Changes in the attitudes of GPs to health screening of patients with learning disabilities

GP's appear reluctant to undertake health screening for people with learning disabilities. This article describes a specialist health screening service delivered mainly by community learning disability nurses to nearly 600 children and adults. Prior to the service being established, 141 GPs within a defined area were surveyed and 51% responded. Although a majority thought the service would be helpful, three-quarters felt it was better provided within the context of specialist services. After screening, 54% of the sample (318 persons) were referred to their GP for further assessment and treatment, nearly all for physoical health needs. A second study investigated the attitudes of 91 GPs who had patients refrrered. Those (45) who reported dealing with a referral were more favourably disposed to undertaking health screening within their practice, whereas those (23) who had been uninvolved continued to opt for specialist provision. Options for encouraging more GPs' to offer preventive health care to theisclient group are discussed, including medical training, extra consulting time and linking community learning disbaility nurses with GP practices.

Psychological problems in children with cerebral palsy: A cross-sectional European study

Objectives: To describe psychological symptoms in 8–12-year-old children with cerebral palsy; to investigate predictors of these symptoms and their impact on the child and family.

Design: A cross-sectional multi-centre survey.

Participants: Eight hundred and eighteen children with cerebral palsy, aged 8–12 years, identified from population-based registers of cerebral palsy in eight European regions and from multiple sources in one further region.

Main outcome measures: The Strengths and Difficulties Questionnaire (SDQ)P4-16 and the Total Difficulties Score (TDS) dichotomised into normal/borderline (TDS = 16) versus abnormal (TDS > 16).

Statistical analysis: Multilevel, multivariable logistic regression to relate the presence of psychological symptoms to child and family characteristics.

Results: About a quarter of the children had TDS > 16 indicating significant psychological symptoms, most commonly in the domain Peer Problems. Better gross motor function, poorer intellect, more pain, having a disabled or ill sibling and living in a town were independently associated with TDS > 16. The risk of TDS > 16 was odds ratio (OR) = .2 (95% CI: .1 to .3) comparing children with the most and least severe functional limitations; OR = 3.2 (95%CI: 2.1 to 4.8) comparing children with IQ < 70 and others; OR = 2.7 (95% CI: 1.5 to 4.6) comparing children in severe pain and others; OR = 2.7 (95% CI:1.6 to 4.6) comparing children with another disabled sibling or OR = 1.8 (95%CI: 1.2 to 2.8) no siblings and others; OR = 1.8 (95% CI: 1.1 to 2.8) comparing children resident in a town and others. Among parents who reported their child to have psychological problems, 95% said they had lasted over a year, 37% said they distressed their child and 42% said they burdened the family at least ‘quite a lot’.

Conclusions: A significant proportion of children with cerebral palsy have psychological symptoms or social impairment sufficiently severe to warrant referral to specialist services. Care must be taken in the assessment and management of children with cerebral palsy to ensure psychological problems are not overlooked and potentially preventable risk factors like pain are treated effectively. The validity of the SDQ for children with severe disability warrants further assessment.

Flexible Natural Language Generation in Multiple Contexts

We present a practical approach to Natural Language Generation (NLG) for spoken dialogue systems. The approach is based on small template fragments (mini-templates). The system’s object architecture facilitates generation of phrases across pre-defined business domains and registers, as well as into different languages. The architecture simplifies NLG in well-understood application contexts, while providing the flexibility for a developer and for the system, to vary linguistic output according to dialogue context, including any intended affective impact. Mini-templates are used with a suite of domain term objects, resulting in an NLG system (MINTGEN – MINi-Template GENerator) whose extensibility and ease of maintenance is enhanced by the sparsity of information devoted to individual domains. The system also avoids the need for specialist linguistic competence on the part of the system maintainer.

The prevalence of nonadherence in difficult asthma

Rationale: With the advent of new and expensive therapies for severe refractory asthma, targeting the appropriate patients is important. An important issue is identifying nonadherence with current therapies. The extent of nonadherence in a population with difficult asthma has not been previously reported.

Objectives: To examine the prevalence of nonadherence to corticosteroid medication in a population with difficult asthma referred to a Specialist Clinic and to examine the relationship of poor adherence to asthma outcome.

