The national impact of regional policy : policy simulation with labour market constraints in a two-regional computable general equilibrium model

The first step in a comprehensive evaluation of regional policy is to identify its full spatial impact. This involves two tasks. The first is to determine the form and strength of inter-regional linkages. The second is to specify the national constraints within which the system of regional economies operates. In this paper we use simulation results from a two-region Computable General Equilibrium (CGE) model of Scotland and the rest of the UK (RUK) to investigate these issues. The inter-regional linkages incorporate trade and income flows, inter-regional capital mobility and migration. The constraint that we focus on is an overall national population constraint and its impact on regional wage determination. The paper is structured in the following way. Section 2 outlines the AMOSRUK modelling framework. Section 3 describes the alternative labour-market model configurations used in the simulations. Section 4 reports the results for the model simulation and Section 5 is a short conclusion

Reproductive Failure in UK Harbour Porpoises Phocoena phocoena : Legacy of Pollutant Exposure?

This research was supported by a Marie Curie International Outgoing Fellowship within the Seventh European Community Framework Programme (Project Cetacean-stressors, PIOF-GA-2010-276145 to PDJ and SM). Additional funding was provided through the Agreement on the Conservation of Small Cetaceans of the Baltic, North East Atlantic, Irish and North Seas (ASCOBANS) (Grants SSFA/2008 and SSFA / ASCOBANS / 2010 / 5 to SM). Analysis of Scottish reproductive and teeth samples was funded by the EC-funded BIOCET project (BIOaccumulation of persistent organic pollutants in small CETaceans in European waters: transport pathways and impact on reproduction, grant EVK3-2000-00027 to GJP), and Marine Scotland (GJP). Samples examined in this research were collected under the collaborative Cetacean Strandings Investigation Programme (http://ukstrandings.org/), which is funded by the Department for Environment, Food and Rural Affairs (Defra) and the UK’s Devolved Administrations in Scotland and Wales (http://sciencesearch.defra.gov.uk/Defaul​t.aspx?Menu=Menu&Module=More&Location=No​ne&Completed=0&ProjectID=15331) (grants to PDJ, RD). UK Defra also funded the chemical analysis under a service-level agreement with the Centre for Environment, Fisheries and Aquaculture Science (grants to RJL, JB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Clinical Performance of an Automated Reader in Interpreting Malaria Rapid Diagnostic Tests in Tanzania.

Parasitological confirmation of malaria is now recommended in all febrile patients by the World Health Organization (WHO) to reduce inappropriate use of anti-malarial drugs. Widespread implementation of rapid diagnostic tests (RDTs) is regarded as an effective strategy to achieve this goal. However, the quality of diagnosis provided by RDTs in remote rural dispensaries and health centres is not ideal. Feasible RDT quality control programmes in these settings are challenging. Collection of information regarding diagnostic events is also very deficient in low-resource countries. A prospective cohort of consecutive patients aged more than one year from both genders, seeking routine care for febrile episodes at dispensaries located in the Bagamoyo district of Tanzania, were enrolled into the study after signing an informed consent form. Blood samples were taken for thick blood smear (TBS) microscopic examination and malaria RDT (SD Bioline Malaria Antigen Pf/PanTM (SD RDT)). RDT results were interpreted by both visual interpretation and DekiReaderTM device. Results of visual interpretation were used for case management purposes. Microscopy was considered the "gold standard test" to assess the sensitivity and specificity of the DekiReader interpretation and to compare it to visual interpretation. In total, 1,346 febrile subjects were included in the final analysis. The SD RDT, when used in conjunction with the DekiReader and upon visual interpretation, had sensitivities of 95.3% (95% CI, 90.6-97.7) and 94.7% (95% CI, 89.8--97.3) respectively, and specificities of 94.6% (95% CI, 93.5--96.1) and 95.6% (95% CI, 94.2--96.6), respectively to gold standard. There was a high percentage of overall agreement between the two methods of interpretation. The sensitivity and specificity of the DekiReader in interpretation of SD RDTs were comparable to previous reports and showed high agreement to visual interpretation (>98%). The results of the study reflect the situation in real practice and show good performance characteristics of DekiReader on interpreting malaria RDTs in the hands of local laboratory technicians. They also suggest that a system like this could provide great benefits to the health care system. Further studies to look at ease of use by community health workers, and cost benefit of the system are warranted

