Developing the Children's Measurement Framework : selecting the indicators

The Measurement Frameworks are being developed by the Equality and Human Rights Commission to monitor and evaluate progress towards achieving equality and human rights in Britain. This report documents the next step in their development, to select a set of indicators for children and young people within each of the 10 domains of the Equality Measurement Framework

Evaluation of complex integrated care programmes: the approach in North West London

Background: Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing. This paper sets out the evaluation approach adopted to measure its effect. Study design: We present a mixed methods evaluation methodology. It includes a quantitative approach measuring changes in service utilization, costs, clinical outcomes and quality of care using routine primary and secondary data sources. It also contains a qualitative component, involving observations, interviews and focus groups with patients and professionals, to understand participant experiences and to understand the pilot within the national policy context. Theory and discussion: This study considers the complexity of evaluating a large, multi-organisational intervention in a changing healthcare economy. We locate the evaluation within the theory of evaluation of complex interventions. We present the specific challenges faced by evaluating an intervention of this sort, and the responses made to mitigate against them. Conclusions: We hope this broad, dynamic and responsive evaluation will allow us to clarify the contribution of the pilot, and provide a potential model for evaluation of other similar interventions. Because of the priority given to the integrated agenda by governments internationally, the need to develop and improve strong evaluation methodologies remains strikingly important

Evaluating the design and implementation of the whole systems integrated care programme in North West London: why commissioning proved (again) to be the weakest link

Background: Commissioning is a term used in the English National Health Service (NHS) to refer to what most health systems call health planning or strategic purchasing. Drawing on research from a recent in-depth mixed methods study of a major integrated care initiative in North West London, we examine the role of commissioning in attempts to secure large-scale change within and between health and social care services to support the delivery of integrated care for people living with complex long-term conditions. Methods: We analysed data collected in semi-structured interviews, surveys, workshops and non-participant observations using a thematic framework derived both deductively from the literature on commissioning and integrated care, as well as inductively from our coding and analysis of interview data. Results: Our findings indicate that commissioning has significant limitations in enabling large-scale change in health services, particularly in engaging providers, supporting implementation, and attending to both its transactional and relational dimensions. Conclusions: Our study highlights the consequences of giving insufficient attention to implementation, and especially the need for commissioners to enable, support and performance manage the delivery of procured services, while working closely with providers at all times. We propose a revised version of Øvretveit's cycle of commissioning that gives greater emphasis to embedding effective implementation processes within models of commissioning large-scale change

Reconfigurable Training and Reservoir Computing in an Artificial Spin-Vortex Ice via Spin-Wave Fingerprinting

Strongly-interacting artificial spin systems are moving beyond mimicking naturally-occurring materials to emerge as versatile functional platforms, from reconfigurable magnonics to neuromorphic computing. Typically artificial spin systems comprise nanomagnets with a single magnetisation texture: collinear macrospins or chiral vortices. By tuning nanoarray dimensions we achieve macrospin/vortex bistability and demonstrate a four-state metamaterial spin-system 'Artificial Spin-Vortex Ice' (ASVI). ASVI can host Ising-like macrospins with strong ice-like vertex interactions, and weakly-coupled vortices with low stray dipolar-field. Vortices and macrospins exhibit starkly-differing spin-wave spectra with analogue-style mode-amplitude control and mode-frequency shifts of df = 3.8 GHz. The enhanced bi-textural microstate space gives rise to emergent physical memory phenomena, with ratchet-like vortex training and history-dependent nonlinear fading memory when driven through global field cycles. We employ spin-wave microstate fingerprinting for rapid, scaleable readout of vortex and macrospin populations and leverage this for spin-wave reservoir computation. ASVI performs linear and non-linear mapping transformations of diverse input signals as well as chaotic time-series forecasting. Energy costs of machine learning are spiralling unsustainably, developing low-energy neuromorphic computation hardware such as ASVI is crucial to achieving a zero-carbon computational future

Neuromorphic Few-Shot Learning: Generalization in Multilayer Physical Neural Networks

Neuromorphic computing leverages the complex dynamics of physical systems for computation. The field has recently undergone an explosion in the range and sophistication of implementations, with rapidly improving performance. Neuromorphic schemes typically employ a single physical system, limiting the dimensionality and range of available dynamics - restricting strong performance to a few specific tasks. This is a critical roadblock facing the field, inhibiting the power and versatility of neuromorphic schemes. Here, we present a solution. We engineer a diverse suite of nanomagnetic arrays and show how tuning microstate space and geometry enables a broad range of dynamics and computing performance. We interconnect arrays in parallel, series and multilayered neural network architectures, where each network node is a distinct physical system. This networked approach grants extremely high dimensionality and enriched dynamics enabling meta-learning to be implemented on small training sets and exhibiting strong performance across a broad taskset. We showcase network performance via few-shot learning, rapidly adapting on-the-fly to previously unseen tasks

Experimental evolution of viruses: Microviridae as a model system

φX174 was developed as a model system for experimental studies of evolution because of its small genome size and ease of cultivation. It has been used extensively to address statistical questions about the dynamics of adaptive evolution. Molecular changes seen during experimental evolution of φX174 under a variety of conditions were compiled from 10 experiments comprising 58 lineages, where whole genomes were sequenced. A total of 667 substitutions was seen. Parallel evolution was rampant, with over 50 per cent of substitutions occurring at sites with three or more events. Comparisons of experimentally evolved sites to variation seen among wild phage suggest that at least some of the adaptive mechanisms seen in the laboratory are relevant to adaptation in nature. Elucidation of these mechanisms is aided by the availability of capsid and pro-capsid structures for φX174 and builds on years of genetic studies of the phage life history

