What are children's trusts? Early findings from a national survey

<i>Background:</i> The Children Act 2004 and National Service Framework for Children, Young People and Maternity Services require fuller integration of health, education and social services for children and young people in England and Wales. The UK government supported the establishment of 35 experimental children's trust pathfinders (henceforth called children's trusts) in England. <i>Methods:</i> A questionnaire was completed by managers in all 35 children's trusts a year after their start. Children's trust documents were examined. Census and performance indicators were compared between children's trust areas and the rest of England. <i>Results</i> Children's trust areas had demographic and social characteristics typical of England. All children's trusts aimed to improve health, education and social services by greater managerial and service integration. All had boards representing the three sectors; other agencies’ representation varied. Two-thirds of children's trusts had moved towards pooling budgets in at least some service areas. At this stage in their development, some had prioritized joint procurement or provision of services, with formal managerial structures, while others favoured an informal strategic planning, co-ordination and information sharing approach. The commonest priorities for services development were for disabled children (16 children's trusts), followed by early intervention (11) and mental health services (8). <i>Conclusions:</i> The diverse strategies adopted by these 35 children's trusts during their first year is due to their own characteristics and to the way government strategy developed during this period. Whilst some prioritized organizational development, joint financing and commissioning, and information sharing, others laid more emphasis on mechanisms for bringing front-line professionals closer together. Their experiences are of value to others deciding how best to integrate children's services

Issues in the incorporation of economic perspectives and evidence into Cochrane reviews

Methods for systematic reviews of the effects of health interventions have focused mainly on addressing the question of 'What works?' or 'Is this intervention effective in achieving one or more specific outcomes?' Addressing the question 'Is it worth it given the resources available?' has received less attention. This latter question can be addressed by applying an economic lens to the systematic review process.This paper reflects on the value and desire for the consideration by end users for coverage of an economic perspective in a Cochrane review and outlines two potential approaches and future directions

Producing Cochrane systematic reviews—a qualitative study of current approaches and opportunities for innovation and improvement

Background: Producing high-quality, relevant systematic reviews and keeping them up to date is challenging. Cochrane is a leading provider of systematic reviews in health. For Cochrane to continue to contribute to improvements in heath, Cochrane Reviews must be rigorous, reliable and up to date. We aimed to explore existing models of Cochrane Review production and emerging opportunities to improve the efficiency and sustainability of these processes. Methods: To inform discussions about how to best achieve this, we conducted 26 interviews and an online survey with 106 respondents. Results: Respondents highlighted the importance and challenge of creating reliable, timely systematic reviews. They described the challenges and opportunities presented by current production models, and they shared what they are doing to improve review production. They particularly highlighted significant challenges with increasing complexity of review methods; difficulty keeping authors on board and on track; and the length of time required to complete the process. Strong themes emerged about the roles of authors and Review Groups, the central actors in the review production process. The results suggest that improvements to Cochrane's systematic review production models could come from improving clarity of roles and expectations, ensuring continuity and consistency of input, enabling active management of the review process, centralising some review production steps; breaking reviews into smaller "chunks", and improving approaches to building capacity of and sharing information between authors and Review Groups. Respondents noted the important role new technologies have to play in enabling these improvements. Conclusions: The findings of this study will inform the development of new Cochrane Review production models and may provide valuable data for other systematic review producers as they consider how best to produce rigorous, reliable, up-to-date reviews

Economics methods in Cochrane systematic reviews of health promotion and public health related interventions.

Peer reviewedPublisher PD

Are isomeric alkenes used in species recognition among neo-tropical stingless bees (Melipona spp)

The majority of our understanding of the role of cuticular hydrocarbons (CHC) in recognition is based largely on temperate ant species and honey bees. The stingless bees remain relatively poorly studied, despite being the largest group of eusocial bees, comprising more than 400 species in some 60 genera. The Meliponini and Apini diverged between 80-130 Myr B.P. so the evolutionary trajectories that shaped the chemical communication systems in ants, honeybees and stingless bees may be very different. Therefore, the main aim of this study was to study if a unique species CHC signal existed in Neotropical stingless bees, as shown for many temperate species, and if so what compounds are involved. This was achieved by collecting CHC data from 24 colonies belonging to six species of Melipona from North-eastern Brazil and comparing this new data with all previously published CHC studies on Melipona. We found that each of the eleven Melipona species studied so far each produced a unique species CHC signal based around their alkene isomer production. A remarkable number of alkene isomers, up to 25 in M. asilvai, indicated the diversification of alkene positional isomers among the stingless bees. The only other group to have really diversified in alkene isomer production are the primitively eusocial Bumblebees (Bombus spp), which are the sister group of the stingless bees. Furthermore, among the eleven Neotropical Melipona species we could detect no effect of the environment on the proportion of alkane production as has been suggested for some other species

Sources of variation in cuticular hydrocarbons in the ant formica exsecta

Phenotypic variation arises from interactions between genotype and environment, although how variation is produced and then maintained remains unclear. The discovery of the nest-mate recognition system in Formica exsecta ants has allowed phenotypic variation in chemical profiles to be quantified across a natural population of 83 colonies. We investigated if this variation was correlated or not with intrinsic (genetic relatedness), extrinsic (location, light, temperature) or social (queen number) factors. (Z)-9-Alkenes and n-alkanes showed different patterns of variance: island (location) explained only 0.2% of the variation in (Z)-9-alkenes, but 21¬–29% in n-alkanes, whereas colony of origin explained 96% and 45–49% of the variation in (Z)-9-alkenes and n-alkanes, respectively. By contrast, within-colony variance of (Z)-9-alkenes was 4%, and 23–34% in n-alkanes, supporting the function of the former as recognition cues. (Z)-9-Alkene and n-alkane profiles were correlated with the genetic distance between colonies. Only n-alkane profiles diverged with increasing spatial distance. Sampling year explained a small (5%), but significant, amount of the variation in the (Z)-9-alkenes, but there was no consistent directional trend. Polygynous colonies and populous monogynous colonies were dominated by a rich C23:1 profile. We found no associations between worker size, mound exposure, or humidity, although effect sizes for the latter two factors were considerable. The results support the conjecture that genetic factors are the most likely source of between-colony variation in cuticular hydrocarbons

