A Simple Model Describes Development of Early Peaks in Oomycete Zoospore Inoculum Detected in Southern UK Outdoors Horticultural Reservoirs

The numbers of water-borne oomycete propagules in outdoor reservoirs used in horticultural nurseries within the UK are investigated in this study. Water samples were recovered from 11 different horticultural nurseries in the southern UK during Jan-May in two ‘cool’ years (2010.and 2013; winter temperatures 2.0 and 0.4oC below UK Met Office 30 year winter average respectively) and two ‘warm’ years (2008 and 2012; winter temperatures 1.2 and 0.9oC above UK Met Office 30 year winter average respectively). Samples were analysed for total number of oomycete colony forming units (CFU), predominantly members of the families Saprolegniaceae and Pythiaceae, and these were combined to give monthly mean counts. The numbers of CFU were investigated with respect to prevailing climate in the region: mean monthly air temperatures calculated by using daily observations from the nearest climatological station. The investigations show that the number of CFU during spring can be explained by a linear first-order equation and a statistically significant r2 value of 0.66 with the simple relationship: [CFU] = a(T-Tb )-b, where a is the rate of inoculum development with temperature T, and b is the baseload population at temperatures below Tb. Despite the majority of oomycete CFU detected being non-phytopathogenic members of the Saprolegniaceae, total oomycete CFU counts are still of considerable value as indicators of irrigation water treatment efficacy and cleanliness of storage tanks. The presence/absence of Pythium spp. was also determined for all samples tested, and Pythium CFU were found to be present in the majority, the exceptions all being particularly cold months (January and February 2010 and January 2008). A simple scenario study (+2 deg C) suggests that abundance of water-borne oomycetes during spring could be affected by increased temperatures due to climate change.

IRIS Guidelines: Early Intervention in Psychosis IRIS Guidelines Update September 2012

Revision of the original 1998 IRIS Guidelines.

A Service Model For Delivering Care Closer to Home.

Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient. This is a practical example of early implementation of the principles underlying the Department of Health’s (DH) recent Best Practice Guidance, ‘Delivering Care Closer to Home’ (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the ‘Customer Care’ award by ‘Management in Practice’. The Surgery was also awarded the ‘Practice of the Year’ award for this and a number of other customer-focussed projects.