Methods: General practitioner prescription refill records for the previous 6 months for inhaled combination therapy and short-acting ß-agonists were compared with initial prescriptions and expressed as a percentage. Blood plasma prednisolone and cortisol assay levels were used to examine the utility of these measures in assessing adherence to oral prednisolone. Patient demographics, hospital admissions, lung function, oral prednisolone courses, and quality of life data were analyzed to indentify the variables associated with reduced medication adherence.

Measurements and Main Results: A total of 182 patients were assessed. Sixty-three patients (35%) filled 50% or fewer inhaled medication prescriptions; 88% admitted poor adherence with inhaled therapy after initial denial. Twenty-one percent of patients filled more than 100% of presciptions, and 45% of subjects filled between 51 and 100% of prescriptions. Twenty-three of 51 patients (45%) prescribed oral steroids were found to be nonadherent.

Conclusions: A significant proportion of patients with difficult-to-control asthma remained nonadherent to corticosteroid therapy. Objective surrogate and direct measures of adherence should be performed as part of a difficult asthma assessment and are important before prescibing expensive novel biological therapies.

Tooth loss and implant outcomes in patients refractory to treatment in a periodontal practice

Aim: The aim of this study was to investigate the factors associated with continued significant tooth loss due to periodontal reasons during maintenance following periodontal therapy in a specialist periodontal practice in Norway.
Material and Methods: A case-control design was used. Refractory cases were patients who lost multiple teeth during a maintenance period of 13.4 (range 8-19) years following definitive periodontal treatment in a specialist practice. Controls were age- and gender-matched maintenance patients from the same practice. Characteristics and treatment outcomes were assessed, and all teeth classified as being lost due to periodontal disease during follow-up were identified. The use of implants in refractory cases and any complications relating to such a treatment were recorded.
Results: Only 27 (2.2%) patients who received periodontal treatment between 1986 and 1998 in a specialist practice met the criteria for inclusion in the refractory to treatment group. Each refractory subject lost 10.4 (range 4-16) teeth, which represented 50% of the teeth present at baseline. The rate of tooth loss in the refractory group was 0.78 teeth per year, which was 35 times greater than that in the control group. Multivariate analysis indicated that being in the refractory group was predicted by heavy smoking (p=0.026), being stressed (p=0.016) or having a family history of periodontitis (p=0.002). Implants were placed in 14 of the refractory patients and nine (64%) of these lost at least one implant. In total, 17 (25%) of the implants placed in the refractory group were lost during the study period.
Conclusions: A small number of periodontal maintenance patients are refractive to treatment and go on to experience significant tooth loss. These subjects also have a high level of implant complications and failure. Heavy smoking, stress and a family history of periodontal disease were identified as factors associated with a refractory outcome.

Refractory asthma in the UK: cross-sectional findings from a UK multicentre registry

Introduction: Refractory asthma represents a significant unmet clinical need where the evidence base for the assessment and therapeutic management is limited. The British Thoracic Society (BTS) Difficult Asthma Network has established an online National Registry to standardise specialist UK difficult asthma services and to facilitate research into the assessment and clinical management of difficult asthma.
Methods: Data from 382 well characterised patients, who fulfilled the American Thoracic Society definition for refractory asthma attending four specialist UK centres—Royal Brompton Hospital, London, Glenfield Hospital, Leicester, University Hospital of South Manchester and Belfast City Hospital—were used to compare patient demographics, disease characteristics and healthcare utilisation.
Results: Many demographic variables including gender, ethnicity and smoking prevalence were similar in UK centres and consistent with other published cohorts of refractory asthma. However, multiple demographic factors such as employment, family history, atopy prevalence, lung function, rates of hospital admission/unscheduled healthcare visits and medication usage were different from published data and significantly different between UK centres. General linear modelling with unscheduled healthcare visits, rescue oral steroids and hospital admissions as dependent variables all identified a significant association with clinical centre; different associations were identified when centre was not included as a factor.
Conclusion: Whilst there are similarities in UK patients with refractory asthma consistent with other comparable published cohorts, there are also differences, which may reflect different patient populations. These differences in important population characteristics were also identified within different UK specialist centres. Pooling multicentre data on subjects with refractory asthma may miss important differences and potentially confound attempts to phenotype this population.

