Apps for AHP’s

An evaluation of Allied Health Professionals’ use of iPads for a variety of clinical specialties within NHS Fife. Sarah Mitchell-Thain – Occupational Therapist

Adapted from the NHS Fife poster which recently won first prize in the British Computer Society poster presentation. Ref: Leech, A., Braid, M. and Chung, C

1Getting the kit …

A number of AHP’s working in the community have been allocated an iPad to use in clinical practice as a result of a successful bid to the Scottish Governments funding for ‘mobile devices in community health services’. The NHS Fife AHP eHealth Delivery Group which involves both eHealth and AHP services coordinated the Mobile Device Project.

iPads were allocated to Physiotherapists, Occupational Therapists, Podiatrists, Pharmacists, and Dieticians across specialties including child health, chronic pain, learning disabilities, mental health, stroke rehabilitation and rheumatology.

Using the kit …

The iPad roll out started small with trials in 2 services using a couple of the allocated devices. However it quickly grew as the conversations and understanding provoked an appetite for trials in other AHP services. Widening the trial enabled a fuller and richer evaluation of the value in a range of specialities. A combination of 3G and WiFi only devices were used.

iPad confidence and knowledge varied greatly amongst staff and sparked many enlightening and educational conversations both with each other and service users who on the whole we have found to be the ‘expert users’.

Various informal and formal forums were utilised for AHP’s to share the knowledge and experience of using the iPads in clinical practice for example; department demo’s, meetings, video conferencing, supervision, reflective practice, SWOT analysis etc……


Clinicians explored a range of applications and functionalities to determine whether they added value to service delivery. They were asked to record their finding in relation to the below:


  1. The type, scope and frequency of usage
  2. Difficulties encountered
  3. Availability and usage comparison of 3G and wi-fi
  4. The range of therapeutic applications available
  5. Efficiencies in ways of working and cost savings






Aims of the Project

  1. To explore different ways in which mobile technology could be used in clinical settings
  2. To evaluate the effectiveness of the mobile technology in clinical practice
  3. To highlight patient /carer opinion of using mobile devices in their treatment and or self management.
  4. To share experiences of iPad usage across the allied health professions

“Apps – tick all the boxes”

Screenshot 2014-10-06 19.46.57























Scottish Government 2010 The Healthcare Quality Strategy for NHS Scotland. The Scottish Government May 2010

Building Dementia Friendly Communities? It’s just so AHP!


By Sandra Shafii  AHP Dementia Consultant 

I wrote a blog a while ago called “Suffering from Brilliance” [1] that described the “Aha!” moments that create excitement and energy in me.  And I have to say that the idea of developing dementia friendly communities created that same wonderfully familiar energetic feeling….a feeling that drives you forward…. that makes sitting impossible….that gets you out of your chair (or bed!!!) and galvanises you into action….

Motherwell’s dementia friendly community initiative is now well known.  Our simple approach and easy to use tools and methodology have been picked up across Scotland ….across the rest of the UK…and even wider…. by Norway and other European countries.

It has been an exciting time….talking about our work, sharing our experience and encouraging others to take up the concept and get out there!

I don’t think I need to say anything more really…..EXCEPT……why me?

Why do I think that building dementia friendly communities is an AHP’s business ….?

The answer for me lies firmly in policy and strategy.

Current health and social care policy supports people to remain in their own homes for as long as possible, safely and confidently.  Health and social care integration demands new ways of working together.


But we also find words like “coproduction”, “community capacity” and “assets based” approaches being used extensively as we work together in our new (and existing!!!) partnerships.

Scotland’s National Dementia Strategies, The Charter of Rights for People with Dementia and their Carers in Scotland[2] emphasise the importance of citizenship, social inclusion and full participation in society….

And this feels like a call to action ……!!!!

It calls to the heart of what we as AHPs believe in and aspire to achieve.

