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Mental health services in the UK National Health Service have evolved to include primary-care generalist, secondary-care generalist and secondary-care specialist services. We argue that there continues to be an important role for the secondary-care generalists as they minimise interfaces, can live with diagnostic uncertainty and support continuity of care. The lack of commissioning and clinical boundaries in secondary-care generalist services can undermine their feasibility, leading to difficulties recruiting and retaining staff. There is a risk of a polo-mint service, where the specialist services on the edge are well resourced, but the secondary-care generalist services taking the greatest burden struggle to recruit and retain clinicians. We need to establish equity in resources and expectations between generalist and specialist mental health services.
Background:ATP8A2 mutations have only recently been associated with human disease. We present the clinical features from the largest cohort of patients with this disorder reported to date. Methods: An observational study of 9 unreported and 2 previously reported patients with biallelic ATP8A2 mutations was carried out at multiple centres. Results: The mean age of the cohort was 9.4 years old (range: 2.5-28 yrs). All patients demonstrated developmental delay, severe hypotonia and movement disorders: chorea/choreoathetosis (100%), dystonia (27%) or facial dyskinesia (18%). Hypotonia was apparent at birth (70%) or before 6 months old (100%). Optic atrophy was observed in 75% of patients who had a funduscopic examination. MRI of the brain was normal for most patients with a small proportion showing mild cortical atrophy (30%), delayed myelination (20%) and/or hypoplastic optic nerves (20%). Epilepsy was seen in two older patients. Conclusions:ATP8A2 gene mutations have emerged as a cause of a novel phenotype characterized by developmental delay, severe hypotonia and hyperkinetic movement disorders. Optic atrophy is common and may only become apparent in the first few years of life, necessitating repeat ophthalmologic evaluation. Early recognition of the cardinal features of this condition will facilitate diagnosis of this disorder.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
There are roughly 25 very metal-poor (VMP; [Fe/H] < -2.0), highly r-process-enhanced (‘r-II’; [Eu/Fe] > + 1.0) stars currently known, discovered over the past 20+ years. These stars provide nearly pure signatures of r-process events early in the Galactic history. We are conducting a high-resolution follow-up survey of RAVE and other bright targets to identify a total of > 100 r-II stars. Our pilot runs on the du Pont 2.5-m at Las Campanas Observatory and the ARC 3.5-m at Apache Point Observatory have already identified up to fourteen new r-II stars. We are continuing our high-resolution follow-up efforts to constrain the astrophysical site(s) and nature of the r-process.
We are using SPH to model the evolution of triaxial molecular cores to investigate the fragmentation of these cores and the possible production of multiple systems. Molecular cores appear to be triaxial in shape and this may have a significant effect on their evolution as they collapse to form filament-like structures which can then fragment into multiple 'protostars'.
In 1988, a Joint Commission (9 and 25) meeting on the causes of the well-known limitations on the precision of infrared astronomy led to several suggestions to improve matters (see Milone 1989). These included better reporting of the photometric systems in use by practitioners, redesign of the infrared passbands to be more optimally placed inside the atmospheric windows, and development of a method to ascertain the water vapor content of the atmosphere when the astronomical infrared measurements were being made. An Infrared Astronomy Working Group was formed to look into the matter. Advice and suggestions were solicited from the community at large. All who volunteered information became, de facto, members of the Working Group. A small subgroup composed of Andrew Young, Chris Stagg, and Milone set to work on the central of the recommendations: improvement of the passbands. Young, Milone, k Stagg (1994) (hereafter YMS) summarized the work: existing JHKLMN and Q infrared passbands were found to be both far from standardized, and all too frequently defined, to various degrees, by the water vapor and other components of the terrestrial atmosphere. Following extensive numerical simulations with a MODTRAN 3 terrestrial-atmospheres model package, and Kurucz stellar atmospheres, we suggested a set of improved infrared passbands designed explicitly to fit within, and not be defined by, the terrestrial atmospheric windows; however, we sought to optimize them so as to get the maximum throughput consistent with plausible limitations on precision of manufacture of the filters. In 1995 and again in 1997, a number of improvements were made in the code with which the improved passbands were designed. While they do not much affect the optimization trials and thus the passband recommendations, they have been used to extend the modeling.
The use of underground geological repositories, such as in radioactive waste disposal (RWD) and in carbon capture (widely known as Carbon Capture and Storage; CCS), constitutes a key environmental priority for the 21st century. Based on the identification of key scientific questions relating to the geophysics, geochemistry and geobiology of geodisposal of wastes, this paper describes the possibility of technology transfer from high-technology areas of the space exploration sector, including astrobiology, planetary sciences, astronomy, and also particle and nuclear physics, into geodisposal. Synergies exist between high technology used in the space sector and in the characterization of underground environments such as repositories, because of common objectives with respect to instrument miniaturization, low power requirements, durability under extreme conditions (in temperature and mechanical loads) and operation in remote or otherwise difficult to access environments.
In nerve and muscle regeneration applications, the incorporation of conducting elements into biocompatible materials has gained interest over the last few years, as it has been shown that electrical stimulation of some regenerating cells has a positive effect on their development. A variety of different materials, ranging from graphene to conducting polymers, have been incorporated into hydrogels and increased conductivities have been reported. However, the majority of conductivity measurements are performed in a dry state, even though material blends are designed for applications in a wet state, in vivo environment. The focus of this work is to use polypyrrole nanoparticles to increase the wet–state conductivity of alginate to produce a conducting, easily processable, cell–supporting composite material. Characterization and purification of the conducting polymer nanoparticle dispersions, as well as electrochemical measurements, have been performed to assess conductivity of the nanoparticles and hydrogel composites in the wet state, in order to determine whether filling an ionically conducting hydrogel with electrically conductive nanoparticles will enhance the conductivity. It was determined that the introduction of spherical nanoparticles into alginate gel does not increase, but rather slightly reduces conductivity of the hydrogel in the wet state.
We must begin with names. ‘Tony Edwards’ is the person to whom this volume is dedicated, but it is not a name that everyone will immediately recognize, particularly those who know him only from his published work, for he has made himself known in public, from the first, as A. S. G. Edwards. When he began his career, this was the manner in which most scholars, most men at least, named themselves. Fashions have changed, and given names, one, two, or more, are now almost universal. But Tony has held on tenaciously to his initials, perhaps because he has three of them. We do not believe that he did so in any spirit of emulation of or desire to align himself with ‘Edwards A. S. G.’, the Edwards Active Strain Gauge well known to Google, an advanced form of technical engineering equipment which guarantees the vacuum conditions needed for the manufacture of certain precision instruments, such as aircraft engine turbine blades. It seems strangely apt as an analogous form of ‘A. S. G.’, whether one thinks of the ‘active strain’ involved as what he exerts upon himself or upon other people. The analogy fails, of course, when one comes to the creation of vacuum, where it works back to front, for Tony's work has essentially been to fill the vacuum that once existed in the study of manuscript history.