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INTRODUCTION: Children and young people (CYP) in the UK have poor health outcomes, and there is increasing emergency department and hospital outpatient use. To address these problems in Lambeth and Southwark (two boroughs of London, UK), the local Clinical Commissioning Groups, Local Authorities and Healthcare Providers formed The Children and Young People's Health Partnership (CYPHP), a clinical-academic programme for improving child health. The Partnership has developed the CYPHP Evelina London model, an integrated healthcare model that aims to deliver effective, coordinated care in primary and community settings and promote better self-management to over approximately 90 000 CYP in Lambeth and Southwark. This protocol is for the process evaluation of this model of care. METHODS AND ANALYSIS: Alongside an impact evaluation, an in-depth, mixed-methods process evaluation will be used to understand the barriers and facilitators to implementing the model of care. The data collected mapped onto a logic model of how CYPHP is expected to improve child health outcomes. Data collection and analysis include qualitative interviews and focus groups with stakeholders, a policy review and a quantitative analysis of routine clinical and administrative data and questionnaire data. Information relating to the context of the trial that may affect implementation and/or outcomes of the CYPHP model of care will be documented. ETHICS AND DISSEMINATION: The study has been reviewed by NHS REC Cornwall & Plymouth (17/SW/0275). The findings of this process evaluation will guide the scaling up and implementation of the CYPHP Evelina London Model of Care across the UK. Findings will be disseminated through publications and conferences, and implementation manuals and guidance for others working to improve child health through strengthening health systems. TRIAL REGISTRATION NUMBER: NCT03461848.

Incremental Sheet Forming (ISF) is a flexible process, in which a flat sheet is deformed to the desired geometry by a series of localized deformations. Incremental sheet forming is capable of forming complex three-dimensional parts using simple tools. It is characterized by high formability, low forming forces, component independent tooling and low-cost manufacturing of customized/low volume products.

Across social care, healthcare and public policy, enabled by the "big data" revolution (which has normalized large-scale data-based decision-making), there are moves to "join up" citizen databases to provide care workers with holistic views of families they support. In this context, questions of personal data privacy, security, access, control and (dis-)empowerment are critical considerations for system designers and policy makers alike. To explore the family perspective on this landscape of what we call Family Civic Data, we carried out ethnographic interviews with four North-East families. Our design-gamebased interviews were effective for engaging both adults and children to talk about the impact of this dry, technical topic on their lives. Our findings, delivered in the form of design guidelines, show support for dynamic consent: families would feel most empowered if involved in an ongoing co-operative relationship with state welfare and civic authorities through shared interaction with their data., QC 20180528

Objective: The aim of this study was to use prospective data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine association between trajectories of early childhood developmental skills and psychotic experiences (PEs) in early adolescence. Method: This study examined data from n = 6790 children from the ALSPAC cohort who participated in a semi-structured interview to assess PEs at age 12. Child development was measured using parental report at 6, 18, 30, and 42 months of age using a questionnaire of items adapted from the Denver Developmental Screening Test - II. Latent class growth analysis was used to generate trajectories over time for measures of fine and gross motor development, social, and communication skills. Logistic regression was used to investigate associations between developmental trajectories in each of these early developmental domains and PEs at age 12. Results: The results provided evidence that decline rather than enduringly poor social (adjusted OR = 1.28, 95% CI = 1.10-1.92, p = 0.044) and communication skills (adjusted OR = 1.12, 95% CI = 1.03-1.22, p = 0.010) is predictive of suspected or definite PEs in early adolescence, than those with stable and/or improving skills. Motor skills did not display the same pattern of association; although gender specific effects provided evidence that only declining pattern of fine motor skills was associated with suspected and definite PEs in males compared to females (interaction OR = 1.47, 95% CI =1.09-1.97, p = 0.012). Conclusion: Findings suggest that decline rather than persistent impairment in social and communication skills were most predictive of PEs in early adolescence. Findings are discussed in terms of study's strengths, limitations, and clinical implications.

