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There has been a recent expansion of school curricula and extra-curricular activities emphasizing musical creativity and collaboration. Parents have a crucial role in providing children with access to such experiences; their views on music and the nature of creativity influence the types of musical engagement their children will access. Teachers also have an important role, yet can have difficulties when supporting children in open-ended tasks. A qualitative study investigated parents’ and teachers’ constructions of creativity and music. Interviews were held with 11 parents and 4 teachers of preschool children who took part in improvisation workshops. Data were analyzed with thematic analysis, resulting in identification of three themes. Creativity and musicality were described as fundamental to children’s “human nature” but positioned as a non-fundamental part of their own adult identities. “Values” explored conceptualizations of creativity through artistic products; musicality was appreciated demonstration of technical skill. “Frames for engaging” identified adults engaging with their children in creative tasks mainly through child-led narratives; in contrast, parents took on the role of “teacher” in musical tasks. Understanding these influential views offers insight into the types of activities and guidance offered to pre-schoolers and how they can be built on to foster children’s musical creativity.

Introduction Undiagnosed obstructive sleep apnoea (OSA) is increasingly recognized as a serious post-operative risk with bariatric surgery, hence increasing demand for pre-operative screening and a need for simpler ways for screening than the clinical standard, respiratory polygraphy, to mitigate strain on sleep services. WatchPAT 300 (WP) is a finger-mounted sensor that uses peripheral arterial tonometry to estimate the apnoea hyponoea index (AHI). While its use is increasing it has not yet been validated in patients with a BMI >35, the target population in bariatric surgery. Aims To validate WP against polygraphy in pre-bariatric surgery patients with clinically suspected OSA and a BMI>35 and to assess patient acceptability of WP. Methods AHI was measured simultaneously with WP and Embletta. Outcome measures were 1) autoscored AHI from WP and 2) manually re-scored AHI from Embletta. Agreement between AHI from Embletta and WP was assessed using intra-class correlation coefficient (ICC), bland Altman and ROC plots. Results 28 patients (22 female/6 male, mean ± SD age 44.1 ± 11.6, BMI 45.7 ± 7.5) participated. One study failed due to the patient removing the WP probe prematurely. AHI was higher in WP than Embletta (28.1± 17.9 versus 15.0 ±13.4; p 15 (Area under the curve 0.917; p Discussion WP accurately estimates the AHI in pre bariatric surgery patients, has a low failure rate and is clinically acceptable in this group. Further larger scale studies are needed to confirm these findings before incorporating into clinical guidelines.

There is evidence that music interventions can offer opportunities for creative, psychological and social developments for individuals with mild to profound learning disabilities, addressing the disadvantages they face in respect of social outcomes. This paper reports on a qualitative study investigating a community music intervention for such a population. Thirty-seven adult service users (12 female, 25 male) took part in weekly music workshops for ten weeks. Their learning difficulties ranged from mild to profound, and their levels of independence ranged from requiring constant one-to-one care to living alone in sheltered accommodation. Interviews were conducted at multiple time points with music and resource centre staff as well as participants and members of their families and other centre users; researchers also observed all workshops, taking field notes. Thematic analysis of the data informed understanding of the disadvantages facing participants, their experience of the workshop programme and its immediate and wider social outcomes, as well as suggesting key mechanisms for effects. Disadvantages and barriers facing participants included: limited access to enjoying or learning music; boredom, isolation and limited networks; lack of experience of new social contexts; and an associated lack of confidence, low mood or self-esteem. Participants were found to enjoy and sustain engagement with a programme of dedicated group music workshops delivered by staff trained in an empathic and inclusive approach. Impacts included an ongoing enthusiasm to engage in music; wider recognition of musicality; increased self-confidence; being happier, more relaxed and/or enthusiastic after the workshops; better ability to interact with unfamiliar situations and people; and participation in social activities for an unprecedented length of time. Key factors in achieving those impacts are that participants: had fun and interacted socially; felt secure, welcomed and involved at all times; exercised choice; worked with others in non-verbal tasks; and encountered challenge while engaging and progressing at their own rate.

