Background:  Research suggests that the routine measurement of treatment outcomes is a neglected area of clinical practice within mental health care settings. Still it is not clear to what extent such findings apply to child and adolescent mental health services (CAMHS). A cross‐sectional survey of UK CAMHS revealed that although quantitative clinical measures are commonly used within these services, there is little uniformity in the instruments utilised, and they rarely inform a system of routine outcome measurement. However, in general, respondents did not have a philosophical or scientific objection to the practice of routinely measuring outcomes, but rather felt that they lacked the necessary resources to facilitate such initiatives.

The U.S. Geological Survey (USGS), in cooperation with the U.S. Environmental Protection Agency (USEPA) and the New England Interstate Water Pollution Control Commission (NEWIPCC), has developed a water-quality model, called SPARROW (Spatially Referenced Regressions on Watershed Attributes), to assist in regional total maximum daily load (TMDL) and nutrient-criteria activities in New England. SPARROW is a spatially detailed, statistical model that uses regression equations to relate total nitrogen and phosphorus (nutrient) stream loads to nutrient sources and watershed characteristics. The statistical relations in these equations are then used to predict nutrient loads in unmonitored streams. The New England SPARROW models are built using a hydrologic network of 42,000 stream reaches and associated watersheds. Watershed boundaries are defined for each stream reach in the network through the use of a digital elevation model and existing digitized watershed divides. Nutrient source data is from permitted wastewater discharge data from USEPA's Permit Compliance System (PCS), various land-use sources, and atmospheric deposition. Physical watershed characteristics include drainage area, land use, streamflow, time-of-travel, stream density, percent wetlands, slope of the land surface, and soil permeability. The New England SPARROW models for total nitrogen and total phosphorus have R-squared values of 0.95 and 0.94, with mean square errors of 0.16 and 0.23, respectively. Variables that were statistically significant in the total nitrogen model include permitted municipal-wastewater discharges, atmospheric deposition, agricultural area, and developed land area. Total nitrogen stream-loss rates were significant only in streams with average annual flows less than or equal to 2.83 cubic meters per second. In streams larger than this, there is nondetectable in-stream loss of annual total nitrogen in New England. Variables that were statistically significant in the total phosphorus model include discharges for municipal wastewater-treatment facilities and pulp and paper facilities, developed land area, agricultural area, and forested area. For total phosphorus, loss rates were significant for reservoirs with surface areas of 10 square kilometers or less, and in streams with flows less than or equal to 2.83 cubic meters per second. Applications of SPARROW for evaluating nutrient loading in New England waters include estimates of the spatial distributions of total nitrogen and phosphorus yields, sources of the nutrients, and the potential for delivery of those yields to receiving waters. This information can be used to (1) predict ranges in nutrient levels in surface waters, (2) identify the environmental variables that are statistically significant predictors of nutrient levels in streams, (3) evaluate monitoring efforts for better determination of nutrient loads, and (4) evaluate management options for reducing nutrient loads to achieve water-quality goals.

This study investigates nutrient sources and transport to receiving waters, in order to provide spatially detailed information to aid water-resources managers concerned with eutrophication and nutrient management strategies. SPAtially Referenced Regressions On Watershed attributes (SPARROW) nutrient models were developed for the Northeastern and Mid-Atlantic (NE US) regions of the United States to represent source conditions for the year 2002. The model developed to examine the source and delivery of nitrogen to the estuaries of nine large rivers along the NE US Seaboard indicated that agricultural sources contribute the largest percentage (37%) of the total nitrogen load delivered to the estuaries. Point sources account for 28% while atmospheric deposition accounts for 20%. A second SPARROW model was used to examine the sources and delivery of phosphorus to lakes and reservoirs throughout the NE US. The greatest attenuation of phosphorus occurred in lakes that were large relative to the size of their watershed. Model results show that, within the NE US, aquatic decay of nutrients is quite limited on an annual basis and that we especially cannot rely on natural attenuation to remove nutrients within the larger rivers nor within lakes with large watersheds relative to the size of the lake.

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Much recent attention has focused on the fitness to practise of health professionals. Patients expect their care to be provided by therapeutic staff who can give support and guidance without unhelpful subjective influence. On the other hand, those recovered from health problems expect their employment prospects to be free of discrimination. Eating disorder services increasingly encourage patient and public involvement in service design and monitoring but reservations are sometimes expressed about employing staff who have themselves suffered with an eating disorder. This survey canvassed the views of patients, carers and professionals on the suitability of employing people with a history of an eating disorder as therapists in the same field. With some reservations (mainly from professionals), there was a widespread belief that those who had recovered would have therapeutic advantages as a result of their experience. Therapists with a current eating disorder, however, were thought to lack objectivity and to be vulnerable. Current UK policies on employment appear unnecessarily discriminatory and stigmatizing.