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Call to Action: Strengthening Urban Resilience and Sustainable Neighbourhoods for Children
No full textStaff experiences of implementing patient-initiated follow-up (PIFU) in the NHS in England: findings from a rapid qualitative evaluation
No full textObjectivesThe NHS in England has introduced various innovations to keep up with the growing demand for elective care, one of which is patient-initiated follow-up (PIFU). This evaluation sought to understand staff experiences of implementing PIFU.MethodsWe conducted a rapid qualitative service evaluation between June 2022 and July 2023, based on semi-structured interviews (n = 36) with operational/managerial and clinical NHS staff from five English NHS Trusts, and an online workshop with 21 additional members of staff from the English NHS. We drew on the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework to structure qualitative data collection and analysis and to generate new insights into the adoption of the innovation of PIFU.ResultsWe found that implementation of PIFU affected staff roles, workload, and job satisfaction. Levels of PIFU uptake, and experience with similar models, affected the extent to which participants experienced the impact of PIFU. How PIFU was implemented varied. Some staff saw changes in their role because of new administrative demands, safety-netting procedures (such as proactive measures by specialty teams to mitigate the risk of patients not initiating appointments when necessary), and selection of suitable patients. PIFU was felt by some staff to increase, and by others to decrease, workload. PIFU affected intensity of work, interrelated with other factors such as the size of waiting lists, and conditions experienced by patients. Whether staff were satisfied with PIFU related to its impact on their role and workload. Satisfaction was also affected by whether staff believed PIFU delivered benefits for patients, and by the aims they felt were driving rollout.ConclusionPIFU can significantly affect the experiences of staff and change staff roles and workload. However, the impact of PIFU is not uniform. Staff perspectives on PIFU from all parts of the health system should be better understood and considered during pathway design
Identifying the proximate mechanisms that generate plasticity in fecundity for nutrition in Drosophila melanogaster
No full textNutrition is an important determinant of an animal's survival and fitness. Phenotypic plasticity allows a genotype to adjust life history traits to changes in its nutritional environment, and it varies among individuals. To understand how variation in plasticity is achieved, we made use of a Drosophila melanogaster isogenic panel to characterize nutritional plasticity for fecundity by feeding flies diets differing in their yeast content and counting the number of eggs produced. We then identified lines with the highest and lowest plastic responses to diet and dissected the potential proximate mechanisms responsible for these differences in plasticity, including morphology, behaviour, and physiology. Our results suggest that genetic variation in plasticity is not due to differences in ovariole number, but due to both increased food intake, and higher efficiency at converting food into eggs. Our results show that, in this population of D. melanogaster, variation in behaviour and physiology, but not morphology, underlies differences in plasticity for fecundity. Further, they set the stage for future studies aiming to understand how the proximate mechanisms that generate genetic variation in plasticity contribute to a population's persistence when faced with environmental changes
The Globalized Automotive Industries Have Failed to Improve the Overall Carbon Productivity but Exhibit a Polarized Distribution
No full textImproving carbon productivity is essential for simultaneously achieving sustainable development goals and tackling climate change. While the Global Value Chains (GVCs) division enhances productive efficiency, its impact on carbon productivity remains elusive. Here we integrated the GVCs theory with the Environmental Expanded Input-output model to investigate the highly globalized automotive manufacturing industry. We found that CO2 emissions intensity, the inverse of carbon productivity, fluctuated between 0.37 and 0.47 kg/USD in automotive manufacturing GVCs during 2001–2021. Notably, developing economies nearly doubled their CO2 emissions intensity during this period, whereas developed economies almost halved theirs. The global distribution of CO2 emissions and value added is becoming increasingly unequal in industrial production and service segments. Lower production levels and energy efficiency in developing economies, coupled with their upstream roles in GVCs (raw materials and industrial parts suppliers), exacerbate these disparities. Our findings indicate that merely global labor division is insufficient to create low-carbon automotive manufacturing GVCs. Formulating emission reduction targets that consider the diverse roles of economies within GVCs, and supporting developing economies in boosting energy productivity, labor value added efficiency, and skill can help narrow the distribution gaps and enhance the carbon productivity of the entire automotive manufacturing GVCs
Transgenerational transmission of trauma. Heterogeneity in the experiences of mothers who experienced out-of-home care (OHC) and adjustment of their children
No full textThis study examines heterogeneity in adult functioning among mothers with out-of-home care (OHC) experience, and the intergenerational transmission of trauma associated with maternal OHC. The study draws on the nationally representative UK Millennium Cohort Study (MCS). The analytic sample comprises n = 305 mothers (G1) who reported to have experienced OHC before the age of 17 and their children at age 17 (G2). Running a latent class analysis across a range of adult outcomes such as educational attainment, employment, finance, housing, physical and mental health we identified three groups of mothers with OHC experience. These included 27% mothers who reported relative positive adult adjustment (resilient mothers); a group comprising mainly impoverished mothers (39%) and a group of distressed mothers (34%) with relative high levels of mental health problems who are experiencing more chaotic home lives. The children of relative resilient mothers with OHC experience showed higher levels of academic attainment compared to children of mothers who encountered more problems in their transition to adulthood. However, all children of mothers with OHC experiences reported high levels of depression and risk of self-harm by age 17 – including those of resilient mothers. The findings highlight the capacity of mothers with OHC experience to break the vicious cycle, although there is also a long shadow of intergenerational trauma which needs to be addressed