Background and aims Key performance indicators [KPIs] exist across a range of areas in medicine. They help to monitor outcomes, reduce variation, and drive up standards across services. KPIs exist for inflammatory bowel disease [IBD] care, but none specifically cover inflammatory bowel disease [IBD] surgical service provision. Methods This was a consensus-based study using a panel of expert IBD clinicians from across Europe. Items were developed and fed through a Delphi process to achieve consensus. Items were ranked on a Likert scale from 1 [not important] to 5 [very important]. Consensus was defined when the inter quartile range was ≤ 1, and items with a median score > 3 were considered for inclusion. Results A panel of 21 experts [14 surgeons and 7 gastroenterologists] was recruited. Consensus was achieved on procedure-specific KPIs for ileocaecal and perianal surgery for Crohn's disease, [N = 10] with themes relating to morbidity [N = 7], multidisciplinary input [N = 2], and quality of life [N = 1]; and for subtotal colectomy, proctocolectomy and ileoanal pouch surgery for ulcerative colitis [N = 11], with themes relating to mortality [N = 2], morbidity [N = 8], and service provision [N = 1]. Consensus was also achieved for measures of the quality of IBD surgical service provision and quality assurance in IBD surgery. Conclusions This study has provided measurable KPIs for the provision of surgical services in IBD. These indicators cover IBD surgery in general, the governance and structures of the surgical services, and separate indicators for specific subareas of surgery. Monitoring of IBD services with these KPIs may reduce variation across services and improve quality.

Background: UK society is ageing. Older people who drink alcohol, drink more than those from previous generations, drink more frequently than other age groups and are more likely to drink at home and alone. Alcohol problems in later life however are often under-detected and under-reported meaning older people experiencing alcohol problems have high levels of unmet need. Methods: This study sought to identify existing services within South of Tyne, North East England to capture the extent of service provision for older drinkers and identify any gaps. The Age UK definition of ‘older people’ (aged 50 and over) was used. Services were contacted by telephone, managers or their deputy took part in semi-structured interviews. Findings: Forty six service providers were identified. Only one provided a specific intervention for older drinkers. Others typically provided services for age 18+. Among providers, there was no definitive definition of an older person. Data collection procedures within many organisations did not enable them to confirm whether older people were accessing services. Where alcohol was used alongside other drugs, alcohol use could remain unrecorded. Conclusion: To enable alcohol services to meet the needs of older people, greater understanding is needed of the patterns of drinking in later life, the experiences of older people, the scale and scope of the issue and guidance as to the most appropriate action to take. An awareness of the issues related to alcohol use in later life also needs to be integrated into commissioning of other services that impact upon older people.

Group musical improvisation is a unique psychological phenomenon. Cognitive literature on jazz musicians argues that creativity in improvisation is constrained by stylistic conventions and facility with existing musical elements. However the expanding field of free improvisation is predicated on avoiding idiomatic expectations and familiar material. To model musical improvisation in its widest sense, 15 diverse free improvisers were video recorded performing in trios, and interviewed in-depth while reviewing the recording. Improvisers chose on an iterative basis whether to maintain what they were doing or change, either to initiate a new direction or to respond to another improviser. Responses were subjectively understood to adopt, augment or contrast the contributions of others. These choices were based on evaluative dimensions of texture, rate of initiatives, and degrees of novelty and diversity, as well as structural and practical concerns and experience of enjoyment. Improvisers did not perceive consistent agency for themselves while improvising, and their evaluations were influenced by constructions of the social context. Results highlight that new material is generated at a variable rate by any one individual during this collaborative creativity, and indicate that constraints on choices to cope with high cognitive demands are subjective and situation-specific rather than objective.

