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Abstract Background Given the increasing recognition of the value of greater integration of physical and mental health services for children and young people, we aimed to evaluate preferences among parents for the characteristics associated with integrated health service provision for two conditions (eating disorders, functional symptom disorders). Methods Two discrete choice experiments (DCEs) were conducted, using electronic surveys. Participants were adult parents of children and young people. Choice scenarios were based on five attributes for the eating disorders study, and four attributes for the functional symptom disorders study. Results Two hundred parents participated in each DCE. For eating disorders, days missed from school in the last year was the attribute valued most highly, followed by days in hospital in the last year, costs to the NHS, functioning, and interaction with peers with eating disorders. Respondents were willing to trade £531 of costs to the NHS for one less day missed from school. For functional symptom disorders, time to diagnosis was valued most highly, followed by days missed from school while obtaining a diagnosis, reservations about seeing a mental health practitioner, and costs of diagnosis to the NHS. Respondents were willing to trade £4237 of costs to the NHS to wait one month less for a diagnosis. Conclusion Respondents’ preferences were largely consistent with the planned goals of integrating physical and mental health services. Our findings show the factors which ought to be considered when designing new integrated pathways and evaluating them.

Background Evidence suggests that by recognising the psychosocial component of illness as equally important to the biological components, care becomes more holistic, and patients can benefit. Providing this type of care requires collaboration among health professionals, rather than working in isolation, to achieve better outcomes. However, there is a lack of evidence about the implementation of integrated health care. This review focuses on children and young people experiencing eating disorders (i.e. disorders related to feeding and eating) or functional symptom disorders (i.e. medically unexplained symptoms). Aims The present review is part of a larger study that will inform the development of a new children’s hospital in England. Both eating disorders and functional symptom disorders are conditions that may be particularly likely to benefit from an integrated approach to health care, and this review aims to investigate what service models have been used to integrate care, what factors influence their implementation, and what effects these integrated models have on access to and outcomes from care. Method We conducted a systematic review of studies based on children and young people with eating disorders or functional symptom disorders, investigating the effectiveness of integrated mental and physical health services versus any other type of services provided in these populations. We searched MEDLINE, EMBASE and PsycInfo® (American Psychological Association, Washington, DC, USA) electronic bibliographic databases in July 2024 without restriction on the date of publication or country of interest. We reviewed only studies written in English. Results We identified 2668 citations which resulted in 1939 papers eligible for title screening. Only one single-site Australian evaluation of an integrated care model from over 20 years ago was included in our review. The study reported significantly higher number of total admissions and total bed-days utilised in the integrated approach. However, the burden of care shifted from psychiatric wards to medical wards and as a result, the cost per admission and the cost per inpatient decreased. Limitations The lack of conceptual consistency about the definition of integrated care may have driven false screening and loss of some evidence. The same limitation applies in terms of the definition of functional symptom disorders. Conclusions The review identified a gap in the evidence base relating to integrated secondary service provision for children and adolescents with eating disorders or functional symptom disorders in comparison with generic services. No similar studies were identified for children and young people with functional symptom disorders. Our findings align with previous evidence and show that despite the existence of studies describing aspects of integrated care, integration of physical and mental health services for children and young people with eating disorders or functional symptom disorders is underexplored and the limited available evidence is of weak quality. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133613. Plain language summary Children and young people with eating disorders (which involves issues with thoughts about food, eating, weight and shape, as well as eating behaviours) and functional symptom disorders (physical symptoms without clear medical explanation) need specialist health care that includes both physical and mental health services. To address the needs of these children and young people, whose number is growing, more recent trends in care are based on team-based care. This kind of care involves healthcare professionals from various specialties and encourages greater collaboration among them. There are studies that show that children and young people receiving this kind of care – also known as integrated care – might have better outcomes. The aim of this review was to search the relevant literature for studies that explore how this care is implemented and what its impact is on patients with these two conditions. We reviewed existing studies to see how integrated health services (combining mental and physical health care) are being used for these conditions. We specifically looked for studies that compared integrated services to regular, non-integrated services. We found only one study exploring the impact of this kind of care for children and young people with eating disorders. We extracted useful information from this study, and we assessed its quality. That study found that integrated care had better outcomes for children and young people with eating disorders compared to the standard care. Integrated care reduced the hospital admissions to psychiatric wards. However, the study’s quality was weak as it evaluated an integrated care model from over 20 years ago and from a single location. For this reason, these findings should be interpreted with caution.

Abstract Introduction Tympanoplasty is a surgical method, to eradicate middle ear infection and improve its function. In tympanoplasty graft can be by overlay or underlay technique. In underlay technique the graft material can be placed either medial or lateral to the handle of malleus. Objective: To compare the outcome of the surgery when the temporalis fascia graft is placed medial or lateral to the handle of malleus, in terms of complete take up of the graft and hearing improvement after the surgery. Materials & methods A prospective and comparative hospital-based study was done in the Otorhinolaryngology (ENT) department of a tertiary referral hospital of Kolkata, from 1st January, 2021 to 30th June, 2022 (18 months). 60 patients were included in the study. Results We found that association of tympanic membrane status with group was not statistically significant after 1 month of surgery (p=1.0000) and after 3 months of surgery (p=0.6711). Distribution of mean postoperative hearing gain after 3 months of surgery with group was not statistically significant (p=0.3020). Conclusion We found both the techniques are equally effective in terms of complete graft take up and post operative hearing gain after 3 months follow up.

