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While positive and clinically meaningful effects of exercise on cognition and behavior in children have been demonstrated in controlled experimental settings, they have rarely been translated and rigorously evaluated in real-world environments. In particular, there is a lack of research on school-based approaches to sustainable physical activity and exercise interventions targeting children with behavioral health disorders. Manville Moves is an exercise intervention designed to improve behavioral regulation and classroom functioning among children with neurodevelopmental and affective disorders within a therapeutic day-school environment. The curriculum is built around virtual-reality exergaming bicycles (cybercycles) and integrated into physical education (PE) classes. Manville Moves was developed using community based participatory research (CBPR) and implemented as a pragmatic trial. In this paper, we describe (a) the background, theoretical framework and intervention setting, (b) the Manville Moves curriculum, (c) the study design and outcome and process measures, and (d) the strategies used to support implementation compliance and intervention uptake by a population with a variety of behavioral challenges. We conclude with a detailed description of the participatory process by which the intervention was developed and integrated into school programming and a review of the program's key innovations and approaches to addressing threats to internal and external validity.

Missed Parkinson's disease (PD) medications when patients are admitted to hospital are associated with increased ­morbidity and mortality. Swallowing difficulties in hospitalised PD patients are common and should prompt clinicians to ­consider conversion of a patient's PD medications to a non-oral form – this is, however, recognised as a challenging area with potential for error. Northumbria Healthcare NHS Foundation Trust's PD service set out to address this patient safety issue through the development of an innovative online medication ­calculator (pdmedcalc.co.uk). This article summarises the development process underpinning the calculator, presents numerical data on the usage of the calculator and presents survey data ­relating to user experiences of the calculator. Lastly, we highlight how user feedback has been used to refine subsequent iterations of the calculator and how use of the calculator has rapidly spread beyond our trust because of it being freely accessible online.

Total, secondary, and backscatter electron yield data were taken with beam energies between 15 eV and 30 keV, in conjunction with energy emission data, to determine the extent of suppression of yield caused by carbon nanotube (CNT) forest coatings on substrates. CNT forests can potentially lower substrate yield due to both its inherently low-yield, low-atomic number (Z) carbon composition, and its bundled, high-aspect-ratio structure. Rough surfaces, and in particular, surfaces with deep high-aspect-ratio voids, can suppress yields, as the electrons emitted from lower lying surfaces are recaptured by surface protrusions rather than escaping the near-surface region. Yields of multilayered materials can be modeled essentially serially as a combination of the constituents. However, it is shown that suppression of yields due to CNT forest morphology is more significant than simple predicted contributions of homogeneous layered components. This effect is found to be most pronounced at low energies, where the incident electrons interact preferentially with the CNTs. CNT forests between 20 and $50~\mu \text{m}$ tall were grown on a thick silicon substrate capped with a 3-nm diffusion barrier of evaporated aluminum using a wet injection chemical vapor deposition (CVD) method. Yields of an annealed substrate and constituent bulk materials were also investigated. At incident electron energies above ~1200 eV, the substrate secondary yield dominated those of the CNT forests, as incident electrons penetrated through the low-density, low-Z CNT forests, and backscattered from the higher-Z substrate. At lower energies

