Education, Health and Care plans: A qualitative investigation into service user experiences of the planning process

An Education, Health and Care (EHC) plan sets out the education, health and care support that is to be provided to a child or young person aged 0-25 years who has Special Educational Needs or a Disability (SEND). It is drawn up by the local authority after an EHC needs assessment of the child or young person, in consultation with relevant partner agencies, parents and the child or young person themselves. EHC plans, and the needs assessment process through which they are created, were introduced as part of the Children and Families Act 2014. The Act, and an accompanying SEND Code of Practice, sets out how local authorities must deliver EHC plans. In 2016, a national survey commissioned by the Department for Education (DfE) found variations in how EHC plan recipients experienced the EHC planning process across different local authorities.1 Based on these results, DfE commissioned two further research projects: a multivariate analysis of factors affecting satisfaction with the EHC planning process, and this qualitative investigation of user experiences of the EHC planning process. The qualitative investigation consisted of two distinct exercises: • Twenty-five face-to-face in-depth interviews with parents involved in the 2016 survey, with the aim of better understanding factors that lead to satisfaction and dissatisfaction with the EHC plan process. Thirteen interviews were conducted in local authorities with above average satisfaction, and 12 were conducted in local authority areas with below average satisfaction. • An evaluation of EHC plan quality focussing on plans provided by 18 of the 25 parents interviewed. The evaluation was conducted by a panel of 10 SEND experts with wide experience as SEND policy advisors, strategic leaders in LAs, specialist advisory teachers, officers in SEN statutory services, Special Needs Co-ordinators, teachers in special and mainstream schools and lecturers. There was little evidence of a link between families’ satisfaction with the process of getting the EHC plan and experts’ evaluations of the quality of the plan: this report therefore discusses these two strands of research separately.Department for Educatio

Experiences of Education, Health and Care plans: A survey of parents and young people

An Education, Health and Care plan (EHC plan) sets out the education, health and care support that is to be provided to a child or young person aged 0-25 years who has Special Educational Needs (SEN) or a disability (SEND). It is drawn up by the local authority after an Education, Health and Care (EHC) needs assessment of the child or young person has determined that an EHC plan is necessary, and after consultation with relevant partner agencies and with children, young people and parents. EHC plans, and the needs assessment process through which these are made, were introduced as part of the Children and Families Act 2014. The Act, and an accompanying SEND Code of Practice1, sets out how local authorities must deliver these, including:• Developing and maintaining these collaboratively with children, young people and parents; • Supporting children, young people and parents to participate fully; • Focusing on securing the best possible outcomes for the child/young person; • Enabling participation by relevant partner agencies, to enable joined-up provision.The SEND accountability framework established in 20152 sets out an approach for assessing SEND provision in conjunction with the Act and SEND Code of Practice. The framework provides structure for improving outcomes and experiences for children, young people and their families and, when applied, seeks to show how the system is performing, hold partners to account and support self-improvement. The framework applies at the local and national levels and to independent assessments of the EHC plan process – such as those carried out by Ofsted. In this context, the Department for Education commissioned a survey of parents and young people with an EHC plan, in order to build a representative national (and, where the data allows, local) picture of how parents and young people in England were experiencing the EHC needs assessment and planning process and the resultant EHC plans. The aim was to assess whether delivery of the EHC needs assessments and planning process and the resultant EHC plans reflected the intentions set out in the Children and Families Act 2014 and the accompanying SEND Code of Practice. The findings would help inform the SEND accountability framework.To achieve these aims the survey sought to answer the following questions: • To what extent do children, young people and families experience the EHC needs assessment and planning process as they are intended to be experienced; • How satisfied are children, young people and families with the EHC needs assessment and planning process and the resultant EHC plan; and • To what extent does this vary by local authority and by groups with different characteristics? The findings presented here and throughout the main report explore parents’ and young people’s responses to the survey questions. The report also explores where experiences of the EHC needs assessment and planning process varied for groups with different characteristics, applying a bivariate analysis approach3. The report only highlights such differences where these are statistically significant4.Department for Educatio

The History of Geopark Development in Australia, A New Way Forward

Geoparks in Australia have had a complex recent history. Following the demise of the former Kanawinka UNESCO Geopark in 2012, two potential UNESCO Global Geopark projects supported by local government agencies and embracing large areas were initiated in other Australian regions in 2016. These were for the Etheridge Geopark in Far North Queensland and the Warrumbungle Geopark in New South Wales, both featuring important volcanic phenomena. However, both proposals failed to proceed to the stage where they could be nominated by any Australian government as Aspiring UNESCO Global Geoparks. This paper focuses on the genesis of these issues and what steps have been undertaken, lessons learnt, and measures that are now being undertaken to obtain government support and broad community engagement for geopark projects. In essence, it has now been recommended that the proposal should avoid reference to the word ‘geopark’ and focus instead on communicating the concept of a ‘GeoRegion.

