Stratford Hospital

Background: To effectively prevent, detect, and treat health conditions that affect people during their lifecourse, health-care professionals and researchers need to know which sections of the population are susceptible to which health conditions and at which ages. Hence, we aimed to map the course of human health by identifying the 50 most common health conditions in each decade of life and estimating the median age at first diagnosis. Methods: We developed phenotyping algorithms and codelists for physical and mental health conditions that involve intensive use of health-care resources. Individuals older than 1 year were included in the study if their primary-care and hospital-admission records met research standards set by the Clinical Practice Research Datalink and they had been registered in a general practice in England contributing up-to-standard data for at least 1 year during the study period. We used linked records of individuals from the CALIBER platform to calculate the sex-standardised cumulative incidence for these conditions by 10-year age groups between April 1, 2010, and March 31, 2015. We also derived the median age at diagnosis and prevalence estimates stratified by age, sex, and ethnicity (black, white, south Asian) over the study period from the primary-care and secondary-care records of patients. Findings: We developed case definitions for 308 disease phenotypes. We used records of 2 784 138 patients for the calculation of cumulative incidence and of 3 872 451 patients for the calculation of period prevalence and median age at diagnosis of these conditions. Conditions that first gained prominence at key stages of life were: atopic conditions and infections that led to hospital admission in children (<10 years); acne and menstrual disorders in the teenage years (10-19 years); mental health conditions, obesity, and migraine in individuals aged 20-29 years; soft-tissue disorders and gastro-oesophageal reflux disease in individuals aged 30-39 years; dyslipidaemia, hypertension, and erectile dysfunction in individuals aged 40-59 years; cancer, osteoarthritis, benign prostatic hyperplasia, cataract, diverticular disease, type 2 diabetes, and deafness in individuals aged 60-79 years; and atrial fibrillation, dementia, acute and chronic kidney disease, heart failure, ischaemic heart disease, anaemia, and osteoporosis in individuals aged 80 years or older. Black or south-Asian individuals were diagnosed earlier than white individuals for 258 (84%) of the 308 conditions. Bone fractures and atopic conditions were recorded earlier in male individuals, whereas female individuals were diagnosed at younger ages with nutritional anaemias, tubulointerstitial nephritis, and urinary disorders. Interpretation: We have produced the first chronological map of human health with cumulative-incidence and period-prevalence estimates for multiple morbidities in parallel from birth to advanced age. This can guide clinicians, policy makers, and researchers on how to formulate differential diagnoses, allocate resources, and target research priorities on the basis of the knowledge of who gets which diseases when. We have published our phenotyping algorithms on the CALIBER open-access Portal which will facilitate future research by providing a curated list of reusable case definitions. Funding: Wellcome Trust, National Institute for Health Research, Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Department of Health and Social Care (England), Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Institute for Social Care and Health Research, and The Alan Turing Institute.

OBJECTIVE: An absence of food literacy measurement tools makes it challenging for nutrition practitioners to assess the impact of food literacy on healthy diets and to evaluate the outcomes of food literacy interventions. The objective of the present scoping review was to identify the attributes of food literacy. DESIGN: A scoping review of peer-reviewed and grey literature was conducted and attributes of food literacy identified. Subjects included in the search were high-risk groups. Eligible articles were limited to research from Canada, USA, the UK, Australia and New Zealand. RESULTS: The search identified nineteen peer-reviewed and thirty grey literature sources. Fifteen identified food literacy attributes were organized into five categories. Food and Nutrition Knowledge informs decisions about intake and distinguishing between 'healthy' and 'unhealthy' foods. Food Skills focuses on techniques of food purchasing, preparation, handling and storage. Self-Efficacy and Confidence represent one's capacity to perform successfully in specific situations. Ecologic refers to beyond self and the interaction of macro- and microsystems with food decisions and behaviours. Food Decisions reflects the application of knowledge, information and skills to make food choices. These interdependent attributes are depicted in a proposed conceptual model. CONCLUSIONS: The lack of evaluated tools inhibits the ability to assess and monitor food literacy; tailor, target and evaluate programmes; identify gaps in programming; engage in advocacy; and allocate resources. The present scoping review provides the foundation for the development of a food literacy measurement tool to address these gaps.

