The parent programme implementation checklist (PPIC): the development and testing of an objective measure of skills and fidelity for the delivery of parent programmes

This is the author accepted manuscript. The final version is available from Taylor & Francis via the DOI in this recordBackground: Group-based parent programmes demonstrate positive benefits for adult and child mental health, and child behaviour outcomes. Greater fidelity to the programme delivery model equates to better outcomes for families attending, however, fidelity is typically self-monitored using programme specific checklists. Self-completed measures are open to bias, and it is difficult to know if positive outcomes found from research studies will be maintained when delivered in regular services. Currently, ongoing objective monitoring of quality is not conducted during usual service delivery. This is odd given that quality of other services is assessed objectively, for example by the Office for Standards in Education, Children's Services and Skills (OFSTED). Independent observations of programme delivery are needed to assess fidelity and quality of delivery to ensure positive outcomes, and therefore justify the expense of programme delivery. Methods: This paper outlines the initial development and reliability of a tool, the Parent Programme Implementation Checklist (PPIC), which was originally developed as a simple, brief and generic observational tool for independent assessment of implementation fidelity of group-based parent programmes. PPIC does not require intensive observer training before application/use. This paper presents initial data obtained during delivery of the Incredible Years BASIC programme across nine localities in England and Wales, United Kingdom (UK). Results: Reasonable levels of inter-rater reliability were achieved across each of the three subscales (Adherence, Quality and Participant Responsiveness) and the overall total score when applying percentage agreements (>70%) and intra-class correlations (ICC) (ICC range between 0.404 and 0.730). Intra-rater reliability (n = 6) was acceptable at the subscale level. Conclusions: We conclude that the PPIC has promise, and with further development could be utilised to assess fidelity of parent group delivery during research trials and standard service delivery. Further development would need to include data from other parent programmes, and testing by non-research staff. The objective assessment of quality of delivery would inform services where improvements could be made.This research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care – Yorkshire and Humber, and South West Peninsula

Real estate investment and urban density: Exploring the polycentric urban region using a topological lens

Focusing on commercial office real estate as both a manifestation of and a conduit of cross-border capital flows, this paper refers to the concepts of topology and topography in a theoretical and empirical exploration of contemporary ‘network economy’ spatial implications for the ‘polycentric urban region’ (PUR). A body of research has cast doubt on the normative European representation of the multi-centre PUR as a balanced, sustainable spatial development model. Yet, the model has continued to be propagated in European territorial strategy and has been influential internationally. Academic perspectives and qualitative evidence reviewed in the paper shed a light on mutual dependencies and recursive relations between network economy global structural processes, international office real estate investment practices mediated by city governments, and the spatial configuration of density. Commercial investment and city planning actor practices chime with urban agglomeration, spatial concentration and density. Quantitative evidence of associations between urban density and office real estate investment returns and capital flows is found. It is concluded that network economy topology, politics and the city are in a dialectical relationship with the PUR territorial governance agenda for spatially balanced regional development

The Emergence of HIV Transmitted Resistance in Botswana: “When Will the WHO Detection Threshold Be Exceeded?”

BACKGROUND: The Botswana antiretroviral program began in 2002 and currently treats 42,000 patients, with a goal of treating 85,000 by 2009. The World Health Organization (WHO) has begun to implement a surveillance system for detecting transmitted resistance that exceeds a threshold of 5%. However, the WHO has not determined when this threshold will be reached. Here we model the Botswana government's treatment plan and predict, to 2009, the likely stochastic evolution of transmitted resistance. METHODS: We developed a model of the stochastic evolution of drug-resistant strains and formulated a birth-death Master equation. We analyzed this equation to obtain an analytical solution of the probabilistic evolutionary trajectory for transmitted resistance, and used treatment and demographic data from Botswana. We determined the temporal dynamics of transmitted resistance as a function of: (i) the transmissibility (i.e., fitness) of the drug-resistant strains that may evolve and (ii) the rate of acquired resistance. RESULTS: Transmitted resistance in Botswana will be unlikely to exceed the WHO's threshold by 2009 even if the rate of acquired resistance is high and the strains that evolve are half as fit as the wild-type strains. However, we also found that transmission of drug-resistant strains in Botswana could increase to ∼15% by 2009 if the drug-resistant strains that evolve are as fit as the wild-type strains. CONCLUSIONS: Transmitted resistance will only be detected by the WHO (by 2009) if the strains that evolve are extremely fit and acquired resistance is high. Initially after a treatment program is begun a threshold lower than 5% should be used; and we advise that predictions should be made before setting a threshold. Our results indicate that it may be several years before the WHO's surveillance system is likely to detect transmitted resistance in other resource-poor countries that have significantly less ambitious treatment programs than Botswana

Live attenuated HIV vaccines: Predicting the tradeoff between efficacy and safety