The development of path integration: combining estimations of distance and heading

Efficient daily navigation is underpinned by path integration, the mechanism by which we use self-movement information to update our position in space. This process is well-understood in adulthood, but there has been relatively little study of path integration in childhood, leading to an underrepresentation in accounts of navigational development. Previous research has shown that calculation of distance and heading both tend to be less accurate in children as they are in adults, although there have been no studies of the combined calculation of distance and heading that typifies naturalistic path integration. In the present study 5-year-olds and 7-year-olds took part in a triangle-completion task, where they were required to return to the startpoint of a multi-element path using only idiothetic information. Performance was compared to a sample of adult participants, who were found to be more accurate than children on measures of landing error, heading error, and distance error. 7-year-olds were significantly more accurate than 5-year-olds on measures of landing error and heading error, although the difference between groups was much smaller for distance error. All measures were reliably correlated with age, demonstrating a clear development of path integration abilities within the age range tested. Taken together, these data make a strong case for the inclusion of path integration within developmental models of spatial navigational processing

Spirit(ed) away: preventing foetal alcohol syndrome with motivational interviewing and cognitve behavioural therapy

Foetal alcohol syndrome (FAS) is a growing concern in South Africa. In the Western Cape, prevalence rates for FAS are the highest in the world. Not surprisingly, the Western Cape also has some of the highest levels of alcohol consumption per capita. Although FAS is primarily caused by alcohol consumption during pregnancy, the high rate of FAS in South Africa originates from a multitude of complex factors. These factors include heritage, poverty, high levels of unemployment and low-paid menial jobs, depression, low self-esteem, low self-efficacy, increased accessibility to alcohol, lack of recreation, poor education, familial pressure, denial, cultural misconceptions and the smaller physiques of some of the women in the Western Cape. Holistic and comprehensive macro- and micro-level approaches are necessary in order to change the alcohol consumption trend that has developed over the last 300 years. No single strategy will reduce or eliminate the burden of alcohol misuse in this society. However, as the presented discussion suggests, combining the spirit of motivational interviewing (MI) with cognitive behavioural therapy (CBT) practice, borrowed from health psychological interventions for lifestyle-related chronic health conditions, holds promise for reducing the prevalence of FAS within Western Cape communities. These individual-based approaches have yet to be employed in South Africa despite the wealth of evidence that demonstrates their potential in targeting high-risk groups and reducing per capita alcohol consumption

Spirit(ed) away: preventing foetal alcohol syndrome with motivational interviewing and cognitive behavioural therapy

Foetal alcohol syndrome (FAS) is a growing concern in South Africa. In the Western Cape, prevalence rates for FAS are the highest in the world. Not surprisingly, the Western Cape also has some of the highest levels of alcohol consumption per capita. Although FAS is primarily caused by alcohol consumption during pregnancy, the high rate of FAS in South Africa originates from a multitude of complex factors. These factors include heritage, poverty, high levels of unemployment and low-paid menial jobs, depression, low self-esteem, low self-efficacy, increased accessibility to alcohol, lack of recreation, poor education, familial pressure, denial, cultural misconceptions and the smaller physiques of some of the women in the Western Cape. Holistic and comprehensive macro- and micro-level approaches are necessary in order to change the alcohol consumption trend that has developed over the last 300 years. No single strategy will reduce or eliminate the burden of alcohol misuse in this society. However, as the presented discussion suggests, combining the spirit of motivational interviewing (MI) with cognitive behavioural therapy (CBT) practice, borrowed from health psychological interventions for lifestyle-related chronic health conditions, holds promise for reducing the prevalence of FAS within Western Cape communities. These individual-based approaches have yet to be employed in South Africa despite the wealth of evidence that demonstrates their potential in targeting high-risk groups and reducing per capita alcohol consumption.Keywords: foetal alcohol syndrome, preventative health, spirit of motivational interviewing, cognitive behaviour therapy, Western Cap

