Specialist community teams for adults with learning disabilities: referrals to a countywide service in England

Purpose – While “generic” community teams for adults with learning disabilities (CTs) are well-established in the UK, very little recent evidence is available about any aspect of their work. As part of a larger project about the role, structure and functioning of CTs, the purpose of this paper is to provide data about referrals. Design/methodology/approach – Over threemonths, the authors obtained data about 270 consecutive new referrals to five CTs in a countywide integrated health (NHS) and care management (local authority) service. Findings – The 270 referrals related to 255 individuals, mainly already service users, with almost a third (30 per cent, n=204) described as people with severe or profound disabilities. Consistent with the reported living arrangements (residential accommodation or with one or more family members (87 per cent, n=270)), referrals were most often made by social care staff, General Practitioners or carers. The referrals related to a wide range of issues including mental health and/or behavioural needs, physical health and skills, and independence. The major group, however, were requests about a person’s entitlement to specialist learning disability services and/or reviews of an existing social care package. Research limitations/implications – The focus on new referrals and the exclusion of intra-team referrals mean that the data are not representative of a CT’s caseload and cannot be used as a basis for resourcing. Nevertheless, the findings emphasise the heterogeneity of the population, and the long-term and varied nature of their needs, meaning that CTs require access to a range of expertise and, often, an inter-agency approach. The implications for service design are considered. Originality/value – This is the first empirical study of referrals to specialist integrated (health and care management) community learning disabilities teams in England

Normal Values of Circulating IGF-I Bioactivity in the Healthy Population: Comparison with five widely used IGF-I immunoassays

Background: IGF-I immunoassays are primarily used to estimate IGF-I bioactivity. Recently, an IGFI specific Kinase Receptor Activation Assay (KIRA) has been developed as an alternative method. However, no normative values have been established for the IGF-I KIRA. Objective: To establish normative values for the IGF-I KIRA in healthy adults. Design: Cross-sectional study in healthy non-fasting blood donors. Study participants: 426 healthy individuals (310 M, 116 F; age range: 18 – 79 yrs) Main outcome Measures: IGF-I bioactivity determined by the KIRA. Results were compared with total IGF-I, measured by five different IGF-I immunoassays. Results: Mean (± SD) IGF-I bioactivity was 423 (± 131) pmol/L and decreased with age (β = -3.4 pmol/L/yr, p < 0.001). In subjects younger than 55 yrs mean IGF-I bioactivity was significantly higher in women than in men. Above this age this relationship was inverse, suggesting a drop in IGF-I bioactivity after menopause. This drop was not reflected in total IGF-I levels. IGF-I bioactivity was significantly related to total IGF-I (rs varied between 0.46 – 0.52; P-values < 0.001). Conclusions: We established age-specific normative values for the IGF-I KIRA. We observed a significant drop in IGF-I bioactivity in women between 50 and 60 years, which was not perceived by IGF-I immunoassays. The IGF-I KIRA, when compared to IGF-I immunoassays, theoretically has the advantage that it measures net effects of IGF-binding proteins on IGF-I receptor activation. However, it has to be proven whether information obtained by the IGF-I KIRA is clinically more relevant than measurements obtained by IGF-I immunoassays

Electronic and geometric structure of NH₃ on Ge(001) under equilibrium adsorption conditions

The adsorption of NH3 on the Ge(001) surface is studied by angle-resolved UV-photoelectron spectroscopy using synchrotron radiation and by high-resolution low-energy electron diffraction (LEED) measurements. On the clean surface, the phase transition from 2×1 to c(4×2) is observed over a temperature range from 400 to 220 K. Measurements during NH3 admission at varying temperature in adsorption-desorption equilibrium yield a sequential occupation of several states. Up to 1/2 ML (one molecule per reconstruction dimer), NH3 is bound strongly on the dimer down atoms with the Ge-N axis perpendicular to the surface (α state). The adsorption occurs via a mobile precursor state. The α state is connected with a (2×2) superstructure. Yet, the transition c(4×2)→(2×2) starts already at very low coverages (0.01 ML) and is completed for about 0.04 ML. We propose that a long-range attractive interaction causes α-NH3-island formation and that a short-range repulsive interaction is responsible for a change to 2×2 within the islands by a dimer flip of every second dimer row. At the island edges, this dimer flip continues over the clean part of the surface thus changing its structure to 2×2 long before 1/2 ML saturation. Beyond 1/2 ML, the structure changes again. A good-quality 2×1 structure is seen up to 4 ML indicating pseudomorphic growth up to this coverage. Beyond 4 ML, the adsorbate structure changes irreversibly to NH3-ice without any LEED pattern