Objective: The aim of this study was to use prospective data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine association between trajectories of early childhood developmental skills and psychotic experiences (PEs) in early adolescence. Method: This study examined data from n = 6790 children from the ALSPAC cohort who participated in a semi-structured interview to assess PEs at age 12. Child development was measured using parental report at 6, 18, 30, and 42 months of age using a questionnaire of items adapted from the Denver Developmental Screening Test - II. Latent class growth analysis was used to generate trajectories over time for measures of fine and gross motor development, social, and communication skills. Logistic regression was used to investigate associations between developmental trajectories in each of these early developmental domains and PEs at age 12. Results: The results provided evidence that decline rather than enduringly poor social (adjusted OR = 1.28, 95% CI = 1.10-1.92, p = 0.044) and communication skills (adjusted OR 1.12, 95% CI = 1.03-1.22, p = 0.010) is predictive of suspected or definite PEs in early adolescence, than those with stable and/or improving skills. Motor skills did not display the same pattern of association; although gender specific effects provided evidence that only declining pattern of fine motor skills was associated with suspected and definite PEs in males compared to females (interaction OR = 1.47, 95% CI = 1.09-1.97, p = 0.012). Conclusion: Findings suggest that decline rather than persistent impairment in social and communication skills were most predictive of PEs in early adolescence. Findings are discussed in terms of study's strengths, limitations, and clinical implications.

Incremental Sheet Forming (ISF) is gaining importance because of its flexibility to form customized/low volume sheet metal parts. Out of different variants of ISF, Double Sided Incremental Forming (DSIF) is most flexible variant which uses two tools, one to form the geometry and the other to provide local support. Complex geometries with features on both sides of sheet can be formed in single setup by changing the roles of forming and supporting tools based on the geometrical characteristics. This article presents the evolution of DSIF process, machines, methodologies and strategies to form complex geometries and their prediction. A multi-stage methodology is attempted to enhance the accuracy of large components is presented. Results show that the accuracy of a 250 mm × 250 mm size conical component is enhanced by 50% (maximum error reduced from 2.9 mm to 1.4 mm) using two-stage forming.

Incremental sheet forming (ISF) is a cost effective die-less forming process for low volume production. Achieving good accuracy using this process is a challenging task. Bending between clamped boundary and component opening, tool deflection, sheet spring-back and rigid body displacements are the major reasons for geometric inaccuracy in components formed using ISF process. In order to achieve desirable geometric accuracy, accurate prediction of sheet thickness, tool-sheet contact area and forming forces is important. In this article, modified analytical model is presented to accurately predict formed component thickness, contact area and forming forces during single and multi-stage incremental forming. Predictions of models presented in this work are compared with experimental work carried out during this work as well as experimental results available in the literature and they are in good agreement. Prediction models developed during the present work require very less computational resources compared to finite element analysis.

Incremental sheet forming (ISF) is a low cost, die-less forming process suitable for low volume production. In case of components with multiple features, the accuracy of formed component depends on the sequence in which the features are formed. In addition, sheet spring-back, tool deflection and rigid body displacement also effect the accuracy of the component. Predicting the component geometry using finite element analysis is computationally expensive and time consuming. Simple mechanics based methodology is presented in this work to predict the component geometry. Results presented show that the formed component geometry can be predicted with good accuracy. In addition a methodology is developed to achieve uniform thickness distribution with good accuracy in high wall angle components formed using multi-stage strategy. This thickness prediction capability helps the designer to choose intermediate stages and to form components with engineered thickness with reasonable accuracy.

Incremental Sheet Forming (ISF) is a flexible sheet metal forming process that enables forming of complex three dimensional components by successive local deformations without using component specific tooling. ISF is also regarded as die-less manufacturing process and in the absence of part-specific dies, geometric accuracy of formed components is inferior to that of their conventional counterparts. In Single Point Incremental Forming (SPIF), the simplest variant of ISF, bending near component opening region is un-avoidable due to lack of support. The bending in the component opening region can be reduced to a larger extent by another variant of ISF namely Double Sided Incremental Forming (DSIF) in which a moving tool is used to support the sheet locally at the deformation zone. However the overall geometry of formed components still has unacceptable deviation from the desired geometry. Experimental observation and literature indicates that the supporting tool loses contact with the sheet after forming certain depth. Present work demonstrates a methodology to enhance geometric accuracy of formed components by compensating for tool and sheet deflections due to forming forces. Forming forces necessary to predict compensations are obtained using force equilibrium method along with thickness calculation methodology developed using overlap of deformation zone that occurs during forming (instead of using sine law). Number of examples are presented to show that the proposed methodology works for variety of geometries (axisymmetric, varying wall angle, free-forms, features above and below initial sheet plane and multiple features). Results indicate that there is significant improvement in accuracy of the components produced using compensated tool paths using DSIF and support tool maintains contact with sheet throughout the forming process.

