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Optimal transition from child to adult services involves continuity, joint care, planning meetings and information transfer; commissioners and service providers therefore need data on how many people require that service. Although attention-deficit hyperactivity disorder (ADHD) frequently persists into adulthood, evidence is limited on these transitions.
To estimate the national incidence of young people taking medication for ADHD that require and complete transition, and to describe the proportion that experienced optimal transition.
Surveillance over 12 months using the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveillance System, including baseline notification and follow-up questionnaires.
Questionnaire response was 79% at baseline and 82% at follow-up. For those aged 17–19, incident rate (range adjusted for non-response) of transition need was 202–511 per 100 000 people aged 17–19 per year, with successful transition of 38–96 per 100 000 people aged 17–19 per year. Eligible young people with ADHD were mostly male (77%) with a comorbid condition (62%). Half were referred to specialist adult ADHD and 25% to general adult mental health services; 64% had referral accepted but only 22% attended a first appointment. Only 6% met optimal transition criteria.
As inclusion criteria required participants to be on medication, these estimates represent the lower limit of the transition need. Two critical points were apparent: referral acceptance and first appointment attendance. The low rate of successful transition and limited guideline adherence indicates significant need for commissioners and service providers to improve service transition experiences.
Supplementation with n-3 fatty acids may improve long-term outcomes of renal transplant recipients (RTR). Recent evidence suggests that EPA and DHA have different outcomes compared with α-linolenic acid (ALA). We examined the prospective associations of EPA–DHA and ALA intakes with graft failure and all-cause mortality in 637 RTR. During 3·1 years (interquartile range 2·7, 3·8) of follow-up, forty-one developed graft failure and sixty-seven died. In age- and sex-adjusted analyses, EPA–DHA and ALA intakes were not associated with graft failure. EPA–DHA intake was not significantly associated with mortality (hazard ratio (HR) 0·79; 95% CI 0·54, 1·15 per 0·1 energy% difference). ALA intake was significantly associated with mortality (HR 1·17; 95% CI 1·04, 1·31 per 0·1 energy% difference). This association remained following adjustments for BMI, proteinuria and intakes of fat, carbohydrate and protein. RTR in the highest tertile of ALA intake exhibited about 2-fold higher mortality risk (HR 2·21; 95% CI 1·23, 3·97) compared with the lowest tertile. In conclusion, ALA intake may be associated with increased mortality in RTR. Future RCT are needed to confirm these results.
Background: Facial diplegia with parasthesia (FDP) is a rare variant of Guillain–Barre syndrome (GBS), and has been reported in less than 1% of GBS cohorts. Here we describe a case of FDP with novel imaging findings and discuss the differential diagnosis. Methods: Case: A 39-year-old man referred to the emergency department with a 2 week history of right facial palsy progressed to bilateral facial palsy. His exam demonstrated severe, complete facial diplegia with only very mild limb weakness and present but diminished deep tendon reflexes. Results: Cerebrospinal fluid analysis showed albuminocytologic dissociation. Electromyography was consistent with a demyelinating process. MRI with contrast revealed bilateral enhancement of the facial nerves in the intracanalicular portion and in the region of the geniculate ganglion. A diagnosis of GBS was made and the patient was treated with IVIG. Over the course of several weeks the patient improved. Conclusions: Although nerve root enhancement of the spinal cord is described with GBS, nerve root enhancement effecting cranial nerves has only rarely been described. In addition, the relative limb-sparing with complete facial paralysis in this case is also an unusual phenotype. The Gadolinium enhancement of the bilateral facial nerves is thought to represent blood brain barrier breakdown due to GBS.
This research implements a recently proposed framework for meander migration, in order to explore the coevolution of planform and channel width in a freely meandering river. In the model described here, width evolution is coupled to channel migration through two submodels, one describing bank erosion and the other describing bank deposition. Bank erosion is modelled as erosion of purely non-cohesive bank material damped by natural armouring due to basal slump blocks, and bank deposition is modelled in terms of a flow-dependent rate of vegetal encroachment. While these two submodels are specified independently, the two banks interact through the medium of the intervening channel; the morphodynamics of which is described by a fully nonlinear depth-averaged morphodynamics model. Since both banks are allowed to migrate independently, channel width is free to vary locally as a result of differential bank migration. Through a series of numerical runs, we demonstrate coevolution of local curvature, width and streamwise slope as the channel migrates over time. The correlation between the local curvature, width and bed elevation is characterized, and the nature of this relationship is explored by varying the governing parameters. The results show that, by varying a parameter representing the ratio between a reference bank erosion rate and a reference bank deposition rate, the model is able to reproduce the broad range of river width–curvature correlations observed in nature. This research represents a step towards providing general metrics for predicting width variation patterns in river systems.