If we want to support people to live as well as they can with dementia …then it make sense that we need a community that understands and supports its citizens who are living with the disease to continue to enjoy access to mainstream community opportunities and for all of us…as citizens… to be welcomed and understood

If, as AHPs, we believe that our main function in the health and social care system is to promote health and wellbeing, to work alongside people and their communities to help them find ways to compensate for health problems, overcome obstacles and challenges to living an ordinary everyday life, recover function, find ways to adapt to change, to self manage and feel empowered, valued and informed….

Then we must want to create communities around us that are resilient, caring supportive places for us all to live within…..communities that nurture, are understanding, that take pride and responsibility for health and wellbeing, that understand health problems and want to redress inequality.

Our Allied Health Professions Scotland Consensus Statement on Quality Service Values (2013)[3] is designed to unite us as Allied Health Professionals so that we can contribute to integrated service delivery to achieve the 2020 Vision for Healthcare in Scotland[4].


These service values ask us to be compassionate in our care and leadership, work in partnership and build strong networks across a wide range of sectors, be accountable for what we do ….and that the health, safety and wellbeing of all should be at the heart of everything we do.

And specifically in the Person Centred Care section it states “ service users can expect Allied Health Professionals to work in partnership with them to enable access to services within health, social care and their local communities which will support them to self-direct and self manage their health and social care needs”.

Indeed our Allied Health Professions National Delivery Plan (2012 – 2015)[5] encourages us to create added value beyond health and deliver excellent outcomes for people who use services, their families and carers.  Specifically Action 3.2 asks us to enhance community capacity building and use assets based approaches and work in new partnerships

So…in answer to the question that has been posed to me several times……How could I NOT be involved in developing dementia friendly communities?  

As an AHP I have a focus on rehabilitative and recovery based approaches.  AHPs have always supported people to achieve their goals through the development of coping strategies and compensatory techniques… always identifying and building on capacity, strengths and assets……and this approach underpinned our development work in Motherwell!!!

I think being a part of building dementia friendly communities breathes life into our health and social care strategies and policies…..makes them an “on the ground” reality…and what AHP doesn’t want to just get out there and do something that builds on strength and capacity, that demands innovative, creative and energetic input….that supports us to work with people and communities in what matters to them!!!

It is what makes us tick….it describes what an AHP is….and does!

Building Dementia Friendly Communities???? It’s just so AHP!!!!!

Sandra Shafii

[1] “Suffering from Brilliance” AHPScot Blog – Sandra Shafii (2013)

[2] The Charter of Rights for People with Dementia and their Carers in Scotland   (2009)

[3] Allied Health Professions Scotland Consensus Statement on Quality Service Values (2013)

[4] Achieving Sustainable Quality in Scotland’s Healthcare – a 2020 Vision

[5] AHPs as agents of change in health and social care : The National Delivery Plan for the Allied Health Professions in Scotland (2012 -2015)

Improving Later Life

Blog from our newest AHP National Consultants, Jenny ACKLAND and Yolanda STRACHAN.


It’s harvest time already! Jenny and I joined Age Scotland six months ago in February, when actually the weather wasn’t that bad and you could see some green shoots starting to come through.

It has been a great summer and an even greater six months since being in post and we are delighted to have this opportunity to tell you a little more about our role and some of the work we have been harvesting.

Partnership Working

Ours is the fourth of the Allied Health Professional (AHP) Consultant posts to be created within the third sector. For those who are uncertain, third sector comprises not-for-profit organisations and is sometimes also known as the voluntary sector. We also have AHP colleagues working with the Care Inspectorate, Alzheimer Scotland and the Alliance Scotland.

Our posts were created by the Chief Health Professions Office at Scottish Government. Those of you who know your Reshaping Care for Older People will recognise the context for these posts; of ’building partnerships with third sector organisations in order to develop new community driven models of care which help older people maintain their independence’ (and a better quality of life) wherever possible.

Our passion is older people and it might surprise you to know that here at Age Scotland ‘older’ encompasses everyone from the age of 50 years upwards. I love this definition of ‘older’ because it widens the scope of our role and the kind of projects we can look at to increase the awareness of our AHPs and the contribution they make to the health and wellbeing of older people especially in the areas of public health information and prevention.

