Demographic, clinical, and service-use characteristics related to the clinician’s recommendation to transition from child to adult mental health services

Purpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services

Cohort profile : demographic and clinical characteristics of the MILESTONE longitudinal cohort of young people approaching the upper age limit of their child mental health care service in Europe

Purpose: The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports. Participants: Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at. Findings to date: This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be ‘markedly ill’, ‘severely ill’ or ‘among the most extremely ill’ by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year. Future plans: Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared. Trial registration number: NCT03013595

An Integrated Experimental and Numerical Methodology for Plug-In Hybrid Electric Vehicle 0D Modelling

Governments worldwide are taking actions aiming to achieve a sustainable transportation system that can comprise of minimal pollutant and GHG emissions. Particular attention is given to the real-world emissions, i.e. to the emissions achieved in the real driving conditions, outside of a controlled testing environment. In this framework, interest in vehicle fleet electrification is rapidly growing, as it is seen as a way to simultaneously reduce pollutant and GHG emissions, while on the other hand OEMs are facing a significant increase in the number of tests which are needed to calibrate this new generation of electrified powertrains over a variety of different driving scenarios. This paper introduces an integrated and standardized methodology for hybrid electric vehicles (HEVs) testing and modelling, which reduces the testing effort in terms of time and cost, and aims to provide a “virtual test rig” on which the performance of electrified powertrains can be assessed over a wide variety of different real driving scenarios. The experimental part is based on performing customized and non-invasive powertrain instrumentation. Vehicle tear-down is avoided for components characterization, which is instead achieved via a limited set of dedicated tests: constant speed driving, accelerations, standstill starts and different type of decelerations are carried out to extract a sufficient amount of data to feed the simulation models. On the simulation side, the authors have developed and calibrated a comprehensive 0D map-based HEV model, capable of simulating various hybrid architectures with high flexibility also in real driving scenarios. This approach does not require a detailed knowledge of all the powertrain and vehicle components and can be used as a virtual test bench for preliminary assessments regarding various operating conditions and driving cycles. As test case, a P0-P2 architecture gasoline Plug-in HEV has been investigated: in this case the Energy Management System (EMS) plays a crucial role in targeting the optimal power split between different on board energy sources. Using literature data and tests under both steady-state and transient conditions, the EMS model was calibrated. As a result, energy consumption and operating modes are accurately predicted, thus demonstrating the capabilities of the proposed methodology to provide a virtual test rig which can be used in the predevelopment phase of new powertrains

Lucie de Lammermoor (extraits) / Gaetano Donizetti ; Giuseppe Manacchini, Baryton ; Lina Pagliughi, Soprano ; Giovanni Malpiero, Ténor ; L. Neroni, basse ; avec l'Orchestre Symphonique de la Radiotélévision Italienne dir. Ugo Tansini

Titre uniforme : [Lucia di Lammermoor]. ChoixComprend : CRUDA, FUNESTA, SMANIA - CHI MI FRENA - ARDON GLI INCENSIBnF-Partenariats, Collection sonore - BelieveContient une table des matière

demographic clinical, and service-use characteristics related to the clinician’s recommendation to transition from child to adult mental health services

Purpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians' advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians' transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate service

Demographic, clinical, and service-use characteristics related to the clinician’s recommendation to transition from child to adult mental health services

International audiencePurpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services