Set up of a methodology for participatory plant breeding in bread wheat in France

In Organic Agriculture, cultivation environments and agronomic practices are very diverse. This diversity can be handled with decentralized selection based on the knowledge of farmers and scientists. A collaborative work between associations from Réseau Semences Paysannes and the DEAP team from INRA du Moulon set up an innovative breeding approach on farm based on decentralization and participation of farmers. This approach makes it possible to (i) create new population varieties of bread wheat locally adapted (genetic innovation) (ii) set up an organizational scheme based on decentralization and co construction between actors (societal innovation) and (iii) develop experimental designs, create statistical and data management tools which stimulate these genetic and societal innovations

Prediction models for short children born small for gestational age (SGA) covering the total growth phase. Analyses based on data from KIGS (Pfizer International Growth Database)

<p>Abstract</p> <p>Background</p> <p>Mathematical models can be developed to predict growth in short children treated with growth hormone (GH). These models can serve to optimize and individualize treatment in terms of height outcomes and costs. The aims of this study were to compile existing prediction models for short children born SGA (SGA), to develop new models and to validate the algorithms.</p> <p>Methods</p> <p>Existing models to predict height velocity (HV) for the first two and the fourth prepubertal years and during total pubertal growth (TPG) on GH were applied to SGA children from the KIGS (Pfizer International Growth Database) - 1^styear: N = 2340; 2^ndyear: N = 1358; 4^thyear: N = 182; TPG: N = 59. A new prediction model was developed for the 3^rdprepubertal year based upon 317 children by means of the all-possible regression approach, using Mallow's C(p) criterion.</p> <p>Results</p> <p>The comparison between the observed and predicted height velocity showed no significant difference when the existing prediction models were applied to new cohorts. A model for predicting HV during the 3^rdyear explained 33% of the variability with an error SD of 1.0 cm/year. The predictors were (in order of importance): HV previous year; chronological age; weight SDS; mid-parent height SDS and GH dose.</p> <p>Conclusions</p> <p>Models to predict growth to GH from prepubertal years to adult height are available for short children born SGA. The models utilize easily accessible predictors and are accurate. The overall explained variability in SGA is relatively low, due to the heterogeneity of the disorder. The models can be used to provide patients with a realistic expectation of treatment, and may help to identify compliance problems or other underlying causes of treatment failure.</p

Kinetic study of the selective hydrogenation of styrene over a Pd egg-shell composite catalyst

This is a study on the kinetics of the liquid-phase hydrogenation of styrene to ethylbenzene over a catalyst of palladium supported on an inorganic–organic composite. This support has a better mechanical resistance than other commercial supports, e.g. alumina, and yields catalysts with egg-shell structure and a very thin active Pd layer. Catalytic tests were carried out in a batch reactor by varying temperature, total pressure and styrene initial concentration between 353–393 K, 10–30 bar, and 0.26–0.60 mol L−1. Kinetic models were developed on the assumptions of dissociative hydrogen chemisorption and non-negligible adsorption of hydrogen and styrene. Final chemical reaction expressions useful for reactor design were obtained. The models that best fitted the experimental data were those ones that considered the surface reaction as the limiting step. In this sense, a two-step Horiuti–Polanyi working mechanism with half hydrogenation intermediates gave the best fit of the experimental data. The heats of adsorption of styrene and ethylbenzene were also estimated.The authors are gratefully indebted to CONICET, ANPCyT and Universidad Nacional del Litoral for financially sponsoring this research work

Using primary sources to produce a microhistory of translation and translators: theoretical and methodological concerns

In descriptive studies, where the source and target texts are the main primary sources (‘primary text products’), ‘extra-textual’ sources are looked at with ‘circumspection’. However, in historical research methodologies they are central. This article examines the use and value of archives, manuscripts and, especially, translator papers, post-hoc accounts and interviews in producing a history of translation and translators. Rather than informing a ‘traditional’ Rankean history of facts and major personalities, the article underlines the potential value of such material in creating a ‘microhistory’, reclaiming the details of the everyday lives and working processes of sometimes little-known or forgotten translators and contextualising them to construct a social and cultural history of translation and translators. Sometimes these sources are housed in collections where translation may not be very visible, which creates problems of location. Examples are given from the autobiography of A. Birse and research on the working papers of Sam Hileman, Andrew Hurley, Bernard Miall and Margaret Sayers Peden

Motives for choosing growth-enhancing hormone treatment in adolescents with idiopathic short stature: a questionnaire and structured interview study