Life history and chemical ecology of the Warrior wasp Synoeca septentrionalis (Hymenoptera : Vespidae, Epiponini)

Swarm-founding ‘Warrior wasps’ (Synoeca spp.) are found throughout the tropical regions of South America, are much feared due to their aggressive nest defence and painful sting. There are only five species of Synoeca, all construct distinctive nests that consist of a single sessile comb built onto the surface of a tree or rock face, which is covered by a ribbed envelope. Although locally common, research into this group is just starting. We studied eight colonies of Synoeca septentrionalis, a species recently been described from Brazil. A new colony is established by a swarm of 52 to 140 adults that constructs a colony containing around 200 brood cells. The largest colony collected containing 865 adults and over 1400 cells. The number of queen’s present among the eight colonies varied between 3 and 58 and no clear association between colony development and queen number was detected. Workers and queens were morphologically indistinguishable, but differences in their cuticular hydrocarbons were detected, particularly in their (Z)-9-alkenes. The simple cuticular profile, multiple queens, large size and small number of species makes the ‘Warrior wasps’ an excellent model group for further chemical ecology studies of swarm-founding wasps

The Use of Decision–Analytic Models in Atopic Eczema: A Systematic Review and Critical Appraisal

Objective: The objective of this systematic review was to identify and assess the quality of published economic decision–analytic models within atopic eczema against best practice guidelines, with the intention of informing future decision–analytic models within this condition. Methods: A systematic search of the following online databases was performed: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, NHS Economic Evaluation Database, EconLit, Scopus, Health Technology Assessment, Cost-Effectiveness Analysis Registry and Web of Science. Papers were eligible for inclusion if they described a decision–analytic model evaluating both the costs and benefits associated with an intervention or prevention for atopic eczema. Data were extracted using a standardised form by two independent reviewers, whilst quality was assessed using the model-specific Philips criteria. Results: Twenty-four models were identified, evaluating either preventions (n = 12) or interventions (n = 12): 14 reported using a Markov modelling approach, four utilised decision trees and one a discrete event simulation, whilst five did not specify the approach. The majority, 22 studies, reported that the intervention was dominant or cost effective, given the assumptions and analytical perspective taken. Notably, the models tended to be short-term (16 used a time horizon of ≤1 year), often providing little justification for the limited time horizon chosen. The methodological and reporting quality of the studies was generally weak, with only seven studies fulfilling more than 50% of their applicable Philips criteria. Conclusions: This is the first systematic review of decision models in eczema. Whilst the majority of models reported favourable outcomes in terms of the cost effectiveness of the new intervention, the usefulness of these findings for decision-making is questionable. In particular, there is considerable scope for increasing the range of interventions evaluated, for improving modelling structures and reporting quality

Evidence for passive chemical camouflage in the parasitic mite Varroa destructor

Social insect colonies provide a stable and safe environment for their members. Despite colonies been heavily guarded, parasites have evolved numerous strategies to invade and inhabit these hostile places. Two common strategies are chemical mimicry via biosynthesis of the hosts' odour or chemical camouflage were compounds are acquired straight from the host. The ectoparasitic mite Varroa destructor feeds on the heamolymph of its honeybee host Apis mellifera and uses chemical mimicry to remain undetected as it lives on the adult host during its phoretic phase or while reproducing on the honeybee brood. During the mite life cycle it switches between host adults and brood, which requires it to adjust its profile to mimic the very different odours of honeybee brood and adults. In a series of transfer experiments using adult bees and pupae, we tested whether V. destructor does this by synthesising compounds or using chemical camouflage. We show that V. destructor required direct access to the host cuticle to mimic its odour and was unable to synthesise host-specific compounds itself. Mites use chemical camouflage to mimic the host odour, even when dead, indicating a passive physico-chemical mechanism of the parasite cuticle. The chemical profile of V. destructor was adjusted within three to nine hours after switching hosts, demonstrating that passive camouflage is a highly efficient, fast and flexible way for the mite’s to adapt to a new host's profile when moving between different host life stages, or host colonies

Improving ranking for systematic reviews using query adaptation

Identifying relevant studies for inclusion in systematic reviews requires significant effort from human experts who manually screen large numbers of studies. The problem is made more difficult by the growing volume of medical literature and Information Retrieval techniques have proved to be useful to reduce workload. Reviewers are often interested in particular types of evidence such as Diagnostic Test Accuracy studies. This paper explores the use of query adaption to identify particular types of evidence and thereby reduce the workload placed on reviewers. A simple retrieval system that ranks studies using TF.IDF weighted cosine similarity was implemented. The Log-Likelihood, ChiSquared and Odds-Ratio lexical statistics and relevance feedback were used to generate sets of terms that indicate evidence relevant to Diagnostic Test Accuracy reviews. Experiments using a set of 80 systematic reviews from the CLEF2017 and CLEF2018 eHealth tasks demonstrate that the approach improves retrieval performance