Raising awareness is a significant part of our work and it can take many forms.  Everything from contributing the AHP perspective to responses to consultations emanating from Scottish Government to helping with broad enquiries coming through Silver Line Scotland, Age Scotland’s Information, Friendship and Advice Helpline for Older people.

An equally important part of our role is to provide our AHPs with information about the support and resources that Age Scotland provide for older people. Having that knowledge base about the kind of supports available in their areas and nationally from third sector organisations is vitally important for helping AHPs meet the aspirations of their patients for life as they would have it and to petition for service change on that basis. Age Scotland has over 900 member groups. These are organisations big and small who are out there working to ensure that older people enjoy a better later life. Have a look at Age Scotland’s website and the resources available and then please do come back to myself or Jenny if you would like to know more.


One of my favourite questions when I meet other colleagues and professionals is ‘What is keeping you busy today?’ It can often be too much to explain an entire work plan but asking people to tell you where their energies lie on a particular day can be really satisfying for them and you. This is the question I used when I first joined Age Scotland to try and understand the many different roles of the people working here. Jenny and I ‘sit’ with the Policy and Communications Team This is a very lively group of very talented professionals whose role is to campaign on behalf of older people.  I use the word ‘sit’ loosely because one of the flags Jenny has been flying very strongly for us since arriving here is the work on Understanding Sedentary Patterns and how these contribute to ill health. We are soon to take delivery of a prototype of a standing desk, currently being built by one of our Men’s Sheds. If you haven’t heard about Men’s Sheds you might want to take a look here.

We also work closely with the Information and Advice Team, again who represent an incredibly diverse skill and knowledge base, contributing to health information projects where we can and recruiting in the expertise of AHP colleagues as needed. You may get a call from us!

badgeSo…  What has been keeping me busy today? …… I have been meeting with my colleague and health information writer to discuss her findings from a scoping exercise on older people and mental health. I’ll be using this information to represent Age Scotland and our AHPs on a short life working group at Scottish Government looking at psychological services for older people. There are many reasons why our older people have poor access to and uptake of these services so it would be really wonderful to make progress on this issue.

I have been following up with some of our AHPs on articles they have written for Age Scotland Advantage magazine. One of the things that has pleasantly surprised us since being in post is the discovery that people are genuinely very interested in who the Allied Professions are and this is a great way to highlight the very practical help and advice that AHPs can offer.

I have been continuing in dialogue with some of our NES career fellows on questions they have raised regarding co-production and achieving consensus following a visit here to Age Scotland.

Finally I have been scoping for future work streams. One of the things I find most enjoyable about my new role in third sector is the sheer diversity of the work being carried out to ensure that older people can love later life. This is an aspiration we all share as AHPs working with older people.

And what has been keeping Jenny busy today? There have been a few bits of work in progress that I can tell you about.

The former Scottish Pre-retirement Council and the former Tayside Pre-Retirement Council joined forces with Age Scotland in July this year and we have been asked to provide a health and well being input to their training days. Jenny participated in one of these training events herself last March prior to her own voluntary early retirement and she can hardly believe that she will be on the delivering end of this training come September.  Keeping well and active is very dear to our hearts and we are planning an interactive session that we hope will be interesting and of value for the participants approaching a new and exciting chapter in their lives


An element of our workplan is to develop and evaluate practice placements for student AHPs. Our AHP Consultant colleagues in Alzheimer Scotland and the Care Inspectorate have developed contemporary placements for students in care homes and in the third sector in conjunction with NES.  We would like to learn from the experience of our colleagues and currently Jenny is arranging a meeting to debate and agree a way forward for some innovative AHP student placements in the third sector.

Jenny is representing Age Scotland on the dissemination advisory group associated with the Seniors Understanding Sedentary Patterns (USP) study being led by Professor Dawn Skelton at Glasgow Caledonian University. Part of our role on this group is to share information about the study and the

 health risks associated with sedentary behaviours – or prolonged sitting within our member groups and with our own staff. Dawn has organised a free webinar on 27th August to share information and you can register for this and other free informative seminars via the Seniors USP website

An interesting and very pragmatic consequence from this work has been the recognition that we ourselves in Age Scotland are very sedentary indeed … we are sitting a lot at our desks working on computers all day. We have been chatting a lot about how we can change this pattern and if we can possibly work differently and be a bit more active in our workplace. There is also a view that we need to be ’walking the talk’ in terms of being less sedentary if we are really trying to encourage and empower our older people to do the same.