Identification of A Novel Class of Benzofuran Oxoacetic Acid-Derived Ligands that Selectively Activate Cellular EPAC1

Cyclic AMP promotes EPAC1 and EPAC2 activation through direct binding to a specific cyclic nucleotide-binding domain (CNBD) within each protein, leading to activation of Rap GTPases, which control multiple cell responses, including cell proliferation, adhesion, morphology, exocytosis, and gene expression. As a result, it has become apparent that directed activation of EPAC1 and EPAC2 with synthetic agonists may also be useful for the future treatment of diabetes and cardiovascular diseases. To identify new EPAC agonists we have developed a fluorescent-based, ultra-high-throughput screening (uHTS) assay that measures the displacement of binding of the fluorescent cAMP analogue, 8-NBD-cAMP to the EPAC1 CNBD. Triage of the output of an approximately 350,000 compound screens using this assay identified a benzofuran oxaloacetic acid EPAC1 binder (SY000) that displayed moderate potency using orthogonal assays (competition binding and microscale thermophoresis). We next generated a limited library of 91 analogues of SY000 and identified SY009, with modifications to the benzofuran ring associated with a 10-fold increase in potency towards EPAC1 over SY000 in binding assays. In vitro EPAC1 activity assays confirmed the agonist potential of these molecules in comparison with the known EPAC1 non-cyclic nucleotide (NCN) partial agonist, I942. Rap1 GTPase activation assays further demonstrated that SY009 selectively activates EPAC1 over EPAC2 in cells. SY009 therefore represents a novel class of NCN EPAC1 activators that selectively activate EPAC1 in cellulae

Testing Newtonian Gravity with AAOmega: Mass-To-Light Profiles and Metallicity Calibrations From 47 Tuc and M55

Globular clusters are an important test bed for Newtonian gravity in the weak-acceleration regime, which is vital to our understanding of the nature of the gravitational interaction. Recent claims have been made that the velocity dispersion profiles of globular clusters flatten out at large radii, despite an apparent paucity of dark matter in such objects, indicating the need for a modification of gravitational theories. We continue our investigation of this claim, with the largest spectral samples ever obtained of 47 Tucanae and M55. Furthermore, this large sample allows for an accurate metallicity calibration based on the equivalent widths of the calcium triplet lines and K band magnitude of the Tip of the Red Giant Branch. Assuming an isothermal distribution, the rotations of each cluster are also measured with both clusters exhibiting clear rotation signatures. The global velocity dispersions of NGC 121 and Kron 3, two globular clusters in the Small Magellanic Cloud, are also calculated. By applying a simple dynamical model to the velocity dispersion profiles of 47 Tuc and M55, we calculate their mass-to-light profiles, total masses and central velocity dispersions. We find no statistically significant flattening of the velocity dispersion at large radii for M55, and a marked increase in the profile of 47 Tuc for radii greater than approximately half the tidal radius. We interpret this increase as an evaporation signature, indicating that 47 Tuc is undergoing, or has undergone, core-collapse, but find no requirement for dark matter or a modification of gravitational theories in either cluster.Comment: 11 pages, 12 figures, 4 tables. Accepted by MNRA

The Discovery of a Potent, Selective, and Peripherally Restricted Pan-Trk Inhibitor (PF-06273340) for the Treatment of Pain

The neurotrophin family of growth factors, comprised of nerve growth factor (NGF), brain derived neurotrophic factor (BDNF), neurotrophin 3 (NT3), and neurotrophin 4 (NT4), is implicated in the physiology of chronic pain. Given the clinical efficacy of anti-NGF monoclonal antibody (mAb) therapies, there is significant interest in the development of small molecule modulators of neurotrophin activity. Neurotrophins signal through the tropomyosin related kinase (Trk) family of tyrosine kinase receptors, hence Trk kinase inhibition represents a potentially “druggable” point of intervention. To deliver the safety profile required for chronic, nonlife threatening pain indications, highly kinase-selective Trk inhibitors with minimal brain availability are sought. Herein we describe how the use of SBDD, 2D QSAR models, and matched molecular pair data in compound design enabled the delivery of the highly potent, kinase-selective, and peripherally restricted clinical candidate PF-06273340