OBJECTIVES: To describe the experience of Ontario long-term care facilities that used oseltamivir during influenza outbreaks in 1999/2000. DESIGN: Case series. SETTING: Ten Ontario long-term care facilities for older people and their residents. PARTICIPANTS: Older residents of long-term care facilities. INTERVENTION: Oseltamivir for treatment or prophylaxis during 11 influenza outbreaks in 1999/2000. MEASUREMENTS: Control of outbreaks; pneumonia, hospitalization, and death complicating acute influenza. RESULTS: All outbreaks were due to influenza A//H3N2/Sydney/05/97. One facility elected to use oseltamivir for treatment and amantadine for prophylaxis. The remaining nine facilities (10 outbreaks) recommended oseltamivir for treatment and prophylaxis (after amantadine failure in five and as primary prophylaxis in five). Use of oseltamivir was associated with termination of the outbreak in all eight evaluable outbreaks. Overall, 178/185 (96%) case-residents met the case definition of influenza and had complete data for evaluation. Of these, 63 (35%) were treated with antibiotics, 37 (21%) were diagnosed with pneumonia, 19 (11%) were hospitalized, and 16 (9%) died. Compared with residents receiving no therapy or who became ill while taking amantadine, residents who received oseltamivir within 48 hours of the onset of symptoms were less likely to be prescribed antibiotics, to be hospitalized, or to die (P <.05 for each outcome). These differences persisted and remained statistically significant when corrected for influenza immunization status. A total of 730 residents received oseltamivir prophylaxis for a median of 9 days (range 5-12). Of these, side effects were identified in 30 (4.1%), the most common being diarrhea (12 residents, 1.6%), cough (5, 0.7%), confusion (4, 0.5%) and nausea (4, 0.5%). CONCLUSIONS: Oseltamivir is safe and appears to be effective when used as treatment or prophylaxis to control outbreaks of influenza in older nursing home residents.

BACKGROUND: Determining the optimal method of performing second-trimester abortions is important, since they account for a disproportionate amount of abortion-related morbidity and mortality. OBJECTIVES: To compare surgical and medical methods of inducing abortion in the second trimester of pregnancy with regard to efficacy, side effects, adverse events, and acceptability. SEARCH STRATEGY: We identified trials using Pub Med, EMBASE, POPLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL). We also searched the reference lists of identified studies, relevant review articles, book chapters, and conference proceedings for additional, previously unidentified studies. We contacted experts in the field for information on other published or unpublished research. SELECTION CRITERIA: Randomised trials comparing any surgical to any medical method of inducing abortion at >/= 13 weeks' gestation were included. DATA COLLECTION AND ANALYSIS: We assessed the validity of each study using the methods suggested in the Cochrane Handbook. Investigators were contacted as needed to provide additional information regarding trial conduct or outcomes. Two reviewers abstracted the data. Odds ratios and 95% confidence intervals were calculated for dichotomous variables using RevMan 4.2. The trials did not have uniform interventions, therefore, we were unable to combine them into a meta-analysis. MAIN RESULTS: Two studies met criteria for this review. One compared dilation and evacuation (D&E) to intra-amniotic instillation of prostaglandin F(2) (alpha). The second study compared D&E to induction with mifepristone and misoprostol. Compared with prostaglandin instillation, the combined incidence of minor complications was lower with D&E (OR 0.17, 95% CI 0.04-0.65) as was the total number of minor and major complications (OR 0.12, 95% CI 0.03-0.46). The number of women experiencing adverse events was also lower with D&E than with mifepristone and misoprostol (OR 0.06, 95% CI 0.01-0.76). Although women treated with mifepristone and misoprostol reported significantly more pain than those undergoing D&E, efficacy and acceptability were the same in both groups. In both trials, fewer subjects randomised to D&E required overnight hospitalisation. AUTHORS' CONCLUSIONS: Dilation and evacuation is superior to instillation of prostaglandin F(2) (alpha). The current evidence also appears to favour D&E over mifepristone and misoprostol, however larger randomised trials are needed.