The present article reports the effect of transition (Cu ^2+ ) and rare earth metal (Gd ^3+ ) ion doping on structural, microstructural and electrical properties of boehmite nanoparticles. Rietveld refinement is adopted here to refine the x-ray diffractograms for further analyzing the microstructural details and their alteration due to the incorporation of foreign cations. This is probably the first time when dielectric properties of these doped boehmite samples having been reported herein. These samples show remarkably high dielectric constant values which corroborate that doping enhances the microstrain values inside the orthorhombic structure and results in higher crystallographic defects. Enhancement in defect sites causes the augmentation of relative permittivity and ac conductivity. Temperature stability has also been enhanced significantly in our Cu-doped sample. The present study enables us to determine a relationship between crystalline deformation and electrical properties of nanomaterials which may be highly beneficial in fabricating cost-effective energy harvesting devices.

Present investigation is focused on systematic and detailed characterization of alkyl phosphonium intercalated montmorillonite (MMT). The objective of the work is to provide a better understanding of the specific changes in properties of the hybrid material with changes in structure of incoming organic cations. In the present work, Na-MMT was intercalated with phosphonium salts of two different cationic head compositions namely alkyl triphenyl and alkyl tributyl groups. Length of alkyl chain was also varied. Resultant organic-inorganic hybrids were characterized by X-ray diffraction (XRD), Transmission electron microscopy (TEM), Thermogravimetry (TG) and Fourier transformed infrared spectroscopy (FTIR). Effective volume occupied by the cationic heads influenced interlayer arrangements. Intercalated MMT with two different cationic heads behaved differently in relation to thermal decomposition patterns. Possible explanation was given based on hybridization of bonds. Van der Waals attachment of alkyl chains influenced the interlayer stacking and organic loading. Attempts were made to correlate the changes in properties of intercalated MMT with the structural aspects of incoming organic cations.

With the scaling of lateral dimensions in advanced transistors, an increased gate capacitance is desirable both to retain the control of the gate electrode over the channel and to reduce the operating voltage 1 . This led to a fundamental change in the gate stack in 2008, the incorporation of high-dielectric-constant HfO 2  (ref.  2 ), which remains the material of choice to date. Here we report HfO 2 -ZrO 2 superlattice heterostructures as a gate stack, stabilized with mixed ferroelectric-antiferroelectric order, directly integrated onto Si transistors, and scaled down to approximately 20 ångströms, the same gate oxide thickness required for high-performance transistors. The overall equivalent oxide thickness in metal-oxide-semiconductor capacitors is equivalent to an effective SiO 2 thickness of approximately 6.5 ångströms. Such a low effective oxide thickness and the resulting large capacitance cannot be achieved in conventional HfO 2 -based high-dielectric-constant gate stacks without scavenging the interfacial SiO 2 , which has adverse effects on the electron transport and gate leakage current 3 . Accordingly, our gate stacks, which do not require such scavenging, provide substantially lower leakage current and no mobility degradation. This work demonstrates that ultrathin ferroic HfO 2 -ZrO 2 multilayers, stabilized with competing ferroelectric-antiferroelectric order in the two-nanometre-thickness regime, provide a path towards advanced gate oxide stacks in electronic devices beyond conventional HfO 2 -based high-dielectric-constant materials., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Despite the availability of potent antimicrobial drugs, bacterial meningitis remains a serious infection with significant morbidity and mortality. In many studies, pyogenic meningitis is reported in patients with immunoglobulin (Ig) and complement deficiencies. In the present study, a broad range of immunological tests were performed to determine the relative importance of primary immunodeficiency as a predisposing cause of first episode of pyogenic meningitis without any evidence of other major infections in past medical history., Methods: We studied 19 patients with bacterial meningitis confirmed by smear, culture, and cerebrospinal fluid parameters. Immunological tests were performed within 1 to 21 days of diagnosis. Twenty healthy adults served as controls. Serum Ig levels (IgA, IgG, IgM, IgE) and total hemolytic complement (CH5O) as screening tests were done. Lymphocytes, neutrophils, and T-cells were enumerated. Nitroblue tetrazolium test was used for the assessment of neutrophil function., Results: Thirteen patients were male and six were female. The mean age of the patients was 27.8 ± 19 years (range 5-73 years). One patient had subnormal IgA levels; five patients had subnormal IgE levels; one patient had lymphopenia and low CD4, CD3, and CD19; and one patient had subnormal IgM and IgE levels with lymphopenia and low CD4, CD3, CD8, and CD19 counts. All patients had normal complement components (C3 and C4), CH50, and nitroblue tetrazolium test., Conclusion: The most common immunodeficiency in our study was Ig deficiency. Our results support the recommendation that immunological evaluation, especially Ig assay, should be used in patients with bacterial meningitis even in the first episode., (Copyright © 2011. Published by Elsevier B.V.)