Background Despite dramatic advances in the care of people with HIV (PWH), the shortage of HIV providers is worsening. An approach to this workforce shortage has been integration of robust HIV training into residency. We created a national survey to describe curricula and outcomes of formal HIV training pathways and how this may impact the HIV workforce shortage. Methods We designed a cross-sectional study of Internal Medicine (IM) and Family Medicine (FM) Residency HIV pathways in the United States. We identified programs via literature review, internet search, and snowball sampling. A draft survey was piloted with two pathway directors, and in January 2019, the final survey was sent via email to all pathway directors. This survey included 33-items, predominantly quantitative, and focused on program organization, curricular content, graduate outcomes, and challenges. We used descriptive statistics to summarize numeric responses. Results Twenty-five residency programs with dedicated HIV pathways were identified; 11 IM and 15 FM. The majority of the programs are in the West and Northeast United States. Twenty-four (96%) of programs have completed the survey. Since the first program was established in 2006, 228 residents have graduated from HIV pathways in the United States (151 IM, 77 FM). Programs have varying goals, application procedures, clinical requirements, didactic structures, graduation requirements, and assessments of competency. Of graduates, 108 (47%) have American Academy of HIV Medicine (AAHIVM) certification. Ninety-two (42%) of graduates are reported as currently providing primary care to ≥ 20 PWH (the majority in the West and Northeast United States). The most commonly cited reported barrier to graduates finding jobs caring for PWH are lack of job opportunities in their geographic area. Conclusion HIV pathways in IM and FM programs are heterogenous in their structure and curricula. Less than 50% of pathway graduates remain in the HIV provider workforce, and the majority of those work in the West and Northeast United States. The impact of these programs might be enhanced by interventions to increase graduate retention in this workforce and to launch pathways in the areas of greatest need, such as the Southern United States. Disclosures All authors: No reported disclosures.

Objectives (1) To conduct a scoping review of postgraduate specialty training (ST) curricula for doctors within Health Education England in order to identify common themes and variations in requirements for training and assessment of research competencies. (2) To make recommendations on standardisation of training for clinical research across ST programmes. Setting Health Education England North East and National Institute for Health Research Clinical Research Network (CRN)—North East and North Cumbria. Methods Annual Review of Competence Progression (ARCP); Certificate of Completion of Training (CCT) checklists and curricula for ST were obtained from Health Education England North East and reviewed between June and September 2015. Research competence requirements based on knowledge, skills or behaviour-based domains were identified and entered onto a spreadsheet for analysis. Common themes with levels of competence required were identified. This information was used to construct and propose a model for delivery of training in clinical research across ST programmes. Results Sixty-two ST curricula were reviewed and seven common themes for research training were found in up to 97% of the curricula. Requirement for good clinical practice (GCP) in research training was included in 15% of curricula. One of the common themes involved knowledge-based competency, and three each of the remaining seven involved skills or behaviour-based competencies. There was less clarity and larger variation between specialties in how research competencies were assessed; and what evidence was required for ARCP and CCT to assure competence. 63% (19/30) of curricula from medical specialties had no mention of research requirements within their ARCP guidelines. Conclusions Given that the majority of specialty curricula contain consistent themes around core research knowledge, consideration should be given to standardising the delivery and assessment of generic research competencies within ST. Our recommendations from this review could form the basis for developing structured research training for specialty trainees involving: (1) a taught course for knowledge-based competencies; (2) clinical placements with CRN teams for practical workplace-based experience and (3) developing research tutors to help support placements and assessment of these competencies.

This paper reports on the attitudes of 340 government primary principals from New South Wales, Australia, towards the inclusion of students with disruptive behaviours in schools. Principals’ attitudes were examined using the Principals and Behaviour Survey (PABS), a new composite measure built upon a foundation of existing validated surveys on attitudes towards the inclusion of students with disabilities. Principal component analysis identified 3 components that were used as variables for correlations with a range of demographic characteristics, such as age, qualifications, experience, school size and location. School size and the number of students with a diagnosed mental health condition in the school had a small relationship with principals’ attitudes. From the analysis of data from the emotional response scale, it was found that principals’ emotions about inclusion were less positive towards students with disruptive behaviour than towards students with sensory, physical or intellectual disabilities. Overall, principals appeared to hold dichotomous positions in regard to the benefits of inclusion, viewing it as beneficial for students with disruptive behaviour but not for their peers. However, principals who held more positive views were consistently more positive across all measures.