INTRODUCTION: Alexithymia is characterized by a difficulty identifying and describing emotional states, as well as an externally oriented thinking style. This study investigated the prevalence of alexithymia in a British undergraduate sample and assesses its relationship to both parental bonding and dissociation. METHOD: The Toronto alexithymia scale (TAS-20), the Parental Bonding Instrument (PBI), and the Dissociative Experience Scale (DES) were administered to a sample of 181 male and 190 female undergraduate students from both arts and science subjects. RESULTS: Rates of alexithymia were comparable with those observed in some other countries. Contrary to predictions, females were found to have higher rates than males, and the highest presence of alexithymia was in female science students. As in previous studies, alexithymia was linked to both dissociation and perceptions of a lack of maternal care, though the degree of association to the latter was small. Dissociative experiences were predicted by both maternal overprotection and difficulties identifying feelings. DISCUSSION: Some qualified support was found for the relevance of early maternal bonding to later difficulties processing emotions. The presence of greater alexithymia in females, and female science students in particular, was discussed in reference to similar observations elsewhere. There was also an understandable relationship between 'difficulty identifying feelings' (TAS) and both depersonalization/derealization and absorption (DES).

OBJECTIVES: Both insecure attachment style and early maladaptive schemas have been associated with mental health difficulties. This study aimed to investigate how schemas relate to attachment style classification in mental health service users. A further aim was to investigate the nature of the relationship between psychological distress, common psychological difficulties, and attachment style. METHOD: Participants were 72 people in contact with mental health services who completed the short form of Young's schema questionnaire, a measure identifying their attachment style (experience of close relationships), and the clinical outcomes in routine evaluation (CORE; Evans et al., 1998) outcome measure. RESULTS: Overall, 81% of the participants had an insecure attachment style. The fearful group were the most distressed across several domains of the CORE, followed by the preoccupied group. Schemas differed significantly according to attachment style grouping, with the fearful group possessing the greatest degree of maladaptive schemas, followed by the preoccupied group. Discriminant function analysis identified differing patterns of schemas associated with attachment style. CONCLUSIONS: The results supported the relevance of both attachment style and maladaptive schemas to individuals with mental health difficulties. Importantly, several aspects of the individuals' symptoms and difficulties and their schemas were meaningfully related to their adult attachment style. Limitations included the small number of dismissing individuals identified, the problems of self-report in this area, and the absence of information about the quality of participants' current relationships.

In this paper we explore a phenomenon that is currently a key component of the UK government's business support policies. Growing investment in incubation, and increased emphasis on it as a tool for regional development, require an understanding of its practice. We aim to provide insights for policymakers and practitioners to help them meet the needs and aspirations of users. Initially we present the key findings from a significant global review of studies of incubators, conducted on behalf of UK Business Incubation (UKBI), and the UK Department of Trade and Industry. The review identifies key factors in determining the potential added value of incubators. We then present the key findings from a subsequent in-depth study of seven incubators across England and Scotland, commissioned by UKBI. The conclusions of the study highlight the dichotomies relating to the potential polarisation of incubator objectives (from property development focus to business development focus) and how these influence the implementation of effective incubation processes from the perspective of tenant and graduate firms. The policies and practices of operators highlight a blurring of the distinction between incubator management and incubation development.

Abstract Purpose – The purpose of this paper is to examine the role of social and digital media in the business school and particularly to examine how such innovative technological processes can be leveraged to enhance teaching instruction and enrich learning about practice and research. Design/methodology/approach – Taking a broad perspective on the range of social and digital media approaches, the paper discusses a series of extant models of technology‐based learning and conjectures about how they can be used creatively and meaningfully in business school teaching. Findings – Despite the pioneering efforts of the Open University in modelling distance and blended learning, adoption of such models in the business school context has been quite slow. These technologies are used more frequently as support mechanisms for "face‐to‐face" learning in order to enrich the quality of conventional professorial instructional approaches. In many business schools "face‐to‐face" learning is perceived to be of much higher quality than on‐line learning approaches. Originality/value – The paper notes the resistance to the adoption of new technology both by business school professors and deans. In the case of professors, there is inertia to change and a staunch defence of classic forms of "face‐to‐face" instruction. In the case of deans, few have sufficient courage or time (given the short average tenure of deans) to invest in and implement new technology strategies for teaching and learning. However, business school deans can no longer ignore the potentially disruptive innovations that will occur in teaching and learning processes.

