148 research outputs found
The Children and Young People's Health Partnership Evelina London Model of Care: process evaluation protocol
Introduction Children and young people (CYP) in the
UK have poor health outcomes, and there is increasing
emergency department and hospital outpatient use. To
address these problems in Lambeth and Southwark (two
boroughs of London, UK), the local Clinical Commissioning
Groups, Local Authorities and Healthcare Providers formed
The Children and Young People’s Health Partnership
(CYPHP), a clinical-academic programme for improving
child health. The Partnership has developed the CYPHP
Evelina London model, an integrated healthcare model that
aims to deliver effective, coordinated care in primary and
community settings and promote better self-management
to over approximately 90 000 CYP in Lambeth and
Southwark. This protocol is for the process evaluation of
this model of care.
Methods and analysis Alongside an impact evaluation,
an in-depth, mixed-methods process evaluation will
be used to understand the barriers and facilitators to
implementing the model of care. The data collected
mapped onto a logic model of how CYPHP is expected
to improve child health outcomes. Data collection and
analysis include qualitative interviews and focus groups
with stakeholders, a policy review and a quantitative
analysis of routine clinical and administrative data and
questionnaire data. Information relating to the context of
the trial that may affect implementation and/or outcomes
of the CYPHP model of care will be documented.
Ethics and dissemination The study has been reviewed
by NHS REC Cornwall & Plymouth (17/SW/0275). The
findings of this process evaluation will guide the scaling up
and implementation of the CYPHP Evelina London Model
of Care across the UK. Findings will be disseminated
through publications and conferences, and implementation
manuals and guidance for others working to improve child
health through strengthening health systems.
Trial registration number NCT03461848
Agrammatic but numerate
A central question in cognitive neuroscience concerns the extent to
which language enables other higher cognitive functions. In the
case of mathematics, the resources of the language faculty, both
lexical and syntactic, have been claimed to be important for exact
calculation, and some functional brain imaging studies have shown
that calculation is associated with activation of a network of
left-hemisphere language regions, such as the angular gyrus and
the banks of the intraparietal sulcus. We investigate the integrity
of mathematical calculations in three men with large left-hemisphere
perisylvian lesions. Despite severe grammatical impairment
and some difficulty in processing phonological and orthographic
number words, all basic computational procedures were intact
across patients. All three patients solved mathematical problems
involving recursiveness and structure-dependent operations (for
example, in generating solutions to bracket equations). To our
knowledge, these results demonstrate for the first time the remarkable
independence of mathematical calculations from language
grammar in the mature cognitive system
Knowledge-based energy functions for computational studies of proteins
This chapter discusses theoretical framework and methods for developing
knowledge-based potential functions essential for protein structure prediction,
protein-protein interaction, and protein sequence design. We discuss in some
details about the Miyazawa-Jernigan contact statistical potential,
distance-dependent statistical potentials, as well as geometric statistical
potentials. We also describe a geometric model for developing both linear and
non-linear potential functions by optimization. Applications of knowledge-based
potential functions in protein-decoy discrimination, in protein-protein
interactions, and in protein design are then described. Several issues of
knowledge-based potential functions are finally discussed.Comment: 57 pages, 6 figures. To be published in a book by Springe
The impact of out-of-hospital models of care on paediatric emergency department presentations
OBJECTIVE: To estimate the potential impact of enhanced primary care and new out-of-hospital models (OOHMs) on emergency department (ED) presentations by children and young people (CYP).
DESIGN: Observational study.
PATIENTS AND SETTING: Data collected prospectively on 3020 CYP 0–17.9 years from 6 London EDs during 14 days by 25 supernumerary clinicians. CYP with transient acute illness, exacerbation of long-term condition (LTC), complex LTC/disability and injury/trauma were considered manageable within OOHM. OOHMs assessed included nurse-led services, multispecialty community provider (MCP), primary and acute care system (PACS) plus current and enhanced primary care.
MEASURES: Diagnosis, severity; record of investigations, management and outcome that occurred; objective assessment of clinical need and potential alternative management options/destinations.
RESULTS: Of the patients 95.6% had diagnoses appropriate for OOHM. Most presentations required assessment by a clinician with skills in assessing illness (39.6%) or injuries (30.9%). One thousand two hundred and ninety-one (42.75%) required no investigations and 1007 (33.3%) were provided only with reassurance. Of the presentations 42.2% were judged to have been totally avoidable if the family had had better health education.
Of the patients 26.1% were judged appropriate for current primary care (community pharmacy or general practice) with 31.5% appropriate for the combination of enhanced general practice and community pharmacy. Proportions suitable for new models were 14.1% for the nurse-led acute illness team, MCP 25.7%, GP federation CYP service 44.6%, comprehensive walk-in centre for CYP 64.3% and 75.5% for a PACS.