Trainees are the future of medicine in the UK. Theirwellbeing and morale are important not just at anindividual level but as a reflection of a functioning,sustainable and valued workforce that makes up the NHS.In recent years there has been growing concernregarding the wellbeing and morale of trainees and whilethis may have been voiced individually for some time, thejunior doctors’ contract dispute in England has catapultedit into everyday conversations. This is not surprisinggiven the current climate of increasing pressure on NHSstaff and use of the phrase ‘burnt-out’ being nowcommonplace. What are the underlying factors contributing to thissituation? This paper aims to highlight some of the issuesinvolved in this complex topic and suggests how wemight improve the situation in the future.

Background The UK National Institute for Health and Clinical Excellence guidelines state that palliative care options for people with Parkinson9s disease (PD) should be discussed. Aims To investigate whether palliative care guidelines are adhered to for people with PD who die in hospital. Setting/participants The medical notes of all people with a diagnosis of idiopathic PD who were living in two adjacent areas of northeast England and who died over a 3-year period were examined. Demographic data and specific information regarding events around the time of death were recorded. Results For the 236 patients identified, the average age at death was 82.8 years. Of these patients, 110 (46.6%) died in hospital, 56 (23.7%) at home, 59 (25.0%) in a care home and for 11 patients (4.7%) the place of death was not recorded. For those who died in hospital, only three patients, and seven relatives of patients, had had a recorded discussion with a clinician regarding their preferred place of death and only 15 (13.6%) were referred to a specialist palliative care team. Forty-six patients (41.8%) were placed on the Liverpool Care Pathway. Conclusions For those dying in hospital, there are few previously documented end-of-life care discussions with patients or their relatives. The use of end-of-life pathways and access to specialist palliative care is variable. Following the Neuberger report, the Liverpool Care Pathway is to be replaced with individual end-of-life care plans. It is important to engage patients, and their relatives, in decision making regarding preferences at the end of life.

Impulse control behaviours are increasingly recognized as serious complications of dopaminergic therapy in Parkinson's disease. This article outlines a set of practical guidelines for management of these behaviours which have been developed by five experts from neurology, psychiatry and care of the elderly.

To develop an understanding of the medical registrar's experience of acute medicine on-call from their perspective. The research methodology was ethnography. Two researchers were involved in the data collection – a GP trainee and a university researcher. Three trusts within the north of England were used for recruitment. Observations of eight registrars took place June 2014 – February 2015 during acute on-call shifts. A total of 86.5 hours of observation data was collected. Following the shifts, interviews were …

This article discusses the results from an initial quantitative analysis of survey data collected from the Principals and Behaviour Survey (PABS) conducted in New South Wales, Australia. PABS was built upon a foundation of existing validated studies measuring principals' attitudes to the inclusion of students with disabilities in mainstream schools. Principal component analysis as an exploratory procedure indicated that whilst many similarities exist, the geographical context of the school impacts on a principal's skills and confidence, how they use their skills, and their attitudes towards the resources and supports required to support students with disruptive behaviour. Implications for the wide-scale implementation of approaches to managing disruptive behaviour across contexts are discussed alongside continuing dichotomies between the pragmatics of school practice and benefits of inclusive practice.

PurposeThe purpose of this paper is to valuate existing building stock with respect to its contribution to a changing and uncertain future, especially in relation to energy performance.Design/methodology/approachThe authors review literature related to existing buildings, climate change and future environmental needs; present energy performance data from ten case studies; and identify inadequacies and scope for improvements with reference to typical housing stock.FindingsCurrent policies and programmes are inadequate to the scope and scale of the task; a step‐change in thought and practice is needed.Practical implicationsA massive programme is warranted if the substantial stock of existing buildings is to be adapted to meet identified environmental standards to “save the planet”; a radical re‐conceptualisation of building adaptation is required.Originality/valueThe paper prompts a review of the role of the surveyor in achieving sustainability through adaptation of existing buildings.