Abstract This article reports an intensive qualitative study of the subjective experience and meaning of self‐injury for 16 women who identified as lesbian or bisexual and who had deliberately self‐injured on repeated occasions. In individual interviews, the women talked about their experiences of self‐injury and the role it played in their lives as lesbian or bisexual women. Interpretative Phenomenological Analysis (IPA) was used to elicit themes arising within their accounts. These highlighted a number of ways in which social and contextual factors contributed to the development of self‐injury. Although many of these factors seemed applicable to any woman who self‐injures, there were some aspects that were specific to the experience of lesbian and bisexual women. In addition, the women's accounts raised a number of important issues about the way in which mental health services respond to lesbian and bisexual women who self‐injure. It is argued that self‐injury can be understood as a coping response that arises within a social context characterized by abuse, invalidation, and the experience of being regarded as different or in some way unacceptable. These factors are especially salient in the lives of women, and they emerge particularly strongly as part of the experience of women who are developing a lesbian or bisexual identity. Copyright © 2004 John Wiley &amp; Sons, Ltd.

ABSTRACT The impacts of agricultural intensification on farmland wildlife have been the subject of increasing concern, particularly over the last two decades. Population declines have occurred for a number of mammalian species, sometimes drastically so, and changes in farming practice are believed to be significant contributory factors. The major policy instruments for delivering environmental benefits on farmland are agri‐environment schemes. These encourage farmers to adopt more environmentally sensitive farming practices to promote farmland biodiversity. Additionally, compulsory set‐aside, which reduces agricultural surplus, could also have positive impacts on wildlife. In this paper we consider some of the putative benefits of agri‐environment schemes and set‐aside for mammals. We review how establishment and management options within agri‐environment schemes and set‐aside might affect habitat resources for mammals. For example, conservation headlands increase plant and invertebrate resources within the crop edge for mammals such as wood mice. Grassy field margins can support communities of smaller mammals, and hedgerows may act as important commuting and hunting routes. Their potential will depend on factors such as seed mixtures used, timing and severity of cutting, and length of time they have been in place. At a farm level, habitat heterogeneity may be increased through organic agriculture, which is supported by some agri‐environment schemes. Studies suggest significant benefits to mammals, including wood mice and bats. However, it is increasingly recognized that effective conservation of farmland mammals must seek solutions at the landscape scale, addressing such issues as habitat connectivity between farms. One approach may be the better targeting of scheme agreements. We suggest that agri‐environment schemes and set‐aside can contribute to the conservation of mammals on farmland. Recent policy changes are likely to have further positive impacts on farmland wildlife but appropriate mammal monitoring programmes must be developed rigorously to assess their effects.

Economic inequalities have been increasing between and within nations, regions and cities, but questions of redistribution have to some extent been displaced by those of recognition, empowerment and diversity in urban and regional inquiry and policy. A conceptual framework drawing upon Nancy Fraser's and Iris Marion Young's ideas about economic and cultural injustice is proposed for evaluating local empowerment initiatives, which is then drawn upon to explore the nature and effectiveness of participation with reference to one specific New Deal For Communities partnership scheme in the London Borough of Hackney, Shoreditch – Our Way, concerned with regeneration. Our findings suggest that while participation is certainly a necessary condition for moving towards a more egalitarian society, current policies are valuable but limited in terms of the degree of representation and the extent of control. They are part of an affirmative agenda – that is, they tackle symptoms but not causes of deprivation. We conclude that if long‐term remedies are desired, then transformative solutions which address both economic and political injustice are necessary. Les inégalités économiques se sont creusées entre et au sein des nations, régions et villes mais, dans les études et dans les politiques urbaines et régionales, les questions de redistribution ont, dans une certaine mesure, été supplantées par celles de reconnaissance, empowerment et diversité. L'article propose un cadre conceptuel inspiré des idées de Nancy Fraser et Iris Marion Young sur l'injustice économique et culturelle afin d'évaluer les initiatives locales d' empowerment . Cette évaluation permet ensuite d'explorer la nature et l'efficacité de la participation en évoquant un programme de régénération en partenariat de type New Deal for Communities, à Shoreditch, dans la banlieue londonienne de Hackney (Our Way). Les résultats suggèrent que, si la participation est bien sûr une condition nécessaire pour aller vers une société plus égalitaire, les politiques actuelles, quoique précieuses, sont limitées en termes de degré de représentation et niveau de maîtrise. Elles s'inscrivent dans une démarche antidiscriminatoire en traitant les symptômes, mais pas les causes de l'appauvrissement. En conclusion, si l'on souhaite des solutions à long terme, il faut des transformations remédiant aux injustices tant économiques que politiques.

