Leadership of Integrated Health and Social Care Services

This research explores the lived experience of those individuals charged with leading the integration of health and social care services in Scotland. The research was primarily qualitative in nature – comprising of a qualitative survey of front-line managers of integrated health and social care services from a single partnership area. The survey explored the management and leadership tasks and activities expected of those leading health and social care teams. The research uncovers a sense that these new leadership positions are both overwhelming in the scope of tasks required and lack clarity in how these tasks should be undertaken. This highlights a need for coordinated support and training for staff who are charged with leading integrated health and social care teams. Three key recommendations have been drawn from the findings of this research: more support should be provided to managers working within these complex integrated systems; a joint training programme should be developed for managers across both partnering organisations and finally relevant policies and procedures should be compiled into one reference resource for managers of integrated services

Themed issue on advances in solid state chemistry and its applications

Peer reviewedPostprin

Periurbanisation et Transport Artisanal a Yaounde (Cameroun)

La crise économique de la fin des années 1980, a entrainé avec elle, la libéralisation des services qui, autrefois, étaient l’apanage de l’Etat, notamment le transport urbain. Cependant, la croissance démographique et l’étalement urbain spontané ont à leur tour contribué à mettre à mal le système de transport urbain au Cameroun. Cette situation a favorisé un besoin en mobilité urbaine et péri-urbaine qui reste préoccupant pour les populations dont la majeure partie d’activités socio-économiques se concentrent au centre urbain. L’inadéquation, mieux, l’absence de politiques publiques en matière de transport fait que l’Etat peine à satisfaire ce besoin, laissant entrevoir le développement d’un moyen de transport dit « artisanal » dans les villes camerounaises telles que Yaoundé. Ce travail s’appuie sur l’enquête de terrain et l’analyse des sources diachroniques et synchroniques existantes sur la ville de Yaoundé et de ses localités périurbaines. Il montre comment, malgré la présence du transport institutionnel, le « transport artisanal » est devenu depuis près de deux décennies, le principal outil de maintien de la mobilité centre-périphérie.   The economic crisis of the late 1980s brought with it the liberalisation of the services that were previously the prerogative of the state, notably urban transport. However, population growth and spontaneous urban sprawl have in turn contributed to the undermining of the urban transport system in Cameroon. This situation has led to a need for urban and peri-urban mobility which remains a concern for populations whose socio-economic activities are concentrated in the urban centre. The inadequacy, or rather, the absence, of public policies on transport means that the state is struggling to meet this need, leading to the development of a so-called 'artisanal' or ‘craft’ means of transport in Cameroonian cities such as Yaounde. This work is based on field surveys and the analysis of existing diachronic and synchronic sources on the city of Yaounde and its peri-urban localities. It shows how, despite the presence of institutional transport, 'artisanal transport' has become, for nearly two decades, the main tool to maintain centre-periphery mobility

On the dynamics of multiple systems of hot super-Earths and Neptunes: Tidal circularization, resonance and the HD 40307 system

[Abridged] We consider the dynamics of a system of hot super-Earths or Neptunes such as HD 40307. We show that, as tidal interaction with the central star leads to small eccentricities, the planets in this system could be undergoing resonant coupling even though the period ratios depart significantly from very precise commensurability. In a three planet system, this is indicated by the fact that resonant angles librate or are associated with long term changes to the orbital elements. We propose that the planets in HD 40307 were in a strict Laplace resonance while they migrated through the disc. After entering the disc inner cavity, tidal interaction would cause the period ratios to increase from two but with the inner pair deviating less than the outer pair, counter to what occurs in HD 40307. However, the relationship between these pairs that occurs in HD 40307 might be produced if the resonance is impulsively modified by an event like a close encounter shortly after the planetary system decouples from the disc. We find this to be in principle possible for a small relative perturbation on the order of a few 1.d-3 but then we find that evolution to the present system in a reasonable time is possible only if the masses are significantly larger than the minimum masses and tidal dissipation is very effective. On the other hand we found that a system like HD 40307 with minimum masses and more realistic tidal dissipation could be produced if the eccentricity of the outermost planet was impulsively increased to about 0.15. The form of resonantly coupled tidal evolution we consider here is quite general and could be of greater significance for systems with inner planets on significantly shorter orbital periods characteristic of for example CoRoT 7 b.Comment: 38 pages, 12 figures, accepted for publication in MNRA

Cochrane systematic review and meta-analysis of Botulinum toxin for the prevention of migraine