Ultrastrong Magnon-Magnon Coupling and Chiral Symmetry Breaking in a 3D Magnonic Metamaterial

Strongly-interacting nanomagnetic arrays are ideal systems for exploring the frontiers of magnonic control. They provide functional reconfigurable platforms and attractive technological solutions across storage, GHz communications and neuromorphic computing. Typically, these systems are primarily constrained by their range of accessible states and the strength of magnon coupling phenomena. Increasingly, magnetic nanostructures have explored the benefits of expanding into three dimensions. This has broadened the horizons of magnetic microstate spaces and functional behaviours, but precise control of 3D states and dynamics remains challenging. Here, we introduce a 3D magnonic metamaterial, compatible with widely-available fabrication and characterisation techniques. By combining independently-programmable artificial spin-systems strongly coupled in the z-plane, we construct a reconfigurable 3D metamaterial with an exceptionally high 16N microstate space and intense static and dynamic magnetic coupling. The system exhibits a broad range of emergent phenomena including ultrastrong magnon-magnon coupling with normalised coupling rates of $\frac{\Delta \omega}{\gamma} = 0.57$ and magnon-magnon cooperativity up to C = 126.4, GHz mode shifts in zero applied field and chirality-selective magneto-toroidal microstate programming and corresponding magnonic spectral control

Processing of positive newborn screening results: a qualitative exploration of current practice in England.

OBJECTIVE: To explore current communication practices for positive newborn screening results from the newborn bloodspot screening (NBS) laboratory to clinicians to highlight differences, understand how the pathways are implemented in practice, identify barriers and facilitators and make recommendations for future practice and research. DESIGN: A qualitative exploratory design was employed using semi-structured interviews. SETTING: Thirteen NBS laboratories in England. PARTICIPANTS: Seventy-one clinicians; 22 NBS laboratory staff across 13 laboratories and 49 members of relevant clinical teams were interviewed. RESULTS: Assurance of quality and consistency was a priority for all NBS laboratories. Findings indicated variation in approaches to communicating positive NBS results from laboratories to clinical teams. This was particularly evident for congenital hypothyroidism and was largely influenced by local arrangements, resources and the fact individual laboratories had detailed standard operating procedures for how they work. Obtaining feedback from clinical teams to the laboratory after the child had been seen could be challenging and time-consuming for those involved. Pathways for communicating carrier results for cystic fibrosis and sickle cell disease could be ambiguous and inconsistent which in turn could hamper the laboratories efforts to obtain timely feedback regarding whether or not the result had been communicated to the family. Communication pathways for positive NBS results between laboratories and clinical teams could therefore be time-consuming and resource-intensive. CONCLUSION: The importance placed on ensuring positive NBS results were communicated effectively and in a timely fashion from the laboratory to the clinical team was evident from all participants. However, variation existed in terms of the processes used to report positive NBS results to clinical teams and the people involved. Variant practice identified may reflect local needs, but more often reflected local resources and a more consistent 'best practice' approach is required, not just in the UK but perhaps globally. TRIAL REGISTRATION NUMBER: ISRCTN15330120

The Genetics of Adaptation for Eight Microvirid Bacteriophages

Theories of adaptive molecular evolution have recently experienced significant expansion, and their predictions and assumptions have begun to be subjected to rigorous empirical testing. However, these theories focus largely on predicting the first event in adaptive evolution, the fixation of a single beneficial mutation. To address long-term adaptation it is necessary to include new assumptions, but empirical data are needed for guidance. To empirically characterize the general properties of adaptive walks, eight recently isolated relatives of the single-stranded DNA (ssDNA) bacteriophage φX174 (family Microviridae) were adapted to identical selective conditions. Three of the eight genotypes were adapted in replicate, for a total of 11 adaptive walks. We measured fitness improvement and identified the genetic changes underlying the observed adaptation. Nearly all phages were evolvable; nine of the 11 lineages showed a significant increase in fitness. However, fitness plateaued quickly, and adaptation was achieved through only three substitutions on average. Parallel evolution was rampant, both across replicates of the same genotype as well as across different genotypes, yet adaptation of replicates never proceeded through the exact same set of mutations. Despite this, final fitnesses did not vary significantly among replicates. Final fitnesses did vary significantly across genotypes but not across phylogenetic groupings of genotypes. A positive correlation was found between the number of substitutions in an adaptive walk and the magnitude of fitness improvement, but no correlation was found between starting and ending fitness. These results provide an empirical framework for future adaptation theory

The current state-of-the-art of spinal cord imaging: methods.

A first-ever spinal cord imaging meeting was sponsored by the International Spinal Research Trust and the Wings for Life Foundation with the aim of identifying the current state-of-the-art of spinal cord imaging, the current greatest challenges, and greatest needs for future development. This meeting was attended by a small group of invited experts spanning all aspects of spinal cord imaging from basic research to clinical practice. The greatest current challenges for spinal cord imaging were identified as arising from the imaging environment itself; difficult imaging environment created by the bone surrounding the spinal canal, physiological motion of the cord and adjacent tissues, and small cross-sectional dimensions of the spinal cord, exacerbated by metallic implants often present in injured patients. Challenges were also identified as a result of a lack of "critical mass" of researchers taking on the development of spinal cord imaging, affecting both the rate of progress in the field, and the demand for equipment and software to manufacturers to produce the necessary tools. Here we define the current state-of-the-art of spinal cord imaging, discuss the underlying theory and challenges, and present the evidence for the current and potential power of these methods. In two review papers (part I and part II), we propose that the challenges can be overcome with advances in methods, improving availability and effectiveness of methods, and linking existing researchers to create the necessary scientific and clinical network to advance the rate of progress and impact of the research