AIMS: We have demonstrated previously that acute smoking abstinence is associated with lowered reward motivation and impaired response inhibition. This prospective study explores whether these impairments, along with withdrawal-related symptoms, recover over 3 months of sustained abstinence. DESIGN: Participants completed a 12-hour abstinent baseline assessment and were then allocated randomly to quit unaided or continue smoking. All were re-tested after 7 days, 1 month and 3 months. Successful quitters' scores were compared with those of continuing smokers, who were tested after ad libitum smoking. SETTING: Goldsmiths, University of London. PARTICIPANTS: A total of 33 smokers who maintained abstinence to 3 months, and 31 continuing smokers. MEASUREMENTS: Indices demonstrated previously in this cohort of smokers to be sensitive to the effect of nicotine versus acute abstinence: reward motivation [Snaith-Hamilton pleasure scale (SHAPS), Card Arranging Reward Responsivity Objective Test (CARROT), Stroop], tasks of response inhibition [anti-saccade task; Continuous Performance Task (CPT)], clinical indices of mood [Hospital Anxiety and Depression Scale (HADS)], withdrawal symptoms [Mood and Physical Symptoms Scale (MPSS)] and desire to smoke. FINDINGS: SHAPS anhedonia and reward responsivity (CARROT) showed significant improvement and plateaued after a month of abstinence, not differing from the scores of continuing smokers tested in a satiated state. Mood, other withdrawal symptoms and desire to smoke all declined from acute abstinence to 1 month of cessation and were equivalent to, or lower than, the levels reported by continuing, satiated smokers. Neither group showed a change in CPT errors over time while continuing smokers, but not abstainers, showed improved accuracy on the anti-saccade task at 3 months. CONCLUSION: Appetitive processes and related affective states appear to improve in smokers who remain nicotine-free for 3 months, whereas response inhibition does not. Although in need of replication, the results suggest tentatively that poor inhibitory control may constitute a long-term risk factor for relapse and could be a target for intervention.

Abstract This study examined whether close relationship experiences predict change in individuals’attachment Characteristics. Partners from 301 dating couples each rated their attachment characteristics and their conflict avoidance. Five months later 184 women and 138 men reported whether their relationships were intact or broken‐up, and they rated their attachment characteristics again. Women became less secure after a breakup and more secure after remaining together. There was a similar result for men who initially had insecure attachment characteristics. Additionally, women low in conflict avoidance became more secure over time, and those high in conflict avoidance became less secure. For men whose relationships remained intact, conflict avoidance was not related to change in attachment characteristics. For men whose relationships ended, however, initial conflict avoidance predicted increased attachment security. These results extend previous research on the stability of attachment characteristics by exploring predictors of change.

BACKGROUND AND METHODOLOGY: This survey was undertaken to obtain the opinions of women in the UK about their home management of early medical abortion (EMA) with mifepristone and misoprostol. All eligible women undergoing EMA at any BPAS clinic during a 2-week period were invited to participate. Women were contacted by telephone 1 week after the EMA and a five-item structured questionnaire was administered. One open-ended question gave women the opportunity to freely comment. Demographics and responses were tabulated using descriptive statistics. Mulitivariable logistic regression was used to assess the influence of demographic characteristics on responses. RESULTS: Of 249 enrolled participants, 162 were successfully surveyed (a 65% response rate). Most respondents (86%) would rather go home to complete an EMA than remain in a clinical setting. The majority (96%) found home management very or somewhat acceptable and 96% felt they could have obtained medical help easily if necessary. Most respondents (62%) would prefer home use of misoprostol as opposed to returning to the clinic to obtain and use the medication. Women were less likely to prefer home management if they were Asian (OR 0.21, 95% CI 0.05-0.87) or had a gestational age >49 days (OR 0.26, 95% CI 0.10-0.71). DISCUSSION AND CONCLUSIONS: Home management of EMA is acceptable to most women in the UK who have experienced it and is, for many, preferable to a clinical setting. Consideration should be given to updating the interpretation of the UK's 1967 Abortion Act to allow home administration of misoprostol.