The utility of live attenuated vaccines for controlling HIV epidemics is being debated. Live attenuated HIV vaccines (LAHVs) could be extremely effective in protecting against infection with wild-type strains, but may not be completely safe as the attenuated strain could cause AIDS in some vaccinated individuals. We present a theoretical framework for evaluating the consequences of the tradeoff between vaccine efficacy (in terms of preventing new infections with wild-type strains) and safety (in terms of vaccine- induced AIDS deaths). We use our framework to predict, for Zimbabwe and Thailand, the epidemiological impact of 1,000 different (specified by efficacy and safety characteristics) LAHVs. We predict that paradoxically: (i) in Zimbabwe (where transmission is high) LAHVs would significantly decrease the AIDS death rate, but (ii) in Thailand (where transmission is low) exactly the same vaccines (in terms of efficacy and safety characteristics) would increase the AIDS death rate. Our results imply that a threshold transmission rate exists that determines whether any given LAHV has a beneficial or a detrimental impact. We also determine the vaccine perversity point, which is defined in terms of the fraction of vaccinated individuals who progress to AIDS as a result of the vaccine strain. Vaccination with any LAHV that causes more than 5% of vaccinated individuals to progress to AIDS in 25 years would, even 50 years later, lead to perversity (i.e., increase the annual AIDS death rate) in Thailand; these same vaccines would lead to decreases in the annual AIDS death rate in Zimbabwe.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/83498/1/PNAS-sb.pd

Supporting smart urban growth: successful investing in density

This report analyses the characteristics of ‘good density’ and begins to quantify the relation-ship between these characteristics, investor returns, and carbon emissions. We found that cities with good density – that is, dense development thoughtfully designed to promote a high quality of life – are likely to be more resilient and prosperous in the long term, and there-fore more likely to provide sustainable returns for investors, than cities without good density. Based on a quantitative analysis of 63 global cities, the report finds that cities with good density are associated with higher returns, capital values, and levels of investment flows for commercial real estate. The research provides evidence of important issues for the long-term resilience of cities both in the OECD and in fast-growing developing regions

Enhancing Social-Emotional Health and Wellbeing in the Early Years (E-SEE): A study protocol of a community-based randomised controlled trial with process and economic evaluations of the incredible years infant and toddler parenting programmes, delivered in a proportionate universal model

This is the final version. Available from the publisher via the DOI in this record.Introduction: Behavioural and mental disorders have become a public health crisis and by 2020 may surpass physical illness as a major cause of disability. Early prevention is key. Two Incredible Years (IY) parent programmes that aim to enhance child well-being and development, IY Infant and IY Toddler, will be delivered and evaluated in a proportionate universal intervention model called Enhancing Social-Emotional Health and Wellbeing in the Early Years (E-SEE) Steps. The main research question is: Does E-SEE Steps enhance child social emotional well-being at 20 months when compared with services as usual? Methods and analysis: E-SEE Steps will be delivered in community settings by Early Years Children's Services and/or Public Health staff across local authorities. Parents of children aged 8 weeks or less, identified by health visitors, children's centre staff or self-referral, are eligible for participation in the trial. The randomisation allocation ratio is 5:1 (intervention to control). All intervention parents will receive an Incredible Years Infant book (universal level), and may be offered the Infant and/or Toddler group-based programme/s - based on parent depression scores on the Patient Health Questionnaire or child social emotional well-being scores on the Ages and Stages Questionnaire: Social Emotional, Second Edition (ASQ:SE-2). Control group parents will receive services as usual. A process and economic evaluation are included. The primary outcome for the study is social emotional well-being, assessed at 20 months, using the ASQ:SE-2. Intention-to-treat and per protocol analyses will be conducted. Clustering and hierarchical effects will be accounted for using linear mixed models. Ethics and dissemination: Ethical approvals have been obtained from the University of York Education Ethics Committee (ref: FC15/03, 10 August 2015) and UK NHS REC 5 (ref: 15/WA/0178, 22 May 2015. The current protocol is Version 9, 26 February 2018. The sponsor of the trial is the University of York. Dissemination of findings will be via peer-reviewed journals, conference presentations and public events.National Institute for Health Research (NIHR

Psychometric Properties of Parent-Child (0-5 years) Interaction Outcome Measures as Used in Randomized Controlled Trials of Parent Programs: A Systematic Review.

This systematic review sought to identify observational measures of parent-child interactions commonly implemented in parenting program research, and to assess the level of psychometric evidence available for their use with this age group. Two separate searches of the same databases were conducted; firstly, to identify eligible instruments, and secondly to identify studies reporting on the psychometric properties of the identified measures. Five commercial platforms hosting 19 electronic databases were searched from their inception to conducted search dates. Fourteen measures were identified from Search 1; a systematic search of randomized controlled trial evaluations of parenting programs. For Search 2, inclusion/exclusion criteria were applied to 1327 retrieved papers that described the development and/or validation of the 14 measures identified in Search 1. Seventeen articles met the inclusion criteria, resulting in five observational measures for the final review. Data were extracted and synthesized using the COSMIN rating system to describe the methodological quality of each article alongside the overall quality rating of the psychometric property reported for each measure using the Terwee checklist. Measure reliability was categorized into four domains (internal consistency, test-re-test, inter-rater, and intra-rater). Measure validity was categorized into four domains (content, structural, convergent/divergent, and discriminant). Results indicated that the majority of psychometric evidence related to children aged from birth the three with internal consistency, inter-rater reliability, and structural validity the most commonly reported properties, although this evidence was often weak. The findings suggest further validation of the included measures is required to establish acceptability for the whole target age group