The fabrication and performance characteristics of an integrated distributed feedback (DFB) laser and optical amplifier structure are described. The structure utilizes semi-insulating Fe doped InP layers for current confinement to the active region, electrical isolation between the two sections and for lateral index guiding. The amplified output has a slope of 1 mW/mA of laser current with the amplifier biased at 150 mA which is a factor of 5 larger than that for a typical laser. The laser emits near 1.55 μm and the spectral width under modulation of the amplified output is considerably smaller than that for a DFB laser for the same on/off ratio.
We have synthesized Si1−yQy layers and strained layer superlattices on Si (100) with C concentrations of up to a few percent using Solid Source Molecular Beam Epitaxy. The presence of C even in small quantities is known to disrupt the epitaxy of Si. We show that under conditions of high Si flux for a given C/Si flux ratio, defect-free epitaxy results. However, exceeding a critical C/Si flux ratio leads to disruption of epitaxy, initially via twinning and subsequently by amorphous growth. Growth temperature also plays a significant role in preventing twinning and islanding. Low growth temperature also suppresses the precipitation of β-SiC and leads to the formation of pseudomorphic Si1−yQy random alloys. The layers are characterized by X-ray diffraction, Secondary Ion Mass spectroscopy, and Transmission Electron Microscopy. We have also studied the thermal stability of strained layer superlattices and find that the layers are stable to about 800°C (for y = 0.003). Between 800°C and 1000°C, the layers relax by interdiffusion. Above 1000°C, silicon carbide precipitation occurs and the carbide layers nucleate and grow at high C content regions of the film.
We have investigated p-type doping of Si and SiGc layers in M BE by using two different boron sources. One is a SiB alloy which is prepared in situ by melting elemental boron into Si. Typical B concentrations in the source material are a few percent. Doping levels within 1×1018 cm−3 and 5.5×1019 cm−3 can be adjusted within the temperature range of 350°C to 850°C. No indication of segregation or memory effects is found. The activation is between 90 and 100%. The second p-type doping source investigated is a diborane (B2H6) gas source. Diborane provides doping capability in the range between 1016. to 1020. The incorporation efficiency at 550°C is about 2×10'3. It depends on the diborane exposure and the substrate temperature. The activation at 550°C is above 90%. For lower growth temperatures the activation is considerably reduced. The problem of memory effects is discussed.
Monolithic colliding pulse mode-locked (CPM) multiple quantum well lasers
generating optical pulses as short as 600 femtoseconds are reported. The CPM
laser is built on a single chip of InGaAs/InGaAsP multiple quantum well
laser. The pulse repetition rates are synchronized with an rf synthesizer up
to 40 GHz in hybrid mode-locking scheme. In passive mode-locking scheme, a
record high repetition rate of 350 GHz has been achieved. All the
sub-picosecond pulses obtained have pulse shapes of sech2 and
transform-limited timebandwidth products between 0.30 to 0.34. This new
optical source is very useful for ultra-high speed optical switching and
optical logic in optical fibers, and ultra-long distance optical soliton
The integration of high-density CNT bundles as via interconnects in a CNT/Cu-hybrid BEOL stack is evaluated. CNT via-conduits may greatly improve heat dissipation and as such lower interconnect resistance and improve electromigration resistance. Each carbon shell of the nanotube contributes to electrical and thermal conduction and densities as high as 5×1013 shells per cm2 are estimated necessary. CNT growth processes on BEOL compatible metals are presented with tube densities up to 1012cm−2 and shell densities approaching 1013 cm−2 on blanket substrates. Selective growth of CNT bundles with carbon shell densities around 1012cm−2 is demonstrated with high yield. Ohmic behavior of TiN/CNT/Ti contacts is shown with a CNT via resistivity of 1.2 mΩ cm.
Vantage is the third level in a series of specifications of learning objectives developed within the Council of Europe's programme for the promotion of language learning in Europe. The series is intended to offer guidance and support to the many ‘partners for learning’ whose co-operation is necessary to the creation of a coherent and transparent structure of provision for effective learning relevant to the needs of the learners as well as of society, which normally provides the resources. Without setting up bureaucratic mechanisms of control, it provides a series of reference points, common objectives towards the achievement of which all can work independently but in harmony – curriculum planners, examining and qualifying authorities, course designers and materials producers, teacher trainers and last but by no means least the teachers and learners through whose interaction organised learning takes place.
The series is directed towards those – probably the great majority of ordinary language learners – who want to use another language for communication with people who speak it, both for transacting the business of everyday life and for exchanging information and opinions on private life and public affairs.
