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Introduction A long T2 relaxation time can reflect oedema, and myocardial inflammation when combined with increased plasma troponin levels. Cardiovascular magnetic resonance (CMR) T2 mapping therefore has potential to provide a key diagnostic and prognostic biomarkers. However, T2 varies by scanner, software, and sequence, highlighting the need for standardization and for a quality assurance system for T2 mapping in CMR. Aim To fabricate and assess a phantom dedicated to the quality assurance of T2 mapping in CMR. Method A T2 mapping phantom was manufactured to contain 9 T1 and T2 (T1|T2) tubes to mimic clinically relevant native and post-contrast T2 in myocardium across the health to inflammation spectrum (i.e., 43–74 ms) and across both field strengths (1.5 and 3 T). We evaluated the phantom’s structural integrity, B0 and B1 uniformity using field maps, and temperature dependence. Baseline reference T1|T2 were measured using inversion recovery gradient echo and single-echo spin echo (SE) sequences respectively, both with long repetition times (10 s). Long-term reproducibility of T1|T2 was determined by repeated T1|T2 mapping of the phantom at baseline and at 12 months. Results The phantom embodies 9 internal agarose-containing T1|T2 tubes doped with nickel di-chloride (NiCl2) as the paramagnetic relaxation modifier to cover the clinically relevant spectrum of myocardial T2. The tubes are surrounded by an agarose-gel matrix which is doped with NiCl2 and packed with high-density polyethylene (HDPE) beads. All tubes at both field strengths, showed measurement errors up to ≤ 7.2 ms [2 by balanced steady-state free precession T2 mapping compared to reference SE T2 with the exception of the post-contrast tube of ultra-low T1 where the deviance was up to 16 ms [40.0%]. At 12 months, the phantom remained free of air bubbles, susceptibility, and off-resonance artifacts. The inclusion of HDPE beads effectively flattened the B0 and B1 magnetic fields in the imaged slice. Independent temperature dependency experiments over the 13–38 °C range confirmed the greater stability of shorter vs longer T1|T2 tubes. Excellent long-term (12-month) reproducibility of measured T1|T2 was demonstrated across both field strengths (all coefficients of variation Conclusion The T2 mapping phantom demonstrates excellent structural integrity, B0 and B1 uniformity, and reproducibility of its internal tube T1|T2 out to 1 year. This device may now be mass-produced to support the quality assurance of T2 mapping in CMR.

Supplemental Digital Content is available in the text., OBJECTIVES: To evaluate the implementation of a pediatric sepsis pathway in the emergency department as part of a statewide quality improvement initiative in Queensland, Australia. DESIGN: Multicenter observational prospective cohort study. SETTING: Twelve emergency departments in Queensland, Australia. PATIENTS: Children less than 18 years evaluated for sepsis in the emergency department. Patients with signs of shock, nonshocked patients with signs of organ dysfunction, and patients without organ dysfunction were assessed. INTERVENTIONS: Introduction of a pediatric sepsis pathway. MEASUREMENTS AND MAIN RESULTS: Process measures included compliance with and timeliness of the sepsis bundle, and bundle components. Process and outcome measures of children admitted to the ICU with sepsis were compared with a baseline cohort. Five-hundred twenty-three children were treated for sepsis including 291 with suspected sepsis without organ dysfunction, 86 with sepsis-associated organ dysfunction, and 146 with septic shock. Twenty-four (5%) were admitted to ICU, and three (1%) died. The median time from sepsis recognition to bundle commencement for children with septic shock was 56 minutes (interquartile range, 36–99 min) and 47 minutes (interquartile range, 34–76 min) for children with sepsis-associated organ dysfunction without shock; 30% (n = 44) and 40% (n = 34), respectively, received the bundle within the target timeframe. In comparison with the baseline ICU cohort, bundle compliance improved from 27% (n = 45) to 58% (n = 14) within 60 minutes of recognition and from 47% (n = 78/167) to 75% (n = 18) within 180 minutes of recognition (p < 0.05). CONCLUSIONS: Our findings on the introduction of protocolized care in a large and diverse state demonstrate ongoing variability in sepsis bundle compliance. Although bundle compliance improved compared with a baseline cohort, continued efforts are required to ensure guideline targets and sustainability are achieved.

