Uses and Abuses of Patient Reported Outcome Measures (PROMs): Potential Iatrogenic Impact of PROMs Implementation and How It Can Be Mitigated

Abstract Having been a national advocate for the use of patient reported outcome measures (PROMs) in Child and Adolescent Mental Health Services (CAMHS) in the UK for the last decade, I have become increasingly concerned that unless the potential iatrogenic impact of widespread policy requirement for use of PROMs (Department of Health, Children and Young People's Health Outcomes Strategy, 2012) is recognised and addressed their real potential benefits (Sapyta et al., J Clin Psychol 61(2):145-153, 2005) may never be realized. Drawing on examples from PROMs implementation in CAMHS in the UK (Wolpert et al., J Ment Health 21(2):165-173, 2012a; Child Adolesc Mental Health 17(3):129-130, 2012b). I suggest key ways forward if PROMs are to support best clinical practice rather than undermine it

Coarse and synthetic Weil-Petersson geometry: quasi-flats, geodesics, and relative hyperbolicity

We analyze the coarse geometry of the Weil-Petersson metric on Teichm\"uller space, focusing on applications to its synthetic geometry (in particular the behavior of geodesics). We settle the question of the strong relative hyperbolicity of the Weil-Petersson metric via consideration of its coarse quasi-isometric model, the "pants graph." We show that in dimension~3 the pants graph is strongly relatively hyperbolic with respect to naturally defined product regions and show any quasi-flat lies a bounded distance from a single product. For all higher dimensions there is no non-trivial collection of subsets with respect to which it strongly relatively hyperbolic; this extends a theorem of [BDM] in dimension 6 and higher into the intermediate range (it is hyperbolic if and only if the dimension is 1 or 2 [BF]). Stability and relative stability of quasi-geodesics in dimensions up through 3 provide for a strong understanding of the behavior of geodesics and a complete description of the CAT(0)-boundary of the Weil-Petersson metric via curve-hierarchies and their associated "boundary laminations."Comment: References added apropos of equivalence of the notion of asymptotically tree-graded and strong relative-hyperbolicity in the sense of Drutu-Sapir. We thank Jason Behrstock for bringing this to our attention. Proof of thickness in higher dimension streamlined, some comments, questions and references adde