6 resultados para Referral patterns

em WestminsterResearch - UK


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This programme of research used a developmental psychopathology approach to investigate females across the adolescent period. A two-sided story is presented; first, a study of neuroendocrine and psychosocial parameters in a group of healthy female adolescents (N = 63), followed by a parallel study of female adolescents with anorexia nervosa (AN) (N = 8). A biopsychosocial, multi-method measurement approach was taken, which utilised self-report, interview and hypothalamic-pituitary-adrenocortical (HPA) axis measures. Saliva samples for the measurement of cortisol and DHEA were collected using the best-recommended methodology: multiple samples over the day, strict reference to time of awakening, and two consecutive sampling weekdays. The research was adolescent-orientated: specifically, by using creative and ageappropriate strategies to ensure participant adherence to protocol, as well as more generally by adopting various procedures to facilitate engagement with the research process. In the healthy females mean (± SD) age 13.9 (± 2.7) years, cortisol and DHEA secretion exhibited typical adult-like diurnal patterns. Developmental markers of chronological age, menarche status and body mass index (BMI) had differential associations with cortisol and DHEA secretory activity. The pattern of the cortisol awakening response (CAR) was sensitive to whether participants had experienced first menses, but not to chronological age or BMI. Those who were post-menarche generally reached their peak point of cortisol secretion at 45 minutes post-awakening, in contrast to the pre-menarche group who were more evenly spread. Subsequent daytime cortisol levels were also higher in post-menarche females, and this effect was also noted for increasing age and BMI. Both morning and evening DHEA were positively associated with developmental markers. None of the situational or self-report psychosocial variables that were measured modulated any of the key findings regarding cortisol and DHEA secretion. The healthy group of girls were within age-appropriate norms for all the self-report measures used, however just under half of this group were insecurely attached (as assessed by interview). Only attachment style was associated with neuroendocrine parameters. In particular, those with an anxious insecure style exhibited a higher awakening sample (levels were 7.16 nmol/l, 10.40 nmol/l and 7.93 nmol/l for secure, anxious and avoidant groups, respectively) and a flatter CAR (mean increases over the awakening period were 6.38 nmol/l, 2.32 nmol/l and 8.61 nmol/l for secure, anxious and avoidant groups, respectively). The afore-mentioned pattern is similar to that consistently associated with psychological disorder in adults, and so this may be a pre-clinical vulnerability factor for subsequent mental health problems. A group of females with AN, mean (± SD) age 15.1 (± 1.6) years, were recruited from a specialist residential clinic and compared to the above group of healthy control (HC) female adolescents. A general picture of cortisol and DHEA hypersecretion was revealed in those with AN. The mean (± SD) change exhibited in cortisol levels over the 30 minute post-awakening period was 7.05 nmol/l (± 5.99) and 8.33 nmol/l (± 6.41) for HC and AN groups, respectively. The mean (± SD) evening cortisol level for the HC girls was 1.95 nmol/l (± 2.11), in comparison to 6.42 nmol/l (± 11.10) for the AN group. Mean (± SD) morning DHEA concentrations were 1.47 nmol/l (± 0.85) and 2.25 nmol/l (± 0.88) for HC and AN groups, respectively. The HC group’s mean (± SD) concentration of 12 hour DHEA was 0.55 nmol/l (± 0.46) and the AN group’s mean level was 0.89 nmol/l (± 0.90). This adrenal steroid hypersecretion evidenced by the AN group was not associated with BMI or eating disorder symptomatology. Insecure attachment characterised by fearfulness and anger was most apparent; a style which was unparalleled in the healthy group of female adolescents. The causal directions of the AN group findings remain unclear. Examining some of the participants with AN as case studies one year post-discharge from the clinic illustrated that for one participant who was recovered, in terms of returning to ordinary school life and no longer exhibiting clinical levels of eating disorder symptomatology, her CARs were no longer inconsistent over sampling days and her DHEA levels were also now generally comparable to the healthy control group. For another participant who had not recovered from her AN one year later, the profile of her CAR continued to be inconsistent over sampling days and her DHEA concentrations over the diurnal period were significantly higher in comparison to the healthy control group. In its entirety, this work’s unique contribution lies in its consideration of methodological and developmental issues specifically pertaining to adolescents. Findings also contribute to knowledge of AN and understanding of vulnerability factors, and how these may be used to develop interventions dedicated to improving adolescent health.

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The paper addresses road freight transport operations during the London Olympic and Paralympic Games in 2012. It presents work carried out prior to the Games to understand pre-Games patterns of freight deliveries in London (for both light and heavy goods vehicles) and the results of modelling work carried out to assess the likely impacts of the Games road restrictions on freight operations. The modelling results indicated that increases in total hours travelled carrying out collection and delivery work would range from 1.4% to 11.4% in the six sectors considered. The results suggested increases in hours travelled in excess of 3.5% in four of the six sectors modelled. The possible actions that could be taken by organizations to reduce these negative impacts were also modelled and the results indicated that such actions would help to mitigate the impact of the road restrictions imposed on operators during the Games. The actual impacts of the 2012 Games on transport both in general terms and specifically in terms of freight transport are also discussed, together with the success of the actions taken by Transport for London (TfL) to help the road freight industry. The potential freight transport legacy of the London 2012 Games in terms of achieving more sustainable urban freight transport is considered and the steps being taken by TfL to help ensure that such a legacy can be realized are discussed. Such steps include policy-makers continuing to collaborate closely with the freight industry through the ‘London Freight Forum’, and TfL's efforts to encourage and support companies revising their delivery and collection times to the off-peak; improving freight planning in the design and management of TfL-funded road schemes; electronic provision of traffic information by TfL to the freight industry, and the further development of freight journey planning tools.

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The broad capabilities of current mobile devices have paved the way for Mobile Crowd Sensing (MCS) applications. The success of this emerging paradigm strongly depends on the quality of received data which, in turn, is contingent to mass user participation; the broader the participation, the more useful these systems become. However, there is an ongoing trend that tries to integrate MCS applications with emerging computing paradigms such as cloud computing. The intuition is that such a transition can significantly improve the overall efficiency while at the same time it offers stronger security and privacy-preserving mechanisms for the end-user. In this position paper, we dwell on the underpinnings of incorporating cloud computing techniques to facilitate the vast amount of data collected in MCS applications. That is, we present a list of core system, security and privacy requirements that must be met if such a transition is to be successful. To this end, we first address several competing challenges not previously considered in the literature such as the scarce energy resources of battery-powered mobile devices as well as their limited computational resources that they often prevent the use of computationally heavy cryptographic operations and thus offering limited security services to the end-user. Finally, we present a use case scenario as a comprehensive example. Based on our findings, we posit open issues and challenges, and discuss possible ways to address them, so that security and privacy do not hinder the migration of MCS systems to the cloud.