four Streets Community Land Trust. By tracing the surprisingly intimate interactions and multiple contradictions between these apparently opposing spatial projects, the production of neighbourhood is shown to be a complex, often violent political process, whose historical trajectories require disentangling in order to understand how we might construct better urban futures

More than bread and circuses A second look at the chip; a further report by the panel established by the Merseyside Enterprise Forum to consider the social implications of advancing technology

SIGLEAvailable from British Library Lending Division - LD:84/31503(More) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Review of MERCEDO operations 1981-1985 Report of the Chief Economic Adviser

SIGLEAvailable from British Library Lending Division - LD:OP-LG/706 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Initial development strategy

LD:f81/4076 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

New Brighton area strategy

Incl. mapSIGLEAvailable from British Library Document Supply Centre- DSC:OP/LG-6433 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Report of the Chief Constable 1996/97

SIGLEAvailable from British Library Document Supply Centre-DSC:7640.2165(1996/1997) / BLDSC - British Library Document Supply CentreGBUnited Kingdo