Learning Together 1: an educational model for training GPs, paediatricians: initial findings.

Learning Together is primarily an educational intervention, where paediatric registrars [SpRs] and General Practice (GP) registrars [GPSTs] see children together in a primary care setting. Over a six month period in 2013/2014, 44 learning pairs were set up mainly in North East and Central London. Proof of concept for the model at scale was achieved. Reported learning demonstrated: clinical learning themes of new knowledge, skill and communication skills; and collaborative themes of ongoing collaboration, satisfaction with team working and change in attitudes. These themes were identified in both sets of trainees. The self-reported learning is backed up by the results of a retrospective notes review of four common conditions based on NICE guidelines; constipation, asthma, feverish illness and eczema (CAFE). Guidance adherence improved from 57% before the intervention in solo GP training consultations to 72% during the joint clinic intervention (p < 0.01). After the intervention when the GP registrars returned to normal consultations, guidance adherence was 77% compared to before the intervention (p < 0.01). In addition 99% of the parents, who handed in feedback forms or took part in interviews, reported a good experience of care, and 87% reported increased confidence to manage their children's health following the consultation. A second, linked article examines the cost utility of Learning Together in its South London extension

Overgrazing and wind erosion

OVER the last few years wind erosion during the autumn in the wheatbelt districts has become increasingly evident. This has occurred under normal seasonal conditions and observations in this article are not related to unusual conditions such as the extremely low rainfall during the current season.

Controlling the variable of pressure in the production of test footwear impressions

Footwear impression lifting and enhancement techniques may be affected by several variables introduced during the production of test footwear impressions, thus limiting the usefulness of enhancement technique comparisons and the results obtained. One such variable is the force applied when the impressed mark is being made. Producing consistent test impressions for research into footwear enhancement techniques would therefore be beneficial. This study was designed to control pressure in the production of test footwear impressions when mimicking a stamping action. Twenty-seven volunteers were asked to stamp on two different surfaces and the average stamping force was recorded. Information from the data obtained was used to design and build a mechanical device which could be calibrated to consistently deliver footwear impressions with the same force onto a receiving surface. Preliminary experiments using this device and different contaminants on the footwear sole have yielded consistent and repeatable impressions. Controlling the variable of pressure for the production of test impressions in this study demonstrated that the differences observed were visual (due to the amount of contaminant transferred and subsequent enhancement) and did not affect the replication of outer sole characteristics. This paper reports the development of the device and illustrates the quality of the impressions produced

Quobba Point chalet development land capability study [and] Environmental consideration

The preferred area for development is the Old Stabilised Dune System. The Hind Dune Flat is a stable area but is limited in size. Other environmental and town planning considerations may militate against development of this area for Chalet Development

Thermal damage done to bone by burring and sawing with and without irrigation in knee arthroplasty

Heat from bone resecting tools used in knee surgery can induce thermal osteonecrosis, potentially causing aseptic implant loosening. This study compared oscillating saws to burrs in terms of temperature generation and histologic damage. Use of irrigation to reduce bone temperature was also investigated. Temperatures were recorded during sawing and burring with or without irrigation (uncooled or cooled). Histologic analyses were then carried out. Differences between groups were tested statistically (α = 0.05). On average, burring produced higher temperatures than sawing (P < .001). When uncooled irrigation was used, bone temperatures were significantly lower in sawed bone than in burred bone (P < .001). Irrigation lowered temperatures and thermal damage depths and increased osteocyte viability (P < .001). These results suggest that irrigating bone during resection could prevent osteonecrosis onset

Struggling for food in a time of crisis: Responsibility and paradox

Responsibility is a useful lens through which to examine the current state of food poverty in the UK in the context of the Covid‐19 crisis, noting that this concept contains several paradoxes. Currently, responsibility involves the voluntary sector, the food industry and the state, a situation which the author has been exploring for the last five years in an ethnographic study of food poverty and food aid in the UK. Food aid organizations, especially food banks, have mushroomed during the period of austerity. This reveals the first paradox: namely, that the existence of food banks conveys the message that ‘something is being done’, but in actuality this is very far from being sufficient to meet the needs of either the ‘old’ or ‘new’ food insecure. The second paradox is that at the onset of the crisis, a government which had been responsible for inflicting austerity on the country for 10 years, dramatically reversed some of its policies. However, predictably, this did not change the situation vis‐à‐vis food insecurity. The third paradox is that the frequent rhetoric invoking the two world wars has not resulted in lessons being learned – notably, the creation of a ministry to deal with food and rationing, as in the Second World War. The final paradox relates to Brexit and its likely deleterious effects on food security, particularly if no ‘deal’ is achieved with the European Union, as seems likely. The voluntary food aid sector, try as it may, cannot possibly assume responsibility for the long‐standing and now hugely increased problems of food insecurity. That belongs to the state

The I-CAN : using e-Health to get people the support they need

Background: The I-CAN is a comprehensive, reliable and valid system of identifying and classifying support needs of people with disabilities based on the conceptual framework of the International Classification of Functioning, Disability and Health (ICF) [1] and the American Association on Intellectual and Developmental Disability (AAIDD) supports concept [2,3]. Originally developed for people with Developmental Disability, the I-CAN's application of internet technologies is currently being trialled in Mental Health, Rehabilitation Medicine and other disciplines. Conceptual underpinnings, research and implementation to date are summarized. Method: ICF based domains covering Health & Well Being and Activities & Participation have been refined over several versions. A total of 1012 individuals with disabilities across the eastern states of Australia were assessed using the first three versions, and 193 with the fourth versions. Studies investigated reliability, concurrent and predictive validity and user satisfaction. A fourth internet-based version has been implemented and is under continuing investigation and refinement. Results: The I-CAN instrument demonstrated good reliability and validity in studies to date. Domain scales effectively discriminated a range of intensities of support for people with various disabilities, with highest support needs generally recorded by individuals with multiple disabilities and ageing issues. Correlations between I-CAN and adaptive behaviour scales were mixed. The ICAN scales measure individual support needs. However, regression analysis suggests that staffing and other organizational factors play a significant role in resource allocation apart from individual support need. There was general satisfaction with the assessment process from stakeholders and participants groups. Several brief case examples shall be presented. Conclusions: The I-CAN provides a reliable and valid tool for assessing and reporting on the support needs of people with disabilities using a process that involves the person, their family, friends and staff as appropriate. Several possibilities exist for this unique tool and the application of the ICF framework to e-health