Annotating an Oral Corpus using the Text Encoding Initiative. Methodology, Problems, Solutions

The objective of this paper is to describe and evaluate the application of the Text Encoding Initiative (TEI) Guidelines to a corpus of oral French, this being the first corpus of oral French where the TEI has been used. The paper explains the purpose of the corpus, both in creating a specialist corpus of néo-contage that will broaden the range of oral corpora available, and, more importantly, in creating a dataset to explore a variety of oral French that has a particularly interesting status in terms of factors such as conception orale/écrite, réalisation médiale and comportement communicatif (Koch and Oesterreicher 2001). The linguistic phenomena to be encoded are both stylistic (speech and thought presentation) and syntactic (negation, detachment, inversion), and all represent areas where previous research has highlighted the significance of factors such as medium, register and discourse type, as well as a host of linguistic factors (syntactic, phonetic, lexical). After a discussion of how a tagset can be designed and applied within the TEI to encode speech and thought presentation, negation, detachment and inversion, the final section of the paper evaluates the benefits and possible drawbacks of the methodology offered by the TEI when applied to a syntactic and stylistic markup of an oral corpus.

Critical reading of science-based news reports: Establishing a knowledge skills and attitudes framework

A recognised aim of science education is to promote critical engagement with science in the media. Evidence would suggest that this is challenging for both teachers and pupils and that at science education does not yet adequately prepare young people for this task. Furthermore, in the absence of clear guidance as to what this means and how this may be achieved it is difficult for teachers to develop approaches and resources that address the matter and that systematically promote such critical engagement within their teaching programmes. Twenty-six individuals with recognised expertise or interest in science in the media, drawn from a range of disciplines and areas of practice, constituted a specialist panel in this study. The question this research sought to answer was ‘what are the elements of knowledge, skill and attitude which underpin critical reading of science based news reports’? During in-depth individual interviews the panel were asked to explore what they considered to be essential elements of knowledge, skills and attitude which people need to enable them to respond critically to news reports with a science component. Analysis of the data revealed fourteen fundamental elements which together contribute to an individual’s capacity to engage critically with science-based news. These are classified in five categories ‘knowledge of science’, ‘knowledge of writing and language’, ‘knowledge about news, newspapers and journalism’, ‘skills’ and ‘attitudes’. Illustrative profiles of each category along with indicators of critical engagement are presented. The implications for curriculum planning and pedagogy are considered.

Harnessing the slipstream: building educational research capacity in Northern Ireland. Size matters

Northern Ireland is uniquely distinguished from England, Scotland and Wales, by being a society in transition, emerging from a prolonged period of civil conflict and political instability that has affected its infrastructure and has increased the need for co-ordinated and specialist research. The paper traces some of the systemic challenges and opportunities for educational research capacity-building that arise from Northern Ireland being uniquely positioned as a small polity and critically appraises how initiatives elsewhere, while providing valuable exemplars, are unlikely to transfer readily to this context. Rather, building on an expanded definition of research capacity, Northern Ireland needs to capitalize cautiously on the current climate of openness between policymaker and researcher communities to develop a shared, cohesive agenda, improve research support and harness the strengths and pockets of excellence that exist. All of these should simultaneously go towards meeting local priority research needs, addressing the developmental capacity building needs of local researcher, while at the same time contributing to local, national and international knowledge production.

‘Child Care (Amendment) Bill 2009—An attempt to arbitrate on a system’s logic.’

The Child Care (Amendment) Bill was passed by the Seanad on 6th May 2010 and will shortly be enacted as legislation as the Child Care (Amendment) Act, 2010. The Bill, consisting of six Parts amends existing legislation relating to secure or ‘special care’ and makes some further amendments to the Child Care Act, 1991. The Act also provides for the dissolution of the Children Acts Advisory Board, a statutory body established in 2003, whose function was to advise the Minister on policy relating to specialist residential services (specifically Special Care Units) . This article examines the provisions of the Child Care Bill (2009) setting these in the context of current policy and previous legislation. It outlines that while the legislation outlines a detailed process for the application and administration of Special Care Orders, the provisions are weakened by the removal of external oversight mechanisms and the limitations placed on the role of the Guardian ad Litem.