The Oxford hip score: the patient's perspective

BACKGROUND: In the last 25 years, assessment of orthopaedic intervention has become patient focused, with the development of self-completion patient-centred outcome measures. The Oxford hip score (OHS) is a joint specific outcome measure tool designed to assess disability in patients undergoing total hip replacement (THR). Although the psychometric properties of the OHS have been rigorously examined, there is little research on the patient's perspective of the OHS. Therefore, the aim of this study is to assess whether the OHS is an adequate disability measure from the patient's perspective using qualitative analysis of annotations written on the OHS by patients. METHODS: In total, 276 orthopaedic patients completed an OHS between April 2004 and May 2005. One hundred and fifty six pre-operative patients listed for a THR completed the OHS during a pre-admission assessment clinic, and 120 post-operative patients completed the OHS postally in the home setting. Patient's unprompted annotations in response to the questions on the OHS were recorded and grouped into thematic categories. RESULTS: In total, 46 (17%) patients made 52 annotations when completing the OHS. These annotations identified five main areas of difficulty that patients experienced: lack of question clarity (particularly concerning the use of aids), difficulty in reporting measurements of pain, restrictive and irrelevant questions, the influence of co-morbidities on responses, and double-barrelled questions. CONCLUSION: Although the OHS is a useful short tool for the assessment of disability in patients undergoing THR, this study identified several problem areas that are applicable to patient-centred outcome tools in general. To overcome these current limitations, further work is underway to develop a more individualised patient-centred outcome measure of disability for use in patients with osteoarthritis

The effectiveness and acceptability of a computerised cognitive behavioural therapy programme and the psychometric properties of its service user generated outcome measure

Background: Physical and psychological ill-health is strongly interlinked. Poor physical health can amplify psychological symptoms; whilst disabling physical symptomology and illnesses have been improved by the treatment of depression and/or anxiety. Currently, demand outstrips the supply of psychological treatments for common mental health problems. This is mainly due to the lack of trained therapists in the UK. Effective and less herapist-intensive interventions are required. The efficacy of computerised cognitive behavioural therapy (CCBT) has been demonstrated in routine primary care. However, service users in secondary care and those with physical and psychological co-morbidities have frequently been excluded from these studies. Further research, particularly qualitative research, focusing on service users' satisfaction with CCBT has also been called for by National Institute for Health and Clinical Excellence (NICE) reviewers. Concurrently,v ery little knowledge exists on what problems users bring to work on in CCBT sessions; whilst service user empowerment perspectives call for an increase in supported self help interventions and "patient as expert" quality of life outcome measures in order to improve accessibility to services and actively involve service users in the delivery of their care. Aims: The first reported piece of research was a naturalistic non-randomised study carried out to establish the effectiveness and acceptability of a CCBT programme, Beating the Blues, as an intervention for anxiety and depression in an NHS CBT specialist centre. The study also sought to identify whether physical co-morbidities altered the nature of the intervention's impact on clinical outcomes. The following two studies evaluated the psychometric properties of an electronic service user generated Subjective Units of Distress (SUDS) measure. Methods: Five hundred and ninety service users were included in the study. Three groups, a control group, a standard intervention group, and a physical co-morbidity intervention group, were compared on pre- and post-BDI-11 scores. The two intervention groups were also compared on pre- and post-BAI scores. Qualitative feedback and satisfaction rating scores were analysed to establish the acceptability of Beating the Blues. Despina Learmonth DPsych. (Health Psychology) 2007 The validity of the SUDS measurew as assessedu sing the BDI-11B, AI, and CORE-OMa validated measures with which the SUDS could be correlated. The internal reliability and sensitivity of the SUDS measure were also evaluated. A conventional content analysis was carried out to explore what types of problems service users chose to work on when using Beating the Blues. Results: In completer and intention-to-treat analyses, statistically significant differences were found for mean score changes on the BDI-11 between the control group and both the intervention groups. No differences were found between the intervention groups on either the BDI-I I or BAL A quarter and one fifth of completers in each group achieved reliable and clinically significant change on the BDI-11 and BAI respectively. In terms of acceptability, most of the participants found Beating the Blues to be a useful therapeutic tool. The qualitative feedback indicated four active core categories regarding both the features of Beating the Blues that service users found useful, and the ways in which they felt the programme could be improved upon. Seven main categories emerged from a number of sub-categories focusing on the described problems that service users choose to work on when using Beating the Blues. Service users broadly described symptoms, and emotional and practical issues as problems. The SUDS appeared to be sensitive to clinical change and to provide some measure of wellbeing, problems, and functioning; however, further research into certain aspects of its validity is still required. Conclusion: The research findings provided compelling evidence that Beating the Blues may be of value to service users suffering with depression and/or anxiety and varied physical and psychological co-morbidities in secondary care CBT specialist centres. The electronic SUDS measure contained within the programme also demonstrated potential to successfully incorporate service users' perspectives into more comprehensive evaluations of their wellbeing and quality of life. Further research needs to focus on: factors affecting adherence to Beating the Blues and its effectiveness with anxiety, the incorporation of physical health outcome measures, the use of the programme - including the SUDS measure - with individuals from different ethnic and socio-economic backgrounds, acceptability of the SUDS measure to practitioners, and reasons for its non-completion amongst service users