It therefore sets out to define in some detail what such an objective means in practice: what users of a language are most likely to wish or need to be able to do in the communication situations in which they take part and consequently what they have to know and the skills they have to develop in order to be able to communicate effectively in those situations.
Vantage, like its predecessors Threshold and Waystage, is conceived as a contribution to improved communication, particularly among Europeans of all backgrounds. A communicative approach aims to enable the learners to use a foreign language for their own purposes. What these purposes are, depends on the personality, the circumstances, the needs and interests of the learners themselves. They are never fully predictable, but, starting from a particular target group, however heterogeneous it may be, we can make an attempt to identify those things that all of them are at least very likely to need or wish to be able to do in the foreign language. In order to do this in any useful way we have to try to determine in what situations they are most likely to use the foreign language, what roles they will play in these situations, and what matters they are most likely to have to be able to deal with in the foreign language. Determining all this – especially if we want to arrive at a fairly detailed description – is, in a way, a matter of guesswork. However, we can make at least better educated guesses if we make use of our collective experience, our knowledge of the world, and of whatever amount of consensus would appear to have been – explicitly or implicitly – achieved. In fact, the information on this that is available by now is by no means negligible.
In a different context (Learning to learn, see Chapter 13) we noted that, in addition to enabling the learners to satisfy their estimated needs, a course designed for Vantage will ‘inevitably do other things as well’. Some of these things may (have to) be deliberately planned for in the course. ‘Learning to learn’ is one of these; the acquisition of adequate compensation strategies (see Chapter 12) is another. Other things, however, will automatically follow from the experience of learning for Vantage without any provisions having been made for them in the course offered to the learners and even without their having been explicitly included in the objective concerned. They are simply what we may regard as ‘by-products’ of a successful learning experience. This does not mean to say that they could not figure more centrally, or even be the main concern, of other objectives for foreign language learning with a different orientation from that of the Waystage–Threshold–Vantage series. In the present chapter, by way of exemplification, we shall briefly discuss two of such by-products: literary appreciation and mediation skill.
By ‘literary appreciation’ we mean here ‘the ability to understand literary products and to experience – possibly even to evaluate – their impacts’. In the objective for Vantage, notably in Chapter 9 (Dealing with texts), nothing is said about literary texts. Nor, however, are they explicitly excluded.
In relation to Threshold, Vantage is characterised by a relaxation of constraints. A major constraint at Threshold level is that the ability to deal with written and spoken texts that is expected of learners is related – and confined – to texts relevant to certain specified situations and to certain specified topics (see Threshold 1990, 3.3). At Vantage level the limitation to preselected situations and topics is abandoned (see also Chapter 7), and this means that, in principle, the understanding of texts relevant to any situation and to any topic may be required. Yet, Vantage is an objective for a particular target group – however large this group may be and however heterogeneous its composition – and it is still significantly lower than what is often referred to as ‘near-native level’. Consequently, in describing communicative ability at Vantage level we have to provide criteria for the delimitation of the range of texts that learners may be expected to be able to deal with.
These criteria are contained, explicitly or implicitly, in the following description of the relevant part of the objective:
The learner can understand the gist and relevant details, and identify the communicative intention, of written and of spoken texts which have the following characteristics:
1 they are directed at a readership/audience of average educational development;
2 they have a clear structure, both conceptually and formally;
3 the information contained in them is, on the whole, offered explicitly but may be implicit in transparent cases;
4 their understanding may require some familiarity with common features of the foreign culture;
This appendix is a listing of lexical exponents of specific notions which those concerned with the raising of communicative ability up to Vantage with regard to the ‘themes’ of Threshold might wish to consider. The exponents listed here are not presented as a defined lexical syllabus, nor even as ‘recommended exponents’. They represent stimuli which may be found useful by those involved in the development of theme-related ability to Vantage. Together with the common-core elements listed in Chapters 5 and 6 under ‘language functions’ and ‘general notions’, the lexicon contained in this appendix should provide learners with a significantly more advanced linguistic apparatus for dealing with the themes of most likely general interest to them than was available at Threshold level.
In accordance with its intended role the list presented here is to a large extent open-ended. The majority of the lexical items contained in it are listed as members of open classes, to be reduced, expanded, or otherwise altered as may best suit the needs and interests of the learners. To remind the user of this, they are invariably preceded by e.g. following the general indication of the class. Thus, those wishing some guidance as to which ‘names of birds’ (2.8) to consider for inclusion in a Vantage programme will find those which the authors of the present specification think may be particularly useful to them without, however, wishing to impose any selection on them.