Barriers and facilitators in the delivery of a proportionate universal parenting program model (E-SEE Steps) in community family services

This is the final version. Available on open access from Public Library of Science via the DOI in this recordData Availability: The E-SEE data sharing plan follows a controlled access model as described in Good Practice Principles for Sharing Individual Participant Data from Publicly Funded Clinical Trials. Qualitative data is contained within the paper and the accompanying Supporting Information. Anonymized quantitative data is available upon request via the ‘Research Data York’ data repository: https://doi.org/10.15124/41fd35ba-bd9c-4c2f-bb50-c8c92b8661ee. To request access to this dataset please email Research Data York repository at [email protected]. Sharing of this data set will be subject to the completion of a data access request form and, if approved, subject to a data sharing agreement, due to: a) Data containing potentially sensitive participant information such as mental health and domestic violence. b) Ethical concerns around using the data in a way that is not consistent with the PIS, e.g. for research that does not have ethical approval. Data requests will be reviewed by a 'data access committee' which will include members of the trial management team and independent members from ARC-YH Best Start Steering Committee. A data sharing agreement will be required to ensure data is used in accordance with the trial funder, and ethical guidelines.Background A proportionate universal (PU) approach to early years’ service provision has been advocated to improve children’s health and development and to reduce health inequality, by ensuring that services provide timely and high-quality parenting support commensurate with need. Process-oriented research is critical to examine the factors that contribute to, or hinder, the effective delivery/implementation of such a model in community-based family services. This study aimed to assess the delivery, acceptability and feasibility of a new PU parenting intervention model (called E-SEE Steps), using the Incredible Years® (IY) parent program, when delivered by trained health/family service staff in three “steps”—one universal step (the IY Babies Book), and two targeted steps (group-based IY Infant and Toddler programs). Methods An embedded mixed-methods process evaluation within a pragmatic parallel two-arm, assessor blinded, randomized controlled trial was conducted in community services in four local authorities in England. The process evaluation used qualitative data gathered via interviews and focus groups with intervention arm parents who were offered the targeted steps (n = 29), practitioners (n = 50), service managers (n = 7) and IY program mentors (n = 3). This was supplemented by quantitative data collected using group leader pre-training (n = 50) and post-delivery (n = 39) questionnaires, and research notes of service design decisions. Results The E-SEE Steps model was acceptable to most parents, particularly when it was accompanied by engagement strategies that supported attendance, such as providing childcare. Practitioners also highlighted the positive development opportunities provided by the IY training and supervision. However, participant views did not support the provision of the IY Babies book as a standalone universal component, and there were barriers to eligible parents—particularly those with low mood—taking up the targeted programs. Service providers struggled to align the PU model with their commissioned service contracts and with their staff capacity to engage appropriate parents, including tackling common barriers to attendance. Conclusions Despite general enthusiasm and support for delivering high-quality parenting programs in community services in the England, several barriers exist to successfully delivering IY in a proportionate universal model within current services/systems.National Institute for Health Research (NIHR

Studies of copper trafficking in a mouse model of Alzheimer's disease by positron emission tomography: comparison of Cu-64 acetate and (64)CuGTSM

Alzheimer's disease can involve brain copper dyshomeostasis. We aimed to determine the effect of AD-like pathology on 64Cu trafficking in mice, using positron emission tomography (PET imaging), during 24 hours after intravenous administration of ionic 64Cu (Cu(II) acetate) and 64Cu-GTSM (GTSMH2 = glyoxalbis(thiosemicarbazone)). Copper trafficking was evaluated in 6–8-month-old and 13–15 month-old TASTPM transgenic and wild-type mice, by imaging 0–30 min and 24–25 h after intravenous administration of 64Cu tracer. Regional 64Cu distribution in brains was compared by ex vivo autoradiography to that of amyloid-β plaque. 64Cu-acetate showed uptake in, and excretion through, liver and kidneys. There was minimal uptake in other tissues by 30 minutes, and little further change after 24 h. Radioactivity within brain was focussed in and around the ventricles and was significantly greater in younger mice. 64CuGTSM was taken up in all tissues by 30 min, remaining high in brain but clearing substantially from other tissues by 24 h. Distribution in brain was not localised to specific regions. TASTPM mice showed no major changes in global or regional 64Cu brain uptake compared to wildtype after administration of 64Cu acetate (unlike 64Cu-GTSM) but efflux of 64Cu from brain by 24 h was slightly greater in 6–8 month-old TASTPM mice than in wildtype controls. Changes in copper trafficking associated with Alzheimer's-like pathology after administration of ionic 64Cu are minor compared to those observed after administration of 64Cu-GTSM. PET imaging with 64Cu could help understand changes in brain copper dynamics in AD and underpin new clinical diagnostic imaging methods