and did not adversely affect TTE during the GXT or cardiorespiratory responses to HIIT compared with the HD.

Reindeer (Rangifer tarandus tarandus) were introduced into Alaska 100 years ago and have been maintained as semidomestic livestock. They have had contact with wild caribou (R.t.granti) herds, including deliberate crossbreeding and mixing in the wild. Reindeer have considerable potential as a domestic animal for meat or velvet antler production, and wild caribou are important to subsistence and sport hunters. Our objective was to quantify the genetic relationships of reindeer and caribou in Alaska. We identified allelic variation among five herds of wild caribou and three herds of reindeer with DNA sequencing and restriction enzymes for three loci: a DQA locus of the major histocompatibility complex (Rata-DQA1), kappa-casein and the D-loop of mitochondrial DNA. These loci are of interest because of their potential influence on domestic animal performance and the fitness of wild populations. There is considerable genetic variation in reindeer and caribou for all three loci, including five, three and six alleles for DQA, kappa-casein and D-loop respectively. Most alleles occur in both reindeer and caribou, which may be the result of recent common ancestry or genetic introgression in either direction. However, allele frequencies differ considerably between reindeer and caribou, which suggests that gene flow has been limited.

BACKGROUND: Profound clinical, conceptual and ideological differences between child and adult mental health service models contribute to transition-related discontinuity of care. Many of these may be related to psychiatry training. METHODS: A systematic review on General Adult Psychiatry (GAP) and Child and Adult Psychiatry (CAP) training in Europe, with a particular focus on transition as a theme in GAP and CAP training. RESULTS: Thirty-four full-papers, six abstracts and seven additional full text documents were identified. Important variations between countries were found across several domains including assessment of trainees, clinical and educational supervision, psychotherapy training and continuing medical education. Three models of training were identified: i) a generalist common training programme; ii) totally separate training programmes; iii) mixed types. Only two national training programs (UK and Ireland) were identified to have addressed transition as a topic, both involving CAP exclusively. CONCLUSION: Three models of training in GAP and CAP across Europe are identified, suggesting that the harmonization is not yet realised and a possible barrier to improving transitional care. Training in transition has only recently been considered. It is timely, topical and important to develop evidence-based training approaches on transitional care across Europe into both CAP and GAP training.

Disagreement exists as to whether the individual components of the quadriceps femoris can be preferentially activated, i.e., that one muscle component is activated to a greater degree of its maximum voluntary contraction ability than the remaining components. Preferential activation of the vastus medialis (VM) might be useful in the treatment of knee patients demonstrating VM atrophy. The purpose of the present investigation was to determine if the vastus medialis oblique (VMO), vastus lateralis (VL), and hip adductor (HA) muscles were preferentially activated in females during the following maximal voluntary isometric exercises: 1) unilateral quadriceps setting (QS) with the ankle positioned in neutral, 2) unilateral quadriceps setting combined with ankle dorsiflexion (QS + D), and 3) maximal bilateral hip adduction. Integrated electromyography (IEMG in mV.sec) was determined for the VMO, VL, and HA muscles of the preferred leg (i.e., that used to kick a ball) of 20 healthy females. Data were normalized using QS exercise as the reference exercise. Nonnormalized IEMG (+/-SD) of the VMO and VL was similar during QS [i.e., VMO = 1050 (+/-802) mV.sec, VL = 1075 (+/-738) mV. sec] and QS + D exercises [i.e., VMO = 1191 (+/-738) mV.sec, VL = 1202 (+/-836) mV.sec], but significantly less than these values during hip adduction exercise [i.e., VMO = 174 (+/-62) mV. sec, VL = 194 (+/-70) mV.sec]. Nonnormalized IEMG of the HA muscles was similar during both QS and QS+D [i.e., 286 (+/-405) mV.sec and 195 (+/-432) mV.sec], but significantly higher than these values during hip adduction exercise [i.e., 413 (+/-235) mV.sec]. Normalized IEMG (+/-SD)(%) demonstrated similar patterns, i.e., the ratios for the VMO and the VL muscles did not differ from one another under either QS + D [i.e., VMO = 121 (+/-60)%, VL = 116 (+/-40)%] or hip adduction conditions [i.e., VMO = 33 (+/-24)%, VL = 36 (+/-25)%]. As a result, the degree of activation of the two muscles was considered the same. These results suggest no preferential activation of the quadriceps femoris component muscles during QS, QS + D, and hip adduction exercises in the nonweight-bearing position. The use of hip adduction to preferentially activate the VMO over the VL compared with QS exercises was not substantiated. A mean increase of 20% in the VMO and VL myoelectric activity during QS (as demonstrated by the normalized IEMG), by the addition of dorsiflexion, may be clinically significant. However, further study is required.