Objectives To assess the effects of botulinum toxin for prevention of migraine in adults.Design Systematic review and meta-analysis.Data sources CENTRAL, MEDLINE, Embase and trial registries.Eligibility criteria We included randomised controlled trials (RCTs) of botulinum toxin compared with placebo, active treatment or clinically relevant different dose for adults with chronic or episodic migraine, with or without the additional diagnosis of medication overuse headache.Data extraction and synthesis Cochrane methods were used to review double-blind RCTs. Twelve week post-treatment time-point data was analysed.Results Twenty-eight trials (n=4190) were included. Trial quality was mixed. Botulinum toxin treatment resulted in reduced frequency of −2.0 migraine days/month (95% CI −2.8 to −1.1, n=1384) in chronic migraineurs compared with placebo. An improvement was seen in migraine severity, measured on a numerical rating scale 0 to 10 with 10 being maximal pain, of −2.70 cm (95% CI −3.31 to −2.09, n=75) and −4.9 cm (95% CI −6.56 to −3.24, n=32) for chronic and episodic migraine respectively. Botulinum toxin had a relative risk of treatment related adverse events twice that of placebo, but a reduced risk compared with active comparators (relative risk 0.76, 95% CI 0.59 to 0.98) and a low withdrawal rate (3%). Although individual trials reported non-inferiority to oral treatments, insufficient data were available for meta-analysis of effectiveness outcomes.Conclusions In chronic migraine, botulinum toxin reduces migraine frequency by 2 days/month and has a favourable safety profile. Inclusion of medication overuse headache does not preclude its effectiveness. Evidence to support or refute efficacy in episodic migraine was not identified

Mitochondrial DNA is critical for longevity and metabolism of transmission stage Trypanosoma brucei.

The sleeping sickness parasite Trypanosoma brucei has a complex life cycle, alternating between a mammalian host and the tsetse fly vector. A tightly controlled developmental programme ensures parasite transmission between hosts as well as survival within them and involves strict regulation of mitochondrial activities. In the glucose-rich bloodstream, the replicative 'slender' stage is thought to produce ATP exclusively via glycolysis and uses the mitochondrial F1FO-ATP synthase as an ATP hydrolysis-driven proton pump to generate the mitochondrial membrane potential (ΔΨm). The 'procyclic' stage in the glucose-poor tsetse midgut depends on mitochondrial catabolism of amino acids for energy production, which involves oxidative phosphorylation with ATP production via the F1FO-ATP synthase. Both modes of the F1FO enzyme critically depend on FO subunit a, which is encoded in the parasite's mitochondrial DNA (kinetoplast or kDNA). Comparatively little is known about mitochondrial function and the role of kDNA in non-replicative 'stumpy' bloodstream forms, a developmental stage essential for disease transmission. Here we show that the L262P mutation in the nuclear-encoded F1 subunit γ that permits survival of 'slender' bloodstream forms lacking kDNA ('akinetoplastic' forms), via FO-independent generation of ΔΨm, also permits their differentiation into stumpy forms. However, these akinetoplastic stumpy cells lack a ΔΨm and have a reduced lifespan in vitro and in mice, which significantly alters the within-host dynamics of the parasite. We further show that generation of ΔΨm in stumpy parasites and their ability to use α-ketoglutarate to sustain viability depend on F1-ATPase activity. Surprisingly, however, loss of ΔΨm does not reduce stumpy life span. We conclude that the L262P γ subunit mutation does not enable FO-independent generation of ΔΨm in stumpy cells, most likely as a consequence of mitochondrial ATP production in these cells. In addition, kDNA-encoded genes other than FO subunit a are important for stumpy form viability

Allied health and complementary therapy usage in Australian women with chronic pelvic pain : a cross-sectional study

Background: Chronic pelvic pain (CPP) causes non-cyclical pelvic pain, period pain, fatigue and other painful symptoms. Current medical and surgical management strategies are often not sufficient to manage these symptoms and may lead to uptake of other therapies. Aims: To determine the prevalence of allied health (AH) and complementary therapy (CM) use, the cost burden of these therapies and explore predictive factors for using allied health or complementary medicines. Materials and methods: An online cross-sectional questionnaire using the WERF EndoCost tool was undertaken between February to April 2017. People were eligible to participate in the survey if they were aged 18–45, living in Australia and had chronic pelvic pain. Results: From 409 responses, 340/409 (83%) of respondents reported a diagnosis of endometriosis. One hundred and five (30%) women with self-reported endometriosis, and thirteen (18%) women with other forms of CPP saw at least one AH or CM practitioner in the previous two months, with physiotherapists and acupuncturists the most common. Women who accessed CM or AH services spent an average of $480.32 AUD in the previous two months. A positive correlation was found between education and number of AH or CM therapies accessed in the past two months (p<0.001) and between income level and number of therapists (p=0.028). Conclusions: Women with CPP commonly access AH and CM therapies, with a high out of pocket cost. The high cost and associations with income and education levels may warrant a change to policy to improve equitable access to these services