Background Growth-enhancing hormone treatment is considered a possible intervention in short but otherwise healthy adolescents. Although height gain is an obvious measure for evaluating hormone treatment, this may not be the ultimate goal for the person, but rather a means to reach other goals such as the amelioration of current height-related psychosocial problems or the enhancement of future prospects in life and society. The aim of our study was to clarify the motives of adolescents and their parents when choosing to participate in a growth-enhancing trial combining growth hormone and puberty-delaying hormone treatment. Methods Participants were early pubertal adolescents (25 girls, 13 boys) aged from 11 to 13 years (mean age 11.5 years) with a height standard deviation score (SDS) ranging from -1.03 to -3.43. All had been classified as idiopathic short stature or persistent short stature born small for the gestational age (intrauterine growth retardation) on the basis of a height SDS below -2, or had a height SDS between -1 and -2 and a predicted adult height SDS below -2. The adolescents and their parents completed questionnaires and a structured interview on the presence of height-related stressors, parental worries about their child's behavior and future prospects, problems in psychosocial functioning, and treatment expectations. Questionnaire scores were compared to norms of the general Dutch population. Results The adolescents reported normal psychosocial functioning and highly positive expectations of the treatment in terms of height gain, whereas the parents reported that their children encountered some behavioral problems (being anxious/depressed, and social and attention problems) and height-related stressors (being teased and juvenilized). About 40% of the parents were worried about their children's future prospects for finding a spouse or job. The motives of the adolescents and their parents exhibited rather different profiles. The most prevalent parental worries related to the current or future functioning of their children, while a few cases were characterized by no observed motives or by psychosocial problems only reported by the adolescents themselves. Conclusion The motives for participating in a growth-enhancing hormone trial are more obvious in the parents than in the adolescents themselves. Two out of three parents report worries about the future opportunities or observe modest current psychosocial problems in their children. The adolescents want to gain height, but the motivation underlying this remains unclear. Few of the adolescents experience psychosocial problems. Our analyses revealed differences among individuals in terms of motives, which implies that in an evaluation of hormone treatment, the importance of divergent outcome variables will also differ among individuals. Effectiveness evaluations of hormone treatment to increase height and the consequential fulfillment of other goals must be awaited

The first-year growth response to growth hormone treatment predicts the long-term prepubertal growth response in children

<p>Abstract</p> <p>Background</p> <p>Pretreatment auxological variables, such as birth size and parental heights, are important predictors of the growth response to GH treatment. For children with missing pretreatment data, published prediction models cannot be used.</p> <p>The objective was to construct and validate a prediction model for children with missing background data based on the observed first-year growth response to GH. The accuracy and reliability of the model should be comparable with our previously published prediction model relying on pretreatment data. The design used was mathematical curve fitting on observed growth response data from children treated with a GH dose of 33 μg/kg/d.</p> <p>Methods</p> <p>Growth response data from 162 prepubertal children born at term were used to construct the model; the group comprised of 19% girls, 80% GH-deficient and 23% born SGA. For validation, data from 205 other children fulfilling the same inclusion and treatment criteria as the model group were used. The model was also tested on data from children born prematurely, children from other continents and children receiving a GH dose of 67 μg/kg/d.</p> <p>Results</p> <p>The GH response curve was similar for all children, but with an individual amplitude. The curve SD score depends on an individual factor combining the effect of dose and growth, the 'Response Score', and time on treatment, making prediction possible when the first-year growth response is known. The prediction interval (± 2 SD_res) was ± 0.34 SDS for the second treatment year growth response, corresponding to ± 1.2 cm for a 3-year-old child and ± 1.8 cm for a 7-year-old child. For the 1–4-year prediction, the SD_reswas 0.13 SDS/year and for the 1–7-year prediction it was 0.57 SDS (i.e. < 0.1 SDS/year).</p> <p>Conclusion</p> <p>The model based on the observed first-year growth response on GH is valid worldwide for the prediction of up to 7 years of prepubertal growth in children with GHD/ISS, born AGA/SGA and born preterm/term, and can be used as an aid in medical decision making.</p

Surface atomic geometry of Si(001)-(2X1): A low-energy electron-diffraction structure analysis

The reconstruction of the Si(001)-2×1 surface consists of asymmetric and buckled Si dimers. The vertical separation between the up and the down atom within the dimer is about 0.72±0.05 Å and the dimer bond length of 2.24±0.08 Å has been found to be slightly smaller than the Si-Si distance in the bulk. The tilt of the dimer is 19±2°. The formation of Si dimers induces pronounced distortions in the substrate that were detectable down to the fifth Si layer. The structure determination is based on two independent low-energy electron-diffraction data sets taken in two different laboratories. The structural results agree well within the error limits, though noticeable differences occur between the experimental data sets. These differences in the experimental data can possibly be attributed to different preparation procedures