There are many elements to the manufacture and preassembly of building components off-site. Maintenance has long been regarded as a Cinderella activity. By comparison, with the attention given to so-called new-build construction and its design, little heed is given to the anticipation and organization of a planned building’s maintenance. This paper develops a professional overview of likely maintenance over the life of a building and seeks to assist in the production and sustaining of better buildings by the integration of these considerations by forethought at the design stage. Mind mapping is explored as a framework on which to build considerations of maintenance of manufactured construction. It brings together and builds on concepts of intelligent and open building maintenance to create a decision support framework or MInD (maintenance integrated design) map or model for the construction of buildings that are economical and efficient to build and to run and meet long-term needs.

The primary aim of this study was to ascertain whether a battery of physical function measures in a Parkinson's disease (PD) patient cohort predicted mortality status at 7-year follow-up. Secondary aims were establishing which specific tests were the most useful, and whether PD phenotype was a predictor. A retrospective correlation design was used in this study. A cohort of 109 PD patients underwent baseline physiotherapy assessment of gait, balance, posture, muscle strength, and ability to change postural set. We compared mortality status at 7-year follow-up and baseline physical assessment tests. Tinetti gait and balance scores, UPDRS score, 10-m walk test (time, velocity, and number of strides), posture in standing, lying to sitting, sitting to standing, getting up from floor assessments, and time to ascend and descend four steps were found to be statistically significant physical predictors of mortality at 7-year follow-up. In addition, age, sex, and mini-mental state examination were significant nonphysical predictors of mortality. Using Cox regression, a survival model was constructed with age, sex, and Tinetti gait score as independent predictors of mortality. The results of this study suggest that there is a link between reduced physical function and an increased mortality risk in PD populations.

The Congressional Monitor provides summaries of all relevant bills and resolutions (joint, concurrent, and simple) introduced during the previous session of Congress that mention, even briefly, either Palestine or Israel. Speeches are not included. The format of this Monitor provides an overview of U.S. legislation related to the Palestine issue and helps to identify the major themes of legislation, its initiators, their priorities, the range of their concerns, and their attitudes toward the regional actors. Material in this compilation is drawn from www.thomas.loc.gov, where readers can also find a detailed primer on the legislative process entitled ““How Our Laws Are Made.””

Urinary dysfunction, primarily in the form of detrusor overactivity, is highly prevalent amongst individuals with idiopathic Parkinson's disease (IPD). There has been increasing realisation of the importance of this and other non-motor features of the condition. The presentation of, pathophysiology behind and management options for bladder dysfunction in IPD are discussed.

The biology of one passerine migrant, the Yellow Wagtail Motacilla flava, is examined in order to identify factors which need to be considered when attempting to conserve migrants on passage. The distribution of Yellow Wagtails in West Africa, prior to northward (spring) migration, is affected by food supplies and by different racial and sexual responses to environmental factors. Consequently, each breeding population relies on a wide range of sites, but those occupied towards the end of the dry season and ones used as stepping-off points for migration may be particularly vital. Energetic considerations point towards a non-stop trans-Saharan flight being used rather than a series of short flights with resting stops in the desert. However, adverse conditions during migration could make stop-overs unavoidable. The most direct routes between wintering and breeding areas are preferred, and the initial desert crossing is accomplished at a faster pace than later stages of the journey. Yellow Wagtails emigrate from West Africa in a sequence related to the onset of spring on their breeding sites, rather than in response to rainfall in Africa: moult, fattening and emigration are probably endogenously controlled. However, competition from African resident birds may also be an important factor affecting the timing of migration. Races breeding in southern Europe are most likely to be adversely affected by degradation of the Sahel. Empirical evidence suggests that conditions on the wintering grounds are more likely to regulate population size than conditions experienced on migration, but more detailed studies are needed in Africa before sound conservation strategies can be designed.

Christians United for Israel, the Zionist lobby group that has grown by leaps and bounds since its founding two years ago, held its second annual conference in Washington, D.C., July 2007. Attended by political figures and rank-and-file members alike, the AIPAC-style conference showcased the group9s formidable financial, organizational, and political strength, signaling that the group seems poised to set the agenda for future Christian Zionist work in the United States.