Effects of Pilates-Based Core Stability Training in Ambulant People With Multiple Sclerosis: Multicenter, Assessor-Blinded, Randomized Controlled Trial

Background Pilates exercise is often undertaken by people with multiple sclerosis (MS) who have balance and mobility difficulties. Objectives The primary aim of the study was to compare the effects of 12 weeks of Pilates exercises with relaxation on balance and mobility. Secondary aims were: (1) to compare standardized exercises with relaxation and (2) to compare Pilates exercises with standardized exercises. Methods A multicenter, assessor-blinded, randomized controlled trial was conducted. Participants with Expanded Disability Status Scale scores of 4.0 to 6.5 were randomly allocated to groups receiving 12 weeks of Pilates exercises, standardized exercises, or relaxation. Assessments were undertaken at baseline and weeks 12 and 16 (primary outcome measure: 10-Meter Timed Walk Test [10MTW]). Results One hundred participants (mean age=54 years, 74% female) were randomized to study groups. Six participants relapsed (withdrew from the study), leaving 94 participants for intention-to-treat analysis. There was no significant difference in mean 10MTW measurements between the Pilates and relaxation groups. At 12 weeks, there was a mean reduction of 4.2 seconds for the standardized exercise group compared with the relaxation group (95% confidence interval [relaxation group minus standardized exercise group measurements]=0.0, 8.4) and a mean reduction of 3.7 seconds for the Pilates group compared with the standardized exercise group (95% confidence interval [Pilates group minus standardized exercise group measurements]=−0.4 to 7.8). At 16 weeks, mean 10MTW times for the standardized exercise group remained quicker than those for the Pilates and relaxation groups, although the differences were nonsignificant. There were no significant differences between the Pilates and relaxation groups for any secondary outcome measure. Limitations In this study, therapists were limited to a standardized basket of exercises that may have affected the study outcomes. Furthermore, choosing measures such as posturography to assess balance, accelerometry to assess walking, or a specific trunk assessment scale might have been more responsive in detecting changes in outcome. Conclusion Participants did not improve significantly, either in the short term or at the 4-week follow-up, on the 10MTW after 12 weeks of Pilates exercises compared with 12 weeks of relaxation

Recommendations for a core outcome set for measuring standing balance in adult populations: a consensus-based approach

Standing balance is imperative for mobility and avoiding falls. Use of an excessive number of standing balance measures has limited the synthesis of balance intervention data and hampered consistent clinical practice.To develop recommendations for a core outcome set (COS) of standing balance measures for research and practice among adults.A combination of scoping reviews, literature appraisal, anonymous voting and face-to-face meetings with fourteen invited experts from a range of disciplines with international recognition in balance measurement and falls prevention. Consensus was sought over three rounds using pre-established criteria.The scoping review identified 56 existing standing balance measures validated in adult populations with evidence of use in the past five years, and these were considered for inclusion in the COS.Fifteen measures were excluded after the first round of scoring and a further 36 after round two. Five measures were considered in round three. Two measures reached consensus for recommendation, and the expert panel recommended that at a minimum, either the Berg Balance Scale or Mini Balance Evaluation Systems Test be used when measuring standing balance in adult populations.Inclusion of two measures in the COS may increase the feasibility of potential uptake, but poses challenges for data synthesis. Adoption of the standing balance COS does not constitute a comprehensive balance assessment for any population, and users should include additional validated measures as appropriate.The absence of a gold standard for measuring standing balance has contributed to the proliferation of outcome measures. These recommendations represent an important first step towards greater standardization in the assessment and measurement of this critical skill and will inform clinical research and practice internationally