UnknownThere is a real energy and enthusiasm to try and change how we work and every team in our office and wider has put forward a representative to be part of a group that will debate ideas to be more active and practically workable for their particular team. I mentioned earlier about the Mens Sheds initiative and we are so excited about the delivery of our very own custom made standing desk. Our CEO at Age Scotland Brian Sloan has very kindly championed and taken this forward for us with one our Mens Shed groups.  Mens Sheds have a core purpose of engaging and utilising the crafting skills of our older people and this group has designed and is actually producing a piece of furniture for our office that has the potential to improve the health outcomes for our staff – WOW!

For us this is co-production in its essence and it just can’t get any better than that!

Screenshot 2014-09-15 16.34.13

Finally, Jenny has been planning for – and what turned out to be a really fabulous day in the middle of August at the Scottish Parliament. Age Scotland had been invited to work in partnership with podiatry colleagues from the Society of Chiropodists and Podiatrists to share information about our work with politicians and visitors in the garden lobby. We had the opportunity with the help of our policy officers to engage and network with a wide range of people and it was a real joy to talk about the issues that are important to older people and the benefits of good footcare – and the real difference this can make to peoples independence, mobility and quality of life.

Serious….for a reason


Serious for a reason – The importance and consequences of red flags – by Mick McMenemy Physiotherapy Clinician and Annie Glover – Founder & Chair of Cauda Equina Syndrome UK

Cauda Equina Syndrome is a relatively rare occurrence but has such potentially serious consequences that it should be screened for in every patient presenting with low back pain. Increasingly patients have direct access to Allied Health Professionals [AHPs] so it is imperative that we have a good understanding of this condition, know how to screen for it and crucially, know what action to take if CES is suspected.

This is of major importance to physiotherapists who typically will be recognised as the health professional of choice to assess and manage the patient with low back pain.


UnknownThe physiotherapist will routinely be presented with the patient who has either self-referred without seeking advice from their GP or who has been advised by their GP to self- refer for treatment but without a medical examination being carried out.

We therefore have to actively assume that there is a possibility that the patient being assessed may have some kind of undiagnosed serious pathology (until we have checked) and that we must immediately screen for these before actively assessing and treating the patient.

Recently, there has been a growing criticism of the current use of lists of red flags. Lists of red flags ( signs and symptoms of serious pathology) often contain flags with little evidence of predictive value and mix together flags of different serious pathologies which is unhelpful and confusing to the health professional, particularly the non-expert in that specific serious pathology. For example, flags for Osteoporotic fracture, infection and CES are often included in one list; these conditions are quite different and have very different signs and symptoms. Confusing lists create the risk that clinicians will miss a specific condition or refer patients to specialists unnecessarily.

UnknownMartin Underwood (2014) has called for a move towards using ‘clusters ‘of red flags for a specific pathology. For example, if screening a patient for CES the following might be asked: since developing your back pain have you had any new symptoms such as

  • Loss [or change] of control of your bladder i.e. incontinence or lack of control such as incomplete voiding or retention.
  • Loss [or change] control of your bowel i.e. incontinence, constipation
  • Saddle anaesthesia (numbness around the perineal area)
  • Gait disturbance; tripping or unsteady on your feet]


If screening for undiagnosed cancer the key red flags are:

  • Past Medical History of cancer
  • Elderly (over 55 with increasing risk with increasing age)
  • Unexplained recent weight loss

You can see the two different conditions are naturally screened for quite differently and if present require quite different management; suspected CES is an immediate transfer to Accident and Emergency for medical assessment, undiagnosed cancer is referred urgently to the patients GP for their assessment.