CONCLUSIONS: High proportions of ED presentations by CYP could potentially be managed in new OOHMs or by enhancement of existing primary care
Efficient Reconstruction of Metabolic Pathways by Bidirectional Chemical Search
One of the main challenges in systems biology is the establishment of the metabolome: a catalogue of the metabolites and biochemical reactions present in a specific organism. Current knowledge of biochemical pathways as stored in public databases such as KEGG, is based on carefully curated genomic evidence for the presence of specific metabolites and enzymes that activate particular biochemical reactions. In this paper, we present an efficient method to build a substantial portion of the artificial chemistry defined by the metabolites and biochemical reactions in a given metabolic pathway, which is based on bidirectional chemical search. Computational results on the pathways stored in KEGG reveal novel biochemical pathways
Parameter estimate of signal transduction pathways
BACKGROUND: The "inverse" problem is related to the determination of unknown causes on the bases of the observation of their effects. This is the opposite of the corresponding "direct" problem, which relates to the prediction of the effects generated by a complete description of some agencies. The solution of an inverse problem entails the construction of a mathematical model and takes the moves from a number of experimental data. In this respect, inverse problems are often ill-conditioned as the amount of experimental conditions available are often insufficient to unambiguously solve the mathematical model. Several approaches to solving inverse problems are possible, both computational and experimental, some of which are mentioned in this article. In this work, we will describe in details the attempt to solve an inverse problem which arose in the study of an intracellular signaling pathway. RESULTS: Using the Genetic Algorithm to find the sub-optimal solution to the optimization problem, we have estimated a set of unknown parameters describing a kinetic model of a signaling pathway in the neuronal cell. The model is composed of mass action ordinary differential equations, where the kinetic parameters describe protein-protein interactions, protein synthesis and degradation. The algorithm has been implemented on a parallel platform. Several potential solutions of the problem have been computed, each solution being a set of model parameters. A sub-set of parameters has been selected on the basis on their small coefficient of variation across the ensemble of solutions. CONCLUSION: Despite the lack of sufficiently reliable and homogeneous experimental data, the genetic algorithm approach has allowed to estimate the approximate value of a number of model parameters in a kinetic model of a signaling pathway: these parameters have been assessed to be relevant for the reproduction of the available experimental data
Identifying the cognitive predictors of early counting and calculation skills: Evidence from a longitudinal study.
The extent that phonological, visual-spatial STM and non-symbolic quantitative skills support the development of counting and calculation skills was examined in this 14-month longitudinal study of 125 children. Initial assessments were made when the children were 4:8. Phonological awareness, visual-spatial STM and non-symbolic approximate discrimination predicted growth in early calculation skills. These results suggest that both the approximate number system and domain-general phonological and visual-spatial skills support early calculation. In contrast, only performance on a small non-symbolic quantity discrimination task (where the presented quantities were always within the subitising range) predicted growth in cardinal counting skills. These results suggest that the development of counting and calculation are supported by different cognitive abilities
Adverse Drug Reactions in Children—A Systematic Review
Adverse drug reactions in children are an important public health problem. We have undertaken a systematic review of observational studies in children in three settings: causing admission to hospital, occurring during hospital stay and occurring in the community. We were particularly interested in understanding how ADRs might be better detected, assessed and avoided
Identification of Shell Colour Pigments in Marine Snails Clanculus pharaonius and C. margaritarius (Trochoidea; Gastropoda)
This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. https://creativecommons.org/publicdomain/zero/1.0/
The attached file is the published version of the article
Identifying Fishes through DNA Barcodes and Microarrays
Background: International fish trade reached an import value of 62.8 billion Euro in 2006, of which 44.6% are covered by the European Union. Species identification is a key problem throughout the life cycle of fishes: from eggs and larvae to adults in fisheries research and control, as well as processed fish products in consumer protection. Methodology/Principal Findings: This study aims to evaluate the applicability of the three mitochondrial genes 16S rRNA (16S), cytochrome b (cyt b), and cytochrome oxidase subunit I (COI) for the identification of 50 European marine fish species by combining techniques of ‘‘DNA barcoding’’ and microarrays. In a DNA barcoding approach, neighbour Joining (NJ) phylogenetic trees of 369 16S, 212 cyt b, and 447 COI sequences indicated that cyt b and COI are suitable for unambiguous identification, whereas 16S failed to discriminate closely related flatfish and gurnard species. In course of probe design for DNA microarray development, each of the markers yielded a high number of potentially species-specific probes in silico, although many of them were rejected based on microarray hybridisation experiments. None of the markers provided probes to discriminate the sibling flatfish and gurnard species. However, since 16S-probes were less negatively influenced by the ‘‘position of label’’ effect and showed the lowest rejection rate and the highest mean signal intensity, 16S is more suitable for DNA microarray probe design than cty b and COI. The large portion of rejected COI-probes after hybridisation experiments (.90%) renders the DNA barcoding marker as rather unsuitable for this high-throughput technology. Conclusions/Significance: Based on these data, a DNA microarray containing 64 functional oligonucleotide probes for the identification of 30 out of the 50 fish species investigated was developed. It represents the next step towards an automated and easy-to-handle method to identify fish, ichthyoplankton, and fish products
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