Aims To explore the impact of incorporating a faster cardiac magnetic resonance (CMR) imaging protocol in a low–middle-income country (LMIC) and using the result to guide chelation in transfusion-dependent patients. Methods and results A prospective UK–India collaborative cohort study was conducted in two cities in India. Two visits 13 months apart included clinical assessment and chelation therapy recommendations based on rapid CMR results. Participants were recruited by the local patient advocate charity, who organized the patient medical camps. The average scanning time was 11.3 ± 2.5 min at the baseline and 9.8 ± 2.4 min (P Conclusion For thalassaemia patients in an LMIC, a simplified CMR protocol linked to therapeutic recommendation via the patient camp model led to enhanced chelation therapy and a reduction in cardiac iron in 1 year.

Background: Survival in transfusion dependent thalassemia is closely linked to iron overload with severe cardiac iron causing heart failure. MRI guided chelation improves survival in high income countries. We explored the use of rapid MRI to guide therapy in a Lower Middle Income Country (LMIC), India, via locally organized thalassemia patient medical camps. Methods: Rapid cardiac MRI (rCMR) was implemented at two sites with clinical assessment and therapy recommendations based on rCMR findings. Investigations and clinical reassessment were repeated at 13 months. Findings: The baseline visit was attended by 103 patients, the second by 86. Average time of scanning was 10 minutes. At baseline 29% had a cardiac T2* = 17ms). At 13 months more patients were taking 2 oral chelators (21% to 37%, p

IntroductionThe National Pupil Database (NPD) is a record-level administrative data resource curated by the UK government’s Department for Education that is used for funding purposes, school performance tables, policy making, and research. ProcessesData are sourced from schools, exam awarding bodies, and local authorities who collect data on an on-going basis and submit to the Department for Education either termly or yearly. Data contentsNPD contains child-level and school-level data on all pupils in state schools in England (6.6 million in the 2016/17 academic year). The primary module is the census, which has information on characteristics and school enrolment. Other modules include alternative provision, exam attainment, absence and exclusions. Data from children’s social care are also available on children referred for support and those who become looked after. Children’s records are linkable across different modules and across time using a nationally unique, anonymised child-level identifier. Linkage to external datasets has also been accomplished using child-level identifiers. ConclusionsThe NPD is an especially valuable data resource for researchers interested in the educational experience and outcomes of children and young people in England. Although limited by the fact that children in private schools or who are home schooled are not included, it provides a near-complete picture of school trajectories and outcomes for the majority of children. Linkage to other datasets can enhance analyses and provide answers to questions that would otherwise be costly, time consuming and difficult to find.

BackgroundEarly identification of child adversity (comprising abuse, neglect, social or material adversity) is essential to target early interventions to safeguard children, and support vulnerable families. We determined the prevalence of indicators of adversity recorded in diagnostic codes in child and/or maternal hospital admissions in England. Data SourceAll birth admissions recorded in the NHS in England in 2011, and subsequent admissions up to 5 years old, linked to maternal records from 1 year before to up to 5 years after delivery. MethodsPrevalence of adversity indicators in child and/or maternal admission records that reflect adversity-related injury (ARI), or social or material adversity (SMA). ResultsAmong 646,956 live born children, 2.6% (95% CI: 2.6 to 2.7) had at least one adversity indicator by

