This paper examines diagnostic timelines for people suspected of having ALS/MND over a 20-year period, evaluates the impact of a 'fast track' diagnostic process and discusses typical causes of diagnostic delay. Key diagnostic timelines (dates of first symptom, diagnosis and death) were reviewed for people diagnosed between 1989 and 2008. Patients evaluated through a fast-track diagnostic process and those investigated through traditional neurology clinics were compared. Typical causes of diagnostic delay were investigated. Results showed that diagnostic timelines have been surprisingly consistent over this 20-year period. Time from first symptom to diagnosis hovered around 12 months, with the diagnosis typically being made around the midpoint (50% of total disease duration elapsed) of the disease pathway. The introduction of a fast-track process has not to date affected overall performance but has shortened times from referral to diagnosis. Diagnostic delays appear to be associated with clinical complexity and delays in referral, both within primary and secondary care services. In conclusion, more widespread implementation of fast-track processes could potentially reduce diagnostic delays. Educational interventions among health care professionals both in primary and secondary care may also help shorten diagnostic pathways.

Abstract:Intensive parenting debates reflect the critical importance of a child's early years, and parents' roles in determining later developmental outcomes. Mothers are usually assigned primary responsibility for facilitating their infants' cognitive development through adequate and appropriate sensory stimulation. Drawing on Foucault's technologies of the self we explore how new mothers shape their mothering practices in order to provide appropriately stimulating interactions. Using findings from 64 interviews (31 women were interviewed twice, 2 women were interviewed only once) we identify three main positions whereby mothers function in relation to their infants' development; mother as committed facilitator, creative provider and careful/caring monitor. We consider the perceived normative nature of these positions and the impact they can have on middle-class women's subjectivities as new mothers. Our study of parental agendas and infant cognitive development suggests that a continued focus on the mother's role within early infant development reflects and upholds ideologies of child-centred, intensive mothering, which risks precluding 'alternative' maternal subjectivities and promotes conservative feminine identities.

Teenage mothers find themselves caught between two discourses: the irresponsibility of youth and the responsibility of motherhood. We unravel some of the complexities surrounding the performance of socially approved 'good mothering', from a position of restricted resources. We demonstrate the relevance of Skeggs' (1997) notion of respectability in attempts to understand young mothers' management of a complex interplay of consumption meanings. Our informants seek to secure social value and legitimacy through employing a number of consumption strategies centred around identification and disidentification. However, we recognize that young mothers' careful marshalling of resources, in relation to consumption, risk being misread and could leave young women open to further scrutiny and negative evaluation, ultimately limiting their opportunity for securing respectability in wider society.

Our objective was to determine the efficacy and feasibility of a new approach for identifying candidate biomarkers for knee osteoarthritis (OA), based on selecting promising candidates from a range of high-frequency acoustic emission (AE) measurements generated during weight-bearing knee movement. Candidate AE biomarkers identified by this approach could then be validated in larger studies for use in future clinical trials and stratified medicine applications for this common health condition. A population cohort of participants with knee pain and a Kellgren-Lawrence (KL) score between 1-4 were recruited from local NHS primary and secondary care sites. Focusing on participants’ self-identified worse knee, and using our established movement protocol, sources of variation in AE measurement and associations of AE markers with other markers were explored. Using this approach we identified 4 initial candidate AE biomarkers, of which “number of hits” showed the best reproducibility, in terms of within-session, day to day, week to week, between-practitioner, and between-machine variation, at 2 different machine upper frequency settings. “Number of hits” was higher in knees with KL scores of 2 than in KL1, and also showed significant associations with pain in the contralateral knee, and with body weight. “Hits” occurred predominantly in 2 of 4 defined movement quadrants. The protocol was feasible and acceptable to all participants and professionals involved. This study demonstrates how AE measurement during simple sit-stand-sit movements can be used to generate novel candidate knee OA biomarkers. AE measurements probably reflect a composite of structural changes and joint loading factors. Refinement of the method and increasing understanding of factors contributing to AE will enable this approach to be used to generate further candidate biomarkers for validation and potential use in clinical trials.

A retrospective case note study explored réadmissions to an acute psychiatric in-patient unit within six months of discharge. The study aimed to calculate a hospital readmission rate, to investigate the timing of readmissions, and to identify risk factors associated with readmission. The readmission rate was 27% with the majority of readmissions occurring within three months after discharge, suggesting the need for investigation of such early readmissions. The three factors found to predict readmission were: discharge against medical advice, number of previous admissions, and living alone or with family rather than in care. Implications for hospital service planning are considered.