Purpose – The purpose of this paper is to examine the prevalence of alcohol use disorders (AUDs) amongst young people in the criminal justice system (CJS) in the North East of England and to compare the ability of the Alcohol Use Disorders Identification Test (AUDIT) to the Youth Justice Board ASSET tool in identifying alcohol-related need in Youth Offending Team (YOT) clients. Design/methodology/approach – A validated screening tool (AUDIT) was used to identify alcohol-related health risk or harm. Findings from AUDIT were compared with those of the standard criminogenic risk screening tool used in CJS (ASSET). An anonymous cross-sectional questionnaire was administered during a one-month period in 2008. The questionnaires were completed by 11-17-year-old offenders who were in contact with three YOTs, one Youth Offending Institution and one Secure Training Estate. Findings – In total, 429 questionnaires were completed out of a possible 639 (67 per cent). The majority (81 per cent) of the young offenders were identified as experiencing alcohol-related health risk or harm and 77 per cent scored within a possibly alcohol-dependent range. In total, 77 (30 per cent) of young people completing both assessments were identified as having an AUD by AUDIT but not identified as needing alcohol-related treatment using ASSET. Research limitations/implications – This research was confined to one geographical area of England, however, the results show that even in this area of high drinking by young people the levels of AUDs amongst young people in the CJS are very high. Social implications – There are major social implications to this research. It is imperative for changes to be made to the care pathways in place in the UK for young people coming through the CJS with alcohol-related issues. Originality/value – This paper adds to the evidence base by using well-validated tools to measure alcohol use amongst young people in the CJS in the UK.

With quadrotor use seeing extensive growth in recent years, the autonomous control of these Unmanned Aerial Vehicles (UAVs) is an increasing relevant and intersting field. In this paper a linear state-space approach at designing a stable hover controller in the presence of disturbances is presented along with simulation of control system performance. Additionally the design of a tracking system, for linear inertial position and yaw, is presented with simulation results. The gain matrix developed for this control system is independent of the specific quadrotor parameters, meaning that this same gain matrix can be used on a wide variety of quadrotors without modification. The hover and tracking controllers designed in this paper proved to perform well in simulation under perturbation disturbances and normally distributed disturbances on the UAVs linear speeds and angular speeds., 8 pages, 10 figures

Background Return to employment is one of the key goals of joint replacement surgery in the working-age population. There is limited quantitative and qualitative research focusing on return to work after hip and knee replacement. It remains unclear why certain groups of patients are not able to achieve sufficient functional improvement to allow productive return to work while others can. Very little is known about the individual patient and employer perspectives in this regard.Aims To review current evidence for the factors influencing employment outcomes in patients undergoing hip and knee replacement.Methods Original articles and reviews in Medline, Embase and PsycINFO from 1987 to 2013 were included in the analysis.Results Age, patient motivation, employment before surgery and type of job were found to be important factors in determining return to work following hip and knee replacement.Conclusions There is a need for further qualitative work on how and why these factors influence employment outcomes.

It is important that the impact of the offshore environment on wind turbine reliability is reduced significantly due to the importance of offshore wind deployment to global energy targets. Future development may otherwise be compromised by unsustainable operation and maintenance (O&M) costs. This paper aims to improve the accuracy of offshore O&M models by accounting for any relationship between certain weather characteristics and wind turbine failure modes. This is done using maintenance data from a UK onshore wind farm and weather data from a weather station located nearby. Non-parametric Mixture Models are estimated from the data and they are used to calculate a more accurate, weather dependent, failure rate which will be used in future research for Markov Chain Monte Carlo Simulation. This research will be of particular interest to wind turbine operators and manufacturers