Time-resolved studies of ultrafast wavepacket dynamics in hydrogen molecules

Recent advances in the study of quantum vibrations and rotations in the fundamental hydrogen molecules are reported. Using the deuterium molecules (D-2(+) and D-2) as exemplars, the application of ultrafast femtosecond pump-probe experiments to study the creation and time-resolved imaging of coherent nuclear wavepackets is discussed. The ability to study the motion of these fundamental molecules in the time-domain is a notable milestone, made possible through the advent of ultrashort intense laser pulses with durations on sub-vibrational (and sub-rotational) timescales. Quantum wavepacket revivals are characterised for both vibrational and rotational degrees of freedom and quantum models are used to provide a detailed discussion of the underlying ultrafast physical dynamics for the specialist and non-specialist alike. (C) 2009 Elsevier B.V. All rights reserved.

On the Sources of Private Information in FX Markets

We investigate the source of information advantage in inter-dealer FX trading using data on trades and counterparty identities. In liquid dollar exchange rates, information is concentrated among dealers that trade most frequently and specialize their activity in a particular rate. In cross-rates, traders that engage in triangular arbitrage are best informed. Better-informed traders are also located on larger trading floors. In cross-rates, the ability to forecast flows explains all of the advantage of the triangular arbitrageurs. In liquid dollar rates, specialist traders can forecast both order flow and the component of exchange rate changes that is uncorrelated with flow.

An evaluation of a domiciliary blood transfusion serivce for palliative care patients in Northern Ireland

Marie Curie Cancer Care (MCCC) is a national charitable organisation which provides specialist palliative care services to patients with cancer and other life limiting illnesses. Marie Curie Nursing Service (MCNS) provides nursing services to patients in their own homes. The administration of blood transfusions to palliative care patients is required to improve symptom management and quality of life; however this procedure often results in unnecessary hospital admissions. Recognising that the majority of patients wish to be cared for and die in their own home, and with National Guidance recommending that specialist palliative care services should be provided to patients in their preferred place of care, a recent service initiative by MCNS was domiciliary blood transfusions. Whilst this is not a new service within domiciliary care, this pilot project aimed to capture patient views to evaluate this service initiative. Telephone interviews were conducted, using a questionnaire, with 11 patients who had received the service. Findings indicated positive evaluation of the service. Domiciliary blood transfusions helped to avoid unnecessary hospital admissions, the quality of life of patients and their families was improved in the palliative phase of illness and they received the service in their preferred place of care.

Can the protein costs of bacterial resistance be offset by altered feeding behaviour?

1. Mounting an immune response is likely to be costly in terms of energy and nutrients, and so it is predicted that dietary intake should change in response to infection to offset these costs. The present study focuses on the interactions between a specialist grass-feeding caterpillar species, the African armyworm Spodoptera exempta, and an opportunist bacterium, Bacillus subtilis.
2. The main aims of the study were (i) to establish the macronutrient costs to the insect host of surviving a systemic bacterial infection, (ii) to determine the relative importance of dietary protein and carbohydrate to immune system functions, and (iii) to determine whether there is an adaptive change in the host's normal feeding behaviour in response to bacterial challenge, such that the nutritional costs of resisting infection are offset.
3. We show that the survival of bacterially infected larvae increased with increasing dietary protein-to-carbohydrate (P:C) ratio, suggesting a protein cost associated with bacterial resistance. As dietary protein levels increased, there was an increase in antibacterial activity, phenoloxidase (PO) activity and protein levels in the haemolymph, providing a potential source for this protein cost. However, there was also evidence for a physiological trade-off between antibacterial activity and phenoloxidase activity, as larvae whose antibacterial activity levels were elevated in response to immune activation had reduced PO activity.
4. When given a choice between two diets varying in their P:C ratios, larvae injected with a sub-lethal dose of bacteria increased their protein intake relative to control larvae whilst maintaining similar carbohydrate intake levels. These results are consistent with the notion that S. exempta larvae alter their feeding behaviour in response to bacterial infection in a manner that is likely to enhance the levels of protein available for producing the immune system components and other factors required to resist bacterial infections (‘self-medication’).