PurposeTo investigate the contribution that existing buildings make to sustainability and thereby to develop a research agenda.Design/methodology/approachReviews literature related to existing buildings in the urban context, positing that there is more “value” in buildings than their “bricks and mortar” and investigates contributory factors.FindingsNo building is an island. Buildings relate one to another and to the infrastructure, which links and serves them and their users. There are, for instance, cultural, heritage and physical links to be built upon and added to by new buildings and improvements to existing buildings. The concept of “embodied energy” is relevant.Research limitations/implicationsMuch of the building stock of the twenty‐second century already exists. To make a serious impact on improving sustainability, existing building stock should be more fully considered, so that fewer resources may be consumed by building new. Further research is needed to develop and test an evaluation model that will make a fuller assessment of the “investment” in existing buildings.Originality/valueThe paper prompts a re‐evaluation of existing buildings and their contribution to sustainability.

PurposeBuilding maintenance is not sexy – yet it is big business, arguably more than new‐build. It is under‐researched. Received wisdom from the 1960s and 1970s is that reactive maintenance is undesirable; planned preventive maintenance (PPM) is “the answer”. That paradigm fails to put people at the centre. Times have moved on. The thinking here challenges the public‐sector “think big’ command economy based approach, and aims to examine new ways ahead. The purpose of this paper is to summarise a range of new approaches and identify common threads. People are an organisation's greatest asset; the maintenance and enhancement of their working and living environments and their wellbeing deserve serious attention.Design/methodology/approachThe research is based on semi‐structured interviews with maintenance and facility managers in organisations noted for their tendencies to innovate in their core business. The paper aims to assist maintenance and facility managers to review their building maintenance priorities in relation to user wants and needs.FindingsWhile the study is insufficient at this stage to support wholesale change in practice to any one new approach, a professional approach to the expenditure of considerable sums on building maintenance suggests that appropriate time should be spent in developing and evaluating alternative approaches.Originality/valueCalls for a complete re‐think on the approach taken to maintenance.

Alternative approaches to maintenance are facilitating a fresh look at design and operation of buildings. For some time, planned preventive maintenance has been the predominant paradigm, based on periodic condition surveys, predictions of future performance, and production of programmes of work. Advances in technology and management techniques have enabled more rapid responses and a focus on meeting user needs. Also there has been a growth of interest in sustainability and “saving the planet”. This paper examines the concepts presented by the author at the Brisbane conference of CIB W70. Suggests that designing and providing for today’s needs is difficult enough without trying to anticipate unknown futures. “Take therefore no thought for the morrow; for the morrow shall take thought for the things of itself” (Matthew 6:34). Work stress could be reduced for facilities and maintenance managers by providing the “right” building – right design; right time; right place; nothing to worry about.

Background Although mental health disorders are common among incarcerated minors, psychiatric urgencies and emergencies often cannot be treated in juvenile detention facilities, necessitating emergency department (ED) transfers. The cost of this ED care has not been well studied. Objective This study aimed to provide information on disposition and cost related to ED visits by juvenile hall patients transported for urgent psychiatric evaluation. Methods A retrospective cross-sectional descriptive study of patients presenting to 1 ED from juvenile detention centers for consideration of psychiatric holds was conducted. Eligible patients were identified by a search of the International Classification of Diseases, Ninth Revision, discharge diagnosis codes and chart review. We collected information on patient demographics and disposition and calculated costs of ED visits, screening laboratories performed, inpatient stays on a medical ward, sitter and parole officer salaries, and ambulance transfers. Results One hundred eight patients accounting for 196 visits were transported from juvenile hall for urgent psychiatric evaluation. Of the 196 visits, 131 (67%) resulted in an involuntary psychiatric hold. More than half of the patients on hold (75 patients) were admitted to a medical ward for boarding because of lack of psychiatric inpatient beds. Included charges for the 196 visits during the 18-month period totaled US $1,357,884, with most of the costs due to boarding on the medical ward. Conclusions We describe the magnitude and cost associated with addressing psychiatric emergencies in a juvenile correctional system relying on transport of patients to an ED for acute psychiatric evaluation and treatment. Further research is needed to determine if costs could be decreased by increasing psychiatric resources in juvenile detention centers.