Seismic design and performance of building structures with self-centering steel-concrete hybrid single-pier coupled walls
No full textChallenges associated with disclosing results from whole genome sequencing to diagnose paediatric rare diseases: analysis of parent-clinician interactions
No full textBACKGROUND: Whole genome sequencing (WGS) has recently been introduced as a diagnostic test for patients with particular rare diseases in the National Health Service (NHS) in England. Little is known about the process of communicating results from WGS to families in practice. METHODS: We audio-recorded clinicians and parents discussing the results of WGS for their child's rare disease diagnosis as part of a larger mixed-methods evaluation of the implementation of the NHS Genomic Medicine Service during its early years. RESULTS: 10 consultations were audio-recorded across four NHS Trusts. Clinical indications for WGS were related to neurological and developmental disorders. Seven parents received a genetic diagnosis for their child's condition, two received a variant of uncertain significance, and one received a no primary finding result. One parent also received an incidental finding for their child. Challenges in discussing results included (1) explaining a diagnosis when the genotype was established before detailed phenotyping, (2) navigating follow-up for an adult-onset condition identified in childhood, (3) disclosing an unexpected diagnosis for a parent from trio testing and (4) conveying a diagnosis with an uncertain prognosis. CONCLUSION: This study illustrates some of the issues that can arise from unexpected and uncertain information when returning results from broad-scope genomic testing for paediatric neurological and developmental disorders. Further study of actual interactions between clinicians and families discussing results from WGS across different specialities and conditions is needed to inform guidance on communication of results within this rapidly evolving area of medicine
Protocol for a feasibility and acceptability trial of Bloom, a co-produced and co-facilitated parent group to enhance the quality of life and well-being of young autistic children
No full textBackground: The autistic and autism communities have identified improving the quality of life and well-being of autistic people as a key priority. Despite this, to date, there are no evidence-based supports for autistic children which specifically focus on improvements in these areas. This project seeks to address this gap by evaluating the acceptability and feasibility of Bloom, an 8-week co-produced and co-facilitated parent group that aims to enhance the quality of life and well-being of young autistic children. Methods: This is a feasibility and acceptability study of a parent group, Bloom, which has been co-designed and co-produced between researchers and representatives from community organisations. The study aims to recruit 80 parents of autistic children aged 3–8 years through community organisations and social media networks. Once informed consent is provided, participants will be asked to complete baseline assessments (questionnaires and semi-structured interviews). These include measures of demographic as well as child, family, and parent well-being. Participants will be invited to attend the Bloom group for eight consecutive weeks during school term times. Groups will either be online or face to face, depending on parent preference and availability. Each group will be co-facilitated between an autistic person and an allied health professional. The assessments conducted at baseline (T1) will be repeated after completion of the group (T2) and at follow-up, 3 months after group completion (T3). At T2 and T3, participants will also be asked about their experiences of both the group and of their participation in the study. Discussion: This feasibility and acceptability trial will provide essential data that, if positive, will inform the design of a fully powered randomised controlled trial (RCT). This includes the acceptability and feasibility of recruitment, study processes, the Bloom parent group, and baseline/outcome measures, including adherence to processes and the group. Additional data will be collected on retention from baseline to follow-up; effect sizes will be calculated for each outcome measure, both of which will inform the sample size of a future RCT. Findings of this study will be disseminated through written and/or audiovisual lay summaries to all participants and partner community organisations, as well as through peer-reviewed manuscripts and conference presentations. Conclusions: This study is one small, but important, step towards autism-specific, relevant, and accessible supports that combine professional and lived experience to improve outcomes for autistic people and their families. Trial registration: Ethical clearance was provided by Griffith University Human Research Ethics Committee (HREC 2023/934). The Universal Trial Number is U1111-1305-0305, and the study has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12624000350527
Variability in isotopes of summer monsoon rainfall across the eastern Indo-Gangetic plains: assessing the moisture sources and transport processes
No full textThe Indian Summer Monsoon (ISM) is the primary contributor of rainfall in the Indo-Gangetic Plains and therefore is of great relevance to the rain-fed agriculture in the region. The hydroclimate dynamics across the Indo-Gangetic plains, despite being critical to the socio-economy of the region, are not well understood. Oxygen- and hydrogen-isotope analyses of precipitation have served as a powerful tool to understand hydroclimate processes. Existing studies have examined the isotopic composition of meteoric water across the Indian subcontinent, but systematic investigation of spatial patterns on the Indo-Gangetic Plains has not been reported. In this study, we present analysis of stable isotopes of rainwater collected weekly, simultaneously from different locations along an east-west transect across the eastern part of the Indo-Gangetic Plains for the 2023 summer monsoon season. Our research findings suggest significant variations in rainwater isotopic values during the summer monsoon season across the Indo-Gangetic Plains. A trend towards lighter oxygen and hydrogen isotope values in rainwater is observed from June to September across all zones, with slightly heavier isotope values during August. However, there is no strong correlation between rainfall amount and isotopic values across the zones. Instead, the isotopic variations show good correlation with the Outgoing Longwave Radiation (OLR) values on a monthly scale. This rainfall variability is associated with the dry and wet phase of the Madden-Julian Oscillation. Correlation analysis between rainwater isotopes and meteorological parameters in concert with back-trajectory simulations demonstrates spatial changes in moisture sources throughout the summer monsoon period over the Indo-Gangetic plains