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development

Background: Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. Objectives: To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. Data sources: All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. Review methods: A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. Results: Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from ‘goals and planning’ and ‘identity’ groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. Limitations: There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. Conclusions: Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. Future work: There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity

Galaxy Formation Theory

We review the current theory of how galaxies form within the cosmological framework provided by the cold dark matter paradigm for structure formation. Beginning with the pre-galactic evolution of baryonic material we describe the analytical and numerical understanding of how baryons condense into galaxies, what determines the structure of those galaxies and how internal and external processes (including star formation, merging, active galactic nuclei etc.) determine their gross properties and evolution. Throughout, we highlight successes and failings of current galaxy formation theory. We include a review of computational implementations of galaxy formation theory and assess their ability to provide reliable modelling of this complex phenomenon. We finish with a discussion of several "hot topics" in contemporary galaxy formation theory and assess future directions for this field.Comment: 58 pages, to appear in Physics Reports. This version includes minor corrections and a handful of additional reference

Crumbs 3b promotes tight junctions in an ezrin-dependent manner in mammalian cells

AMT-L is supported by the School of Biology, University of St Andrews. AMT-L, PAR and FJGM were funded by the Anonymous Trust, University of St Andrews. PAR is supported by the Melville Trust for the Care and Cure of Cancer. The mass spectrometry work was supported by the Wellcome Trust [grant number 094476/Z/10/Z], which funded the purchase of the TripleTOF 5600 mass spectrometer at the BSRC Mass Spectrometry and Proteomics Facility, University of St Andrews. The clinical study was supported by the Department of Pathology, Albert Einstein College of Medicine/ Montefiore Medical Center.Crumbs3 (CRB3) is a component of epithelial junctions that has been implicated in apical-basal polarity, apical identity, apical stability, cell adhesion and cell growth. CRB3 undergoes alternative splicing to yield two variants: CRB3a and CRB3b. Here, we describe novel data demonstrating that as with previous studies on CRB3a, CRB3b also promotes the formation of tight junctions. However, significantly we demonstrate that the 4.1-ezrin-radixin-moesin (FERM) binding motif (FBM) of CRB3b is required for CRB3b functionality and that ezrin binds to the FBM of CRB3b. Furthermore, we show that ezrin contributes to CRB3b functionality and the correct distribution of tight junction proteins. We demonstrate that both CRB3 isoforms are required for the production of functionally mature tight junctions and also the localization of ezrin to the plasma membrane. Finally, we demonstrate that reduced CRB3b expression in head and neck squamous cell carcinoma (HNSCC) correlates with cytoplasmic ezrin, a biomarker for aggressive disease, and show evidence that whilst CRB3a expression has no effect, low CRB3b and high cytoplasmic ezrin expression combined may be prognostic for HNSCC.PostprintPeer reviewe

Patient priorities and decision-making process when choosing between colonic investigation alternatives:a qualitative interview study

Objective To establish patients’ perceptions of decision-making and prioritisation of test attributes when considering a colonic investigation.Methods National Health Service Highland patients on the waiting list for a colon capsule endoscopy (CCE) and colonoscopy were invited to undergo a semistructured qualitative telephone interview. A diverse sample was sought using a purposive sampling strategy, aiming for differences in age, gender and test awaited between participants. An interview guide was developed using an iterative approach and published data on patients’ experience of colonic investigations. Data were analysed using phenomenological approach and thematic analysis.Results Between 12 June 2022 and 02 August 2022, 12 patients underwent telephone interviews. Nine of those patients were on the waiting list for colonoscopy and three were waiting for a CCE. Patients described a mixed level of involvement in the decision-making process for a colonic investigation; some were not involved in the process at all, while others were guided by their clinician. The most important test aspect reported by patients was diagnostic quality, focused on getting a diagnosis, ruling out cancer or the diagnostic accuracy of the test. The importance of the waiting time for the test, the amount of pain or discomfort experienced during the test and the invasiveness of the test were also discussed by patients.Conclusion Through qualitative interviews, we have identified patients’ priorities for colonic investigations, which should be further explored to quantify the value patients place on these aspects of the test. Areas of improvement in the decision-making process have been reported, which could be addressed to improve patient care.Trial registration number NCT05391529