Increasing alcohol consumption among older individuals is a public health concern. Lay understandings of health risks and stigma around alcohol problems may explain why public health messages have not reduced rates of heavy drinking in this sector. A qualitative study aimed to elucidate older people's reasoning about drinking in later life and how this interacted with health concerns, in order to inform future, targeted, prevention in this group. In 2010 a diverse sample of older adults in North East England (ages 50-95) participated in interviews (n = 24, 12 male, 12 female) and three focus groups (participants n = 27, 6 male, 21 female). Data were analysed using grounded theory and discursive psychology methods. When talking about alcohol use older people oriented strongly towards opposed identities of normal or problematic drinker, defined by propriety rather than health considerations. Each of these identities could be applied in older people's accounts of either moderate or heavy drinking. Older adults portrayed drinking less alcohol as an appropriate response if one experienced impaired health. However continued heavy drinking was also presented as normal behaviour for someone experiencing relative wellbeing in later life, or if ill health was construed as unrelated to alcohol consumption. Older people displayed scepticism about health advice on alcohol when avoiding stigmatised identity as a drinker. Drinking patterns did not appear to be strongly defined by gender, although some gendered expectations of drinking were described. Identities offer a useful theoretical concept to explain the rises in heavy drinking among older populations, and can inform preventive approaches to tackle this. Interventions should engage and foster positive identities to sustain healthier drinking and encourage at the community level the identification of heavy drinking as neither healthy nor synonymous with dependence. Future research should test and assess such approaches.

Group musical improvisation, as a spontaneous process of collaborative creativity effected through non-verbal social interaction, is a unique psychological phenomenon and universal capacity. Existing studies focus on improvisation among professional jazz musicians, often using qualitative methods. However, improvisation transcends genres and levels of training or experience, and existing qualitative data are rarely analyzed as discourse. We compare findings from studies of jazz musicians’ improvising with interview data from free improvisers from varied backgrounds focused on their improvising together ( n = 10). The ways jazz musicians construct improvising in talk were distinct from the constructions of this more diverse group, suggesting a specifically professional discourse. By focusing on accounts of deciding whether to play, the ambiguity of musical contributions in the non-verbal context of playing is highlighted. Analysis indicates that musical acts within improvisation are interpreted by the musicians involved in ways that inherently support or resist particular identities. The unique creative, communicative and social process of musical improvising in groups can therefore best be understood when the entirety of improvisational practice and its various contexts are acknowledged. Future research can best recognize the diversity of, and change in, what improvisation can encompass with continued discursive investigation of group improvising.

Background Recent evidence shows that workers in white collar roles consume more alcohol than other groups within the workforce, yet little is known about their views of drinking. Methods Focus groups were conducted in five workplaces to examine the views of white collar workers regarding the effect of alcohol use on personal and professional lives, drinking patterns and perceived norms. Analysis followed the method of constant comparison. Results Alcohol use was part of everyday routine. Acceptable consumption and ‘excess’ were framed around personal experience and ability to function rather than quantity of alcohol consumed. Public health messages or the risk of adverse health consequences had little impact on views of alcohol consumption or reported drinking. Conclusions When developing public health alcohol interventions it is important to consider the views of differing groups within the population. Our sample considered public health messages to be of no relevance to them, rather they reinforced perceptions that their own alcohol use was controlled and acceptable. To develop effective public health alcohol interventions the views of this group should be examined in more detail.

AIMS: To assess whether information in general practitioner (GP) referral letters provides a basis for selection of diagnostic tests in patients referred for specialist respiratory advice. METHODS: We undertook a prospective study within a respiratory outpatients department to compare the diagnostic tests planned at three stages of the referral/specialist consultation process: i) using the GP referral letter alone; ii) using the referral letter and patient history; iii) using the referral letter, patient history, and clinical examination. RESULTS: Analysis of the content of GP referral letters revealed wide variations in referral information. A high proportion of tests selected using the referral letter alone were altered after specialist history-taking and examination. Far fewer changes were recorded between history-taking and examination. CONCLUSIONS: Neither literature review nor our study support a system which bases diagnostic test selection on GP referral letters alone. However, our findings suggest that approaches which include specialist history-taking in advance of face-to-face consultation merit further investigation.