Single Point Incremental Forming (SPIF) is a die-less forming process that can be economically used for low volume production of sheet metal components. One of the limitations of SPIF is the maximum wall angle that can be formed in a single stage. To overcome this limitation, Multi-stage Single Point Incremental Forming (MSPIF) is used to form components with large wall angles. When the tool is moved from out-to-in during any stage, material present ahead of it (towards the centre of the component) moves down rigidly. If this rigid body displacement is not considered during tool path generation for MSPIF, it leads to stepped/unwanted features. Predicting the component geometry after each stage helps in monitoring the shape being developed and in turn is useful in designing intermediate stages to form required final geometry with desired accuracy. In the present work, a simple methodology is proposed to predict rigid body displacement based on tool path and process parameters (tool diameter, incremental depth, sheet thickness) used. Tool and sheet deflections due to forming force are also considered to predict final geometry of the component. Proposed methodology is validated by comparing predicted profiles with experimentally measured profiles of high wall angle axisymmetric components formed using different materials and sheet thicknesses. Predicted profiles are in good agreement with experimental results.

Incremental Sheet Metal Forming (ISMF) is a flexible sheet metal forming process that enables forming of complex three dimensional components by successive local deformations without using component specific tooling. ISMF is also regarded as die-less manufacturing process and in the absence of part-specific dies, geometric accuracy of formed components is inferior to that of their conventional counterparts. In Single Point Incremental Forming (SPIF), the simplest variant of ISMF, bending near component opening region is unavoidable due to lack of support. The bending in the component opening region can be reduced to a larger extent by another variant of ISMF namely Double Sided Incremental Forming (DSIF) in which a moving tool is used to support the sheet locally at the deformation zone. However the overall geometry of formed components still has unacceptable deviation from the desired geometry. Experimental observation and literature indicates that the supporting tool loses contact with the sheet after forming certain depth. Present work demonstrates a methodology to enhance geometric accuracy of formed components by compensating for tool and sheet deflection due to forming forces. Forming forces necessary to predict compensations are obtained using force equilibrium method along with thickness calculation methodology developed using overlap that occurs during forming (instead of using sine law). Results indicate that there is significant improvement in accuracy of the components produced using compensated tool paths.

Incremental Sheet Forming (ISF) is a flexible forming process suitable for low volume production of sheet metal components. Single Point Incremental Forming (SPIF), which has only one tool forming the geometry, is the simplest variant of incremental forming. Bending of sheet between the component opening and the fixed boundary is unavoidable in SPIF due to the absence of support/backup. Double Sided Incremental Forming (DSIF) has two tools which can be used interchangeably for forming and providing local support. The accuracy of parts formed using DSIF is superior to those formed using SPIF as the unwanted bending is substantially reduced by providing local support. In addition DSIF is capable of forming components with features on both sides of the initial plane of sheet and convex and concave features without additional setup. In ISF, as the deformation progresses, the intended geometry slowly develops, this increases the stiffness of the sheet. While forming multiple features, the forming sequence greatly affects the way stiffness builds-up, which further affects the geometry of formed components. In the present work, an experimental investigation is carried out to demonstrate the affect of forming sequence on the geometries and accuracy of formed component. Results presented show that the feature sequencing greatly affects the geometry and accuracy of formed components.

Incremental sheet metal forming (ISMF) has demonstrated its great potential to form complex three-dimensional parts without using component-specific tools against the conventional stamping operation. Forming components without component-specific tooling in ISMF provides a competitive alternative for economically and effectively fabricating low-volume functional sheet metal products; hence, it offers a valid manufacturing process to match the need of mass customization, which is regarded as the future of manufacturing. In ISMF process, sheet is clamped in a fixture/frame with an opening window on a programmable machine, and a hemispherical/spherical ended tool is programmed to move in a predefined path giving shape to the clamped sheet by progressively deforming a small region in incremental steps. Although formability in incremental forming is higher than that of conventional forming, the capability to form components with desired accuracy and surface finish without fracture becomes an important requirement for commercializing the ISMF processes. This chapter presents various configurations developed to incrementally form the sheet metal components, experimental as well as numerical methods for estimating forming limits, procedures for enhancing the accuracy, and methodologies for tool path generation.