BackgroundOutcomes for children in care vary by the stability of their placements (for example, more placement changes have been associated with poorer educational attainment). Official statistics describing the stability of care histories for children in England are limited to placement changes within a 12-month period. These annual statistical ‘snapshots’ cannot capture the complexity of children’s experiences; however, as administrative data have been routinely collected since 1992, it is possible to reconstruct longitudinal care histories. ObjectiveTo identify distinct patterns of care history by applying sequence analysis methods to longitudinal, administrative data. MethodsWe extracted care histories from birth to age 18 for a large, representative sample of children born 1992-94 (N=16,000) from routinely-collected Children Looked After Return data. We explored the heterogeneity of children’s care histories in terms of stability and identified sub-groups based on the number, duration and timing of placements using sequence analysis methods. ResultsChildren’s care histories were varied with the number of placements ranging from 1 to 184 (median: 2). However, six distinct sub-groups of care history were evident including; adolescent entries (17.6%), long-term instability (13.1%) and early intervention (6.9%). Overall, most children (58.4%) had a care history that could be classified as’short-term care’ with an average of 276 days in care and 2.48 placements throughout childhood. Few children (4.0%) had a care history that could be described as ‘long-term stable care’. ConclusionsSequence analyses of longitudinal data can refine our understanding of how out-of-home care is used as a social care intervention. Despite the policy focus on achieving long-term stability for children in care, the vast majority of children remain in care for a short period of time. Future work exploring how outcomes vary between the different sub-groups of care history could enable better evaluation of the effects of longitudinal care experiences.

ObjectivesIn England, approximately one in thirty children spend time in out-of-home care (OHC) by age 18.Use of OHC is known to vary across the country, which may be explained in part by ethnic group differences in the risk of being placed in OHC. This study uses linked administrative data to determine whether local variation in the cumulative proportion of children placed in OHC is explained by differences in the ethnic distribution of the local populations. Approach Administrative social care records from January 1, 1992 to December 31, 2012 for a one-third sample of children were linked to publicly-available local authority population estimates. Two artificial birth cohorts were selected for analysis; 1992-94 and 2009-11. The cumulative proportion of children who entered OHC was calculated for each of the current 150 local authorities (the local government bodies who deliver children’s social care services). Funnel plots were used to identify local authorities with higher or lower than expected rates of entry to OHC, taking into account the size of their child population and its ethnic distribution. ResultsOverall 3.3% of children in England born 1992-94 had entered OHC by age 18. Rates varied considerably by local authority from this national average, ranging from just 1.0% in Rutland to 6.9% in Manchester (both p

We conducted ethnographic research in collaboration with a large, research-intensive London breast cancer service in 2013-2014 so as to understand the practices and potential effects of stratified medicine. Stratified medicine is often seen as a synonym for both personalised and precision medicine but these three terms, we found, also related to distinct facets of treatment and care. Personalised medicine is the term adopted for the developing 2016 NHS England Strategy, in which breast cancer care is considered a prime example of improved biological precision and better patient outcomes. We asked how this biologically stratified medicine affected wider relations of care and treatment. We interviewed formally 33 patients and 23 of their carers, including healthcare workers; attended meetings associated with service improvements, medical decision-making, public engagement, and scientific developments as well as following patients through waiting rooms, clinical consultations and other settings. We found that the translation of new protocols based on biological research introduced further complications into an already-complex patient pathway. Combinations of new and historic forms of stratification had an impact on almost all patients, carers and staff, resulting in care that often felt less rather than more personal.

Envy is a universal human emotion which has increasing interdisciplinary significance in the social sciences. In the organisational setting, envy can be ubiquitous and has often been associated with employee deviance, counterproductive workplace behaviours and bullying. This harmful view of envy can be explained from a psychoanalytic perspective; characterised by feelings of ill will toward the envied person. However comparatively few measures have been developed to capture these feelings of envious hostility. This is most likely because envy is a disguised emotion; hence presenting the researcher with methodological challenges to directly capturing the construct. In fact very few people will admit to being envious of others. The aim of this paper is thus to assess the extent to which existing measures capture the psychoanalytic view of envy and to consider their use in organisational contexts - where envy may be hostile. In doing so, several issues are investigated, firstly in terms of capturing the affect of envious anger, and secondly, in terms of research sampling. The paper concludes with some suggested methodological directions for future research on workplace envy.