Scots law constructs a co-parental role for nonresident fathers without clarifying how this should operate in practice. Personal Construct Theory (PCT) offers a useful approach to understanding such fathers’ distinct and changing conceptions of their role. Findings are presented from a study of 17 nonresident Scottish fathers maintaining contact with nonresident children. Idiographic analysis of data from repertory grid interviews administered three times over the course of a year shows that participants perceive family situations in terms of paternal involvement, impact, emotion, or antagonism. Changes in construing following family events support the PCT understanding of hostility; implications for family services are discussed.

Background Risky drinking in pregnancy by UK women is likely to result in many alcohol-exposed pregnancies. Studies from the USA suggest that brief intervention has promise for alcohol risk reduction in antenatal care. However, further research is needed to establish whether this evidence from the USA is applicable to the UK. This pilot study aims to investigate whether pregnant women can be recruited and retained in a randomized controlled trial of brief intervention aimed at reducing risky drinking in women receiving antenatal care. Methods The trial will rehearse the parallel-group, non-blinded design and procedures of a subsequent definitive trial. Over 8 months, women aged 18 years and over (target number 2,742) attending their booking appointment with a community midwife (n = 31) in north-east England will be screened for alcohol consumption using the consumption questions of the Alcohol Use Disorders Identification Test (AUDIT-C). Those screening positive, without a history of substance use or alcohol dependence, with no pregnancy complication, and able to give informed consent, will be invited to participate in the trial (target number 120). Midwives will be randomized in a 1:1 ratio to deliver either treatment as usual (control) or structured brief advice and referral for a 20-minute motivational interviewing session with an alcohol health worker (intervention). As well as demographic and health information, baseline measures will include two 7-day time line follow-back questionnaires and the EuroQoL EQ-5D-3 L questionnaire. Measures will be repeated in telephone follow-ups in the third trimester and at 6 months post-partum, when a questionnaire on use of National Health Service and social care resources will also be completed. Information on pregnancy outcomes and stillbirths will be accessed from central health service records before the follow-ups. Primary outcomes will be rates of eligibility, recruitment, intervention delivery, and retention in the study population, to inform power calculations for a definitive trial. The health-economics component will establish how cost-effectiveness will be assessed, and examine which data on health service resource use should be collected in a main trial. Participants’ views on instruments and procedures will be sought to confirm their acceptability. Discussion The study will produce a full trial protocol with robust sample-size calculations to extend evidence on effectiveness of screening and brief intervention. Trial Registration Current Controlled Trials ISRCTN43218782

There is an expanding field of research into how making or listening to music can improve wellbeing. As a spontaneous, social, creative nonverbal process unfolding in real time, musical improvisation between individuals is a unique psychological phenomenon distinct from other areas of musical activity. It may therefore have an influence on health or wellbeing distinct from other musical behaviours, and from other components of a musical intervention. Given the psychological complexity of this behaviour it is important to establish the parameters of improvisation, the effects on health or wellbeing that are perceived or claimed for it, and any mechanisms understood to bring about these effects. To establish this, literature was reviewed that explicitly investigates or theorises about the capacity of musical improvisation to influence health or wellbeing. Only work examining its application within music therapy was identified. The behaviours and interactions that constitute improvisation during music therapy are clearly defined. Improvisation in music therapy is seen to have specific benefits for particular populations including the amelioration of neurological damage, improvements in mental health conditions, reductions in stress and anxiety, and improved communication and joint attention behaviours in children with autistic spectrum disorders. Four unique characteristics of musical improvisation are identified as underlying these effects: its potential to link conscious with unconscious processes, the demands on attention of absorption in a creative process, the non-verbal social and creative interaction experienced, and the capacity for expressing difficult or repressed emotions without having to articulate these verbally. Although improvisation is undertaken in music therapy for a purpose distinct from that of improvisation in other contexts, its processes can be seen as substantively similar, suggesting that improvising in itself may offer intrinsic benefits to health or wellbeing to broader populations and outwith the therapeutic context. Based on this review, a model is proposed for how improvisation in music can influence the health or wellbeing of those involved.

