Pupils with social, emotional and mental health special needs: Perceptions of how restrictive physical interventions impact their relationships with teaching staff

Positive teacher-child relationships (TCRs) are vital for pupil well-being and are especially important for at-risk children. This qualitative study investigated the impact of restrictive physical interventions (RPIs) on TCRs in focus groups comprising ten boys aged 9–11 years attending two special schools in England. We examined the immediate and post incident impact of RPIs on the TCRs of two groups: students who have experienced RPIs and those who have witnessed RPIs. A range of consequences for student well-being, educational support and the TCR were identified. The implications of current study findings for the prevention and implementation of RPIs are discussed

How Widespread Is Working at Scale in English General Practice? an Observational Study

Background Over the last five years, national policy has encouraged practices to serve populations of >30,000 people (called 'working at scale'), by collaborating with other practices. Aim To describe the number of English general practices working at scale, and their patient populations. Design and setting Observational study of general practice in England Methods We supplemented data published by the National Health Service on practices' self-reports of working in groups with data from reports by various organisations and websites of practice groups. We categorised practices by the extent to which they were working at scale, and examined age distribution of practice population, level of socioeconomic deprivation, rurality and prevalence of longstanding illness by these categories. Results About 55% English practices (serving 33 million patients) were working at scale, individually or collectively serving populations of >30,000 people. Organisations models representing close collaboration for the purposes of core general practice services were identifiable for ~5% of practices; these were: large practices; superpartnerships, and multisite organisations. About 50% of practices were working in looser forms of collaboration focusing on services beyond core general practice, e.g. primary care in the evenings and weekends. Data on organisations models and purpose of the collaboration were very limited for this group. Conclusions In early 2018, <5% of general practices were working closely at scale; about half of practices were working more loosely at scale. Data were, however, incomplete. Understanding what is happening at practice level is needed so that we can evaluate benefits and harms

Cellular, molecular and functional characterisation of YAC transgenic mouse models of Friedreich Ataxia

Copyright © 2014 Anjomani Virmouni et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.This article has been made available through the Brunel Open Access Publishing Fund.Background - Friedreich ataxia (FRDA) is an autosomal recessive neurodegenerative disorder, caused by a GAA repeat expansion mutation within intron 1 of the FXN gene. We have previously established and performed preliminary characterisation of several human FXN yeast artificial chromosome (YAC) transgenic FRDA mouse models containing GAA repeat expansions, Y47R (9 GAA repeats), YG8R (90 and 190 GAA repeats) and YG22R (190 GAA repeats). Methodology/Principal Findings - We now report extended cellular, molecular and functional characterisation of these FXN YAC transgenic mouse models. FXN transgene copy number analysis of the FRDA mice demonstrated that the YG22R and Y47R lines each have a single copy of the FXN transgene while the YG8R line has two copies. Single integration sites of all transgenes were confirmed by fluorescence in situ hybridisation (FISH) analysis of metaphase and interphase chromosomes. We identified significant functional deficits, together with a degree of glucose intolerance and insulin hypersensitivity, in YG8R and YG22R FRDA mice compared to Y47R and wild-type control mice. We also confirmed increased somatic GAA repeat instability in the cerebellum and brain of YG22R and YG8R mice, together with significantly reduced levels of FXN mRNA and protein in the brain and liver of YG8R and YG22R compared to Y47R. Conclusions/Significance - Together these studies provide a detailed characterisation of our GAA repeat expansion-based YAC transgenic FRDA mouse models that will help investigations of FRDA disease mechanisms and therapy.European Union, Ataxia UK and FARA

Implementation of routine outcome measurement in child and adolescent mental health services in the United Kingdom: a critical perspective

The aim of this commentary is to provide an overview of clinical outcome measures that are currently recommended for use in UK Child and Adolescent Mental Health Services (CAMHS), focusing on measures that are applicable across a wide range of conditions with established validity and reliability, or innovative in their design. We also provide an overview of the barriers and drivers to the use of Routine Outcome Measurement (ROM) in clinical practice

The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle

Background: Routine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes. Within Child and Adolescent Mental Health Services (CAMHS) in the UK the adoption of ROM in CAMHS has been supported by both national and local initiatives (such as government strategies, local commissioning policy, and research). Methods: With the aim of assessing how these policies and initiatives may have influenced the uptake of ROM within two different CAMHS we report the findings of two case-note audits: a baseline audit conducted in January 2011 and a re-audit conducted two years later in December 2012-February 2013. Results: The findings show an increase in both the single and repeated use of outcome measures from the time of the original audit, with repeated use (baseline and follow-up) of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) scale increasing from 10% to 50% of cases. Re-audited case-notes contained more combined use of different outcome measures, with greater consensus on which measures to use. Outcome measures that were applicable across a wide range of clinical conditions were more likely to be used than symptom-specific measures, and measures that were completed by the clinician were found more often than measures completed by the service user. Conclusions: The findings show a substantial improvement in the use of outcome measures within CAMHS. These increases in use were found across different service organisations which were subject to different types of local service priorities and drivers

Continental mass change from GRACE over 2002-2011 and its impact on sea level

Present-day continental mass variation as observed by space gravimetry reveals secular mass decline and accumulation. Whereas the former contributes to sea-level rise, the latter results in sea-level fall. As such, consideration of mass accumulation (rather than focussing solely on mass loss) is important for reliable overall estimates of sea-level change. Using data from the Gravity Recovery And Climate Experiment satellite mission, we quantify mass-change trends in 19 continental areas that exhibit a dominant signal. The integrated mass change within these regions is representative of the variation over the whole land areas. During the integer 9-year period of May 2002 to April 2011, GIA-adjusted mass gain and mass loss in these areas contributed, on average, to −(0.7 ± 0.4) mm/year of sea-level fall and + (1.8 ± 0.2) mm/year of sea-level rise; the net effect was + (1.1 ± 0.6) mm/year. Ice melting over Greenland, Iceland, Svalbard, the Canadian Arctic archipelago, Antarctica, Alaska and Patagonia was responsible for + (1.4±0.2) mm/year of the total balance. Hence, land-water mass accumulation compensated about 20 % of the impact of ice-melt water influx to the oceans. In order to assess the impact of geocentre motion, we converted geocentre coordinates derived from satellite laser ranging (SLR) to degree-one geopotential coefficients. We found geocentre motion to introduce small biases to mass-change and sea-level change estimates; its overall effect is + (0.1 ± 0.1) mm/year. This value, however, should be taken with care owing to questionable reliability of secular trends in SLR-derived geocentre coordinates