What should excellent integrated service delivery feel like and look like from a young person’s point of view? – ‘Don’t treat me like I’m a bother’ (Sharing our experience, Practitioner-led research 2008-2009; PLR0809/096)

Gateshead Young Women’s Outreach Project (GYWOP) offers support, information and empowering learning opportunities for young women, including young mothers, aged 13 to 19. The research team, including peer researchers, worked with young women accessing GYWOP, as well as 58 other services, to ascertain what excellent integrated working practice looks like and feels like for young women. Six focus groups, comprising approximately 30 young women, were involved in the research. The first was peer researchers. Two of the groups consisted of young women who were pregnant, or mothers who were involved in the project as they were not yet ready to move on to other more formal education, employment or training. Another consisted of mothers or expectant mothers who were of statutory school age. Another was made up of young women of statutory school age but not mothers, who either did not attend school or attended very little due to circumstances often related to bullying. The last group consisted of young women, some of whom were mothers, who had issues in their lives, resulting in isolation and low selfesteem. The main findings were as follows. • The importance of the ethos and general environment of the service. This impacts on the engagement of young women and adds to their confidence and general wellbeing, contributing to positive outcomes and progression. • The value of the service and a holistic approach are important, as is ease of access, varied communication methods, a range of social interaction and learning opportunities. • Being treated with respect is paramount. • Perceptions - young women can ‘pick up’ on things that are not necessarily intended - workers need to be extra sensitive and aware of the impact on young women. • It is vital that young women feel that they can trust workers. For young women in care, confidentiality is a serious concern, leading to the feeling that ‘everyone knows their business’. • Young women need to feel in control of what is happening to them and value voluntary engagement with services. • Affirmation by workers has an extremely positive impact, giving feelings of pride and self-worth. The findings will be used to produce awareness-raising interactive training sessions and materials, to be delivere

Tropical Kraus maps for optimal control of switched systems

Kraus maps (completely positive trace preserving maps) arise classically in quantum information, as they describe the evolution of noncommutative probability measures. We introduce tropical analogues of Kraus maps, obtained by replacing the addition of positive semidefinite matrices by a multivalued supremum with respect to the L\"owner order. We show that non-linear eigenvectors of tropical Kraus maps determine piecewise quadratic approximations of the value functions of switched optimal control problems. This leads to a new approximation method, which we illustrate by two applications: 1) approximating the joint spectral radius, 2) computing approximate solutions of Hamilton-Jacobi PDE arising from a class of switched linear quadratic problems studied previously by McEneaney. We report numerical experiments, indicating a major improvement in terms of scalability by comparison with earlier numerical schemes, owing to the "LMI-free" nature of our method.Comment: 15 page

An antigen-driven B-cell response within the salivary glands of patients with Sjögren’s syndrome

Infection with a bacterium or virus induces the production of antibodies, specialised protein molecules that bind to and eliminate the microorganism. These antibodies are produced by B-cells that are stimulated by antigen (any foreign protein or carbohydrate) in the lymph nodes and spleen. During this process, they diversify their variable region genes (V-genes), encoding the antigen-binding region of the antibody, by switching on machinery that mutates the V-genes at a very high rate (somatic hypermutation). In autoimmune diseases, B-cells produce autoantibodies against self-antigens present on the patient's own tissues. Clusters of B- and T-cells are frequently found in the target organs of autoimmune disease. The aim of the work described here was to determine whether these clusters of cells are responding to stimulation by antigen. For this purpose we investigated the B-cell response in patients with an autoimmune disease affecting the salivary and lachrymal glands. By cloning and sequencing the expressed V-genes from indvidual clusters of cells in the salivary glands, we were able to show that the B-cells in these clusters are undergoing clonal proliferation, somatic hypermutation and antigen selection. The presence of similar structures in the target tissues of other autoimmune diseases suggests that this is a widespread phenomenon

'Across the pond'—a response to the NICE guidelines for management of multi-morbidity in older people

No abstract available

Optimisation methods for assisting policy decisions on endemic diseases

Endemic disease of animals is an economic problem as it deprives humans of scarce resources that might otherwise satisfy human wants. Optimisation methods identify the strategies that minimise this economic problem. Given the potentially vast extent of the deprivation, not only in terms of lost wealth but also in terms of animal welfare, human health and environmental damage, this subject offers great benefits to decision-makers from the individual farm to the global level. This paper uses examples to illustrate the basic economic principles concerned. It shows how these principles may be extended to deal with current limitations in theory and practice. Lack of data is a common problem that may be dealt with by using computer simulation, theoretical approaches or the experiential knowledge of the decision-makers themselves. The latter method has the added advantage of greatly assisting with the difficult problem of effectively communicating the results of decision analysis to the decision-maker. In most situations the decision-maker will need to strike a balance between conflicting objectives such as short term profit and long term environmental damage (sustainability). This problem will require a wider perspective, which is greatly facilitated by collaboration between economists and scientists. The paper illustrates ways in which this has been done by using decision analysis methods to focus on the decision rather than the disease. The conclusions highlight priority areas for future research and development in this area. Topics include the contribution of endemic disease control to sustainable development, endemic disease eradication, capturing wider implications such as animal welfare and food safety, accounting for variation in rational decision making and dealing with risk.Economics, decision analysis, optimisation, modelling, endemic disease, knowledge transfer, Health Economics and Policy,