Increasing alcohol consumption among older individuals in the UK is a public health concern. Although brief interventions (BIs) can effectively reduce heavy drinking in older age groups generally, social and contextual factors may influence implementation and effectiveness. Identities offer a useful theoretical concept to explain why the potential for public health messages to reduce rates of heavy drinking in this sector has not been realised, and can inform preventive approaches. A qualitative study explored older people’s reasoning about drinking in later life and how this interacted with health concerns, to inform future, targeted prevention in this group. A diverse sample of older adults in North East England (ages 51-90) participated in interviews (n=24, 12m, 12f) and three focus groups (participants n=27). Data were analysed using grounded theory and discursive psychology methods. Older adults portrayed drinking less alcohol as an appropriate response if one experienced impaired health. However continued heavy drinking could be presented as normal behaviour for someone experiencing relative wellbeing in later life, or if ill health was construed as unrelated to alcohol consumption. When talking about alcohol use older people oriented strongly towards opposed identities of normal or problematic drinker, defined by propriety rather than health considerations. These identities were flexible in older people’s talk since they could be applied to either moderate or heavy drinking. Older people displayed scepticism about health advice on alcohol when avoiding stigmatised identity as a drinker. Findings indicate that older UK adults do not recognise unhealthy drinking as distinct from dependent drinking, and are highly sensitive to stigma when discussing alcohol consumption. Preventive strategies should encourage older people’s identification of heavy drinking as neither healthy nor synonymous with dependence. BIs for heavy drinkers in later life should be tailored to address lay reasoning that is resistant to recognition of health risks.

Wilson, G. B.\ud Wray, C.\ud McGovern, R.\ud Newbury-Birch, D.\ud McColl, E.\ud Crosland, A.\ud Background\ud \ud Many primary care patients with raised blood pressure or depression drink potentially hazardous levels of alcohol. Brief interventions (BI) to reduce alcohol consumption may\ud improve comorbid conditions and reduce the risk of future alcohol problems. However,research has not established their effectiveness in this patient population. This study aimed to establish the feasibility of definitive trials of BI to reduce excessive drinking in primary care patients with hypertension or mild to moderate depression.\ud \ud Methods\ud \ud Thirteen general practices in North East England were randomized to the intervention or control arm of one of two parallel pilot trials. Adult patients drinking excessively and diagnosed with hypertension or mild-to-moderate depression received the Alcohol Use Disorders Identification Test (AUDIT) by postal survey. Consenting respondents scoring more than 7 on AUDIT (score range 0 to 40) received brief alcohol consumption advice plus\ud an information leaflet (intervention) or an information leaflet alone(control) with follow-up at six months. Measurements included the numbers of patients eligible, recruited, and retained, and the AUDIT score and systolic/diastolic blood pressure of each patient or the nine-item Patient Health Questionnaire (PHQ-9) score. Acceptability was assessed via practitioner feedback and patient willingness to be screened, recruited, and retained at follow-up.\ud \ud Results\ud \ud In the hypertension trial, 1709 of 33,813 adult patients(5.1%) were eligible and were surveyed. Among the eligible patients, 468 (27.4%) returned questionnaires; 166 (9.6% of those surveyed) screened positively on AUDIT and 83 (4.8% of those surveyed) were recruited (50.0% of positive screens). Sixty-seven cases (80.7% of recruited patients)completed follow-up at six months. In the depression trial, 1,044 of 73,146 adult patients(1.4%)were eligible and surveyed. Among these eligible patients, 215(20.6%)responded;104(10.0% of those surveyed)screened positively on AUDIT and 29 (2.8% of those surveyed) were recruited (27.9% of positive screens). Nineteen cases(65.5% of recruited patients)completed follow-up at six months.\ud \ud Conclusions\ud \ud Recruitment and retention rates were higher in the hypertension trial than in the depression trial. A full brief intervention trial appears feasible for primary care patients with hypertension who drink excessively. High AUDIT scores in the depression trial suggest the\ud importance of alcohol intervention in this group. However, future work may require alternative screening and measurement procedures.