BACKGROUND: Many national and regional clinical guidelines emphasise the need for good communication of information to young people and their parent/carers about what to expect during transition into adult services. Recent research indicates only a minority of young people in need of transition for Attention Deficit Hyperactivity Disorder (ADHD) experience continuity of care into adulthood, with additional concerns about quality of transition. This qualitative study explored the role that information plays in experiences of transition from the perspectives of parent/carers and young people. METHODS: Participants were recruited from 10 National Health Service Trusts, located across England, with varying service configurations. Ninety two qualitative interviews were conducted: 64 with young people with ADHD at different stages relative to transition, and 28 with parent/carers. Thematic analysis of data was completed using the Framework Method. RESULTS: Interviewees reported a range of experiences; however reliance on parent/carers to gather and translate key information, and negative experiences associated with poor communication of information, were universal. Three themes emerged: Navigating information with help from parents; Information on ADHD into adulthood; Information about the transition process. The first revealed the essential role of parent in the translation and application of information, the other two explored distinct types of information necessary for a smooth transition. Interviewees made recommendations for clinical practice similar to UK (United Kingdom) National Institute for Health and Care Excellence (NICE) guidelines, with an additional emphasis on providing nuanced information on ADHD as a potentially long term condition. It was important to interviewees that General Practitioners had a basic understanding of adult ADHD and also had access to information about service provision. CONCLUSIONS: Our findings illustrate that the availability and communication of information to young people and their parent/carers is an essential component of the transition process between child and adult ADHD services. How and when it is provided may support or impede transition. This study constitutes a substantial contribution to the evidence base, drawing on interviews from a range of participants across England and from Trusts offering different types of services.

Pressure ulcers can have a devastating impact on health and care provision, ranging from patient discomfort and increased healthcare costs to a potential reflection on the quality of care. To evaluate the outcomes of prevention education and skin integrity interventions on the incidence of pressure ulcers, a multiphase project was initiated in an urban 154-bed regional referral community hospital in Ontario, Canada that provides care to an urban and rural population. The prevalence study included 84 adult subjects at baseline, 77 after one year (Phase 1), and 100 after 3 years (Phase 2). The Braden Scale for Predicting Pressure Sore Risk and a data collection form were used to record prevalence, incidence, stage and location of pressure ulcers, and related documented interventions. Incidence data were obtained from patient charts and defined as ulcers that developed over 24 hours following admission. Phase 1 interventions involved staff education and replacement of existing skin care products. Phase 2 interventions included adoption of pressure ulcer prevention protocols, advanced wound care products, improved support surface usage, modification of documentation methods, and staff education. Of the 84 patients assessed at baseline , 15 (17.9 %) developed 22 pressure ulcers compared to 4 of 77 (5.2%) during Phase 1 and 2 out of 100 (2.0%) during Phase 2. The difference between baseline and both subsequent time points was statistically significant (P greater than 0.05). These results suggest that education and the implementation of appropriate skin care products and procedures and pressure ulcer prevention protocols may reduce the incidence of hospital-acquired pressure ulcers.