Placement in out-of-home care (OHC) indicates serious childhood adversity and is associated with multiple adverse outcomes. Each year 0.5% of children in England live in OHC but evidence is lacking on the cumulative proportion who enter during childhood and how this varies over time. We measured the proportion of children born between 1992 and 2011 who entered OHC, including variation in rates of entry over time, and explored the determinants of these changes using decomposition methods. We also described changes in placement type, duration and stability. By age 18, 3.3% of children born 1992–94 entered OHC. This proportion varied by ethnicity (1.6% of White vs. 4.5% of Black children born 2001–03 entered OHC by age 9, 95% CI [1.5–1.7] and [4.4–4.6], p

Patient-reported benefits of research participation have been described by study participants; however, many studies have small sample sizes or are limited to patient groups with poor prognoses. The purpose of this study was to explore the effects of research participation on patient experience using survey responses from a large, national sample of cancer patients (N = 66 462) and interviews with breast cancer patients attending a London trust. Multivariate logistic regression was used to investigate associations between taking part in research and positive patient experience. Based on our analysis, patients who participated in research were more likely to rate their overall care and treatment as 'very good/excellent' (ORadj :1.64, 95%CI: 1.53-1.76, P, info:eu-repo/semantics/published

Insomnia is a common complaint in people living with HIV and AIDS. It contributes to fatigue, functional impairment, and an overall reduction in the quality of life; yet, there remains considerable uncertainty about its cause and significance. Early reports of sleep-specific EEG changes related to HIV infection, in particular an increase in slow wave sleep, have not been confirmed in later controlled studies. Sleep disturbance is reported at all stages of HIV infection, but the presence of cognitive impairment or an AIDS-defining illness is a significant risk factor. Antiretroviral medications have not demonstrated a class effect, but plasma levels of the non-nucleoside reverse transcriptase inhibitor, efavirenz, do correlate with insomnia. Amongst the recognized risk factors, the most notable is psychological morbidity which has shown a consistent and strong association with insomnia in seropositive patients. Insomnia in HIV infection is associated with a reduced quality of life, but in this population, it remains both under-recognized and under-treated. This may in part be a reflection of uncertainty about approaches to management, as there is little data on treatment of insomnia in this population. Insomnia in HIV presents a considerable challenge for the clinician and requires careful evaluation, in particular screening for anxiety and depression, and a familiarity with non-pharmacological interventions as well as drug treatments for sleep disturbance.

Background Ethnic inequalities in cancer patient experience are known to exist; however, variation by ethnic subcategory is not well-explored. Information provision and communication, key domains of patient experience, are also likely to vary by ethnic subcategory, but there have been few detailed analyses to date. The aim of this study was to identify and quantify ethnic variation in cancer patients' experiences of information provision and communication through analysis of data by ethnic categories and subcategories. Methods The National Cancer Patient Experience Survey 2012–13 was sent to all adult cancer patients treated in a National Health Service (NHS) hospital from Sept 1, 2012, to Nov 31, 2012. The publically available dataset contained responses to 70 multiple-choice questions and associated demographic information for 68 737 cancer patients from 155 NHS trusts. In this secondary analysis, multivariate logistic regression was used to investigate associations between ethnicity and patients' ratings of overall care, information provision, and communication as measured by 24 questions. Findings Patients' ratings of communication and information provision varied greatly by ethnicity. For example, non-white patients, in particular Asian patients, were less likely than white patients to receive understandable written information about treatment side-effects (adjusted odds ratio 0·60, 95% CI 0·51–0·70; p Interpretation Effective communication and information provision are key aspects of the patient experience, and are very important to ensure that all patients are well informed and receive the best possible patient care. Ethnic inequalities, such as those identified here, should be addressed at both practice and policy level. Health-care professionals should be aware of the inequalities that exist and of their personal ethnic bias. Cultural and racial awareness training would help them to tailor their consultation to the cultural and linguistic needs of their patients. Future policy should be guided by ethnically diverse patient focus groups, and further work should aim to understand causes of ethnic variation in ratings of communication and information provision. Funding HW and LM-L are supported by the National Institute for Health Research Imperial College Healthcare NHS Trust Biomedical Research Centre and Imperial College Healthcare Charity.