The UK National Institute for Health and Clinical Excellence guidelines state that palliative care options for people with Parkinson's disease (PD) should be discussed.To investigate whether palliative care guidelines are adhered to for people with PD who die in hospital.The medical notes of all people with a diagnosis of idiopathic PD who were living in two adjacent areas of northeast England and who died over a 3-year period were examined. Demographic data and specific information regarding events around the time of death were recorded.For the 236 patients identified, the average age at death was 82.8 years. Of these patients, 110 (46.6%) died in hospital, 56 (23.7%) at home, 59 (25.0%) in a care home and for 11 patients (4.7%) the place of death was not recorded. For those who died in hospital, only three patients, and seven relatives of patients, had had a recorded discussion with a clinician regarding their preferred place of death and only 15 (13.6%) were referred to a specialist palliative care team. Forty-six patients (41.8%) were placed on the Liverpool Care Pathway.For those dying in hospital, there are few previously documented end-of-life care discussions with patients or their relatives. The use of end-of-life pathways and access to specialist palliative care is variable. Following the Neuberger report, the Liverpool Care Pathway is to be replaced with individual end-of-life care plans. It is important to engage patients, and their relatives, in decision making regarding preferences at the end of life.

Botanical records collected over a period of almost 90 years are analysed in order to interpret the distribution and temporal occurrence of plant species on Blakeney Point, a complex near-natural coastal nature reserve in eastern England. A unimodal relationship is found between the number of plant species that are characteristic of each biotope and the persistence of rare plants. This pattern can best be explained in terms of two types of disturbance: (1) the relatively predictable, small-scale, often biotic disturbances that may promote diversity by generating local heterogeneity; and (2) large-scale disturbances which may reduce plant diversity in the harsher biotopes. Both types of disturbance are vital for the maintenance of the overall natural diversity of sites and should be recognised and preserved by managers who may wish to prevent the loss of plant species.

The Isle of Rum is one of the largest protected areas in UK and has been owned and managed by national conservation agencies since 1957. Detailed management plans have been prepared. The restoration of more natural conditions has been a principal objective for over 40 years. Even so, commercial forestry techniques have been used to reinstate native woodlands and domestic livestock were introduced to assist in the diversification of grasslands on the island. Many other management practices have been similar to ones employed in Highland deer forests, rather than specific to the needs of conservation and the restoration of a more natural state. The present population of red deer were introduced to Rum, but it is not certain that deer are truly native to the island. Nevertheless, conservation managers are now attempting to integrate deer into the replanted woodland. This is unlikely to replicate conditions that formerly existed on Rum since the interpretation of a pollen core suggests that, almost 4000 years ago, the native woodland declined when grazing animals arrived on the island. Managers also wish to preserve mementoes of earlier occupation and sustain and expand its present human population. Rum is one of a series of prime conservation sites selected under the Habitats Directive of the European Union. However, in seeking to protect the wildlife that is special to Europe, this legislation may promote the preservation of plant and animal communities that are principally cultural artefacts, rather than encourage a reliance on natural processes and the ecosystems they engender. Whilst this may be a reasonable approach to the conservation management of small and isolated reserves, it is evident that similar practices are used in some of the largest and most secure sites. There is a danger that, in seeking to preserve the parts (species and communities), conservation in Europe may lose sight of the entity that includes natural variability and the processes that sustain wild ecosystems.

Parkinson’s Disease (PD) is an irreversible degenerative neurological disorder with no known cure. Apomorphine is a potent short-acting D1/D2 dopamine agonist administered sub-cutaneously that is used in the treatment of PD. Optimising PD medication is an important aspect of end of life care. There are no previously reported cases of apomorphine providing symptom relief in terminal care of PD patients. This case highlights its potential benefits for symptom control at the end of life.