Screen Shot 2014-08-30 at 16.25.42

National audits in Scotland showed marked variation as to whether screening for serious pathology was even recorded never mind which flags were screened for. Current practice continues to see a wide variation in practice on which flags are screened for and whether this is recorded. This is surely not desirable?   [click here for most recent work around this]

Shifting to a new paradigm of using and recording the screening of specific serious pathologies by implementing the use of ‘clusters’ of flags for each relevant specific condition would be a significant step for AHPs to systematically demonstrate that patient safety is central to our care. The development and utilisation of a standard screening tool would be very helpful for health professionals who are trying to help their patients and not harm them. Most importantly and fitting with the National policy on patient-centred care, routine screening will minimise the risk that patients are harmed due to a serious pathology being missed at the earliest opportunity.

Annie Glover in her blog below describes the personal catastrophic effects that result from suffering CES. Tragically, despite the long- existence of clear guidelines on how to screen for CES (CSAG on back pain 1994), this condition is often still not diagnosed quickly enough to avoid serious medical, physical and emotional consequences to the patient.

Continue reading

Let’s get bothered about self management!

Let’s get bothered about self management! from Health and Social Care Alliance Scotland (the ALLIANCE)


With Scotland’s aging population comes the challenge of living with multiple conditions. People living with multiple conditions are more likely to be admitted to hospital, more likely to be prescribed drugs and have a poorer quality of life. Self management is key to improving outcomes for individuals with multiple conditions – allowing people to live their lives better by being more informed, prepared for everyday challenges and better supported when they need it.

What is self management?

Self management is based on a ‘strengths’ or ‘assets’ based approach. It means working collaboratively with people’s strengths so that together you find the best outcomes and the way to move forwards.


How can Allied Health Practitioners engage in self management?

Allied Health Practitioners (AHPs) can take a shared approach to setting goals and problem solving and can take account of peoples inherent ability for self-healing whilst recognising people with long term conditions as experts in their own life circumstances. Through meaningful conversations, AHPs can encourage self confidence and support people to have more control of their conditions and lives.


Self management makes a difference

Research shows that supporting self management improves:

  • self care behaviours
  • quality of life
  • clinical outcomes
  • patterns of healthcare use

When people are supported to look after themselves:

  • they feel better
  • enjoy life more
  • have less need to visit their doctor or hospital.

By practising self management, AHPs can relieve some of the pressure placed on health providers and help relieve the 70% expenditure which long term conditions are estimated to consume from health and social care resources.  


The figure above shows the journey of a person living their life with a long term condition. The green line depicts the fluctuations associated with managing a long term condition, while the red stripes indicate the episodic consultations from health and social care practitioners. While people themselves are the principle contributors to their health and wellbeing, there are opportunities for AHPs to positively assist with this journey.


What supports self management

  • Gaun Yersel: The Self Management Strategy for Long Term Conditions in Scotland (2008)
  • Mental Health Strategy for Scotland 2012-1015
  • A Route Map to the 2020 Vision for Health and Social Care (2013)
  • House of care:


When to endorse self management.

Now, Now, Now! Supporting self management is essential to the sustainability of delivering quality healthcare services across Scotland. A national acknowledgement of the importance of the individual being at the centre of their health and social care makes it an essential time to embrace an asset based, self management approach.

My Condition, My Terms, My Life

The Health and Social Care Alliance Scotland (the ALLIANCE) has launched the My Condition, My Terms, My Life campaign to share the message that living with a long term condition does not stop you being in charge of your own life. The campaign aims to:

  • help improve public understanding of what self management means for people living with long term conditions, and
  • encourage people living with long term conditions, and the people who support them to adopt a self management approach


The ALLIANCE would welcome collaborating with any AHPs promoting self-management who are looking for advice, support, guidance and materials in their work.

All enquires to or call 0141 404 0231.


For Allied Health Professional information related to Long Term Conditions please contact

Should OTs be taking a tablet?

Should OTs be taking a tablet? Use of touch screen apps in early dev. By Melanie Ross Specialist OT, Keycomm AAC service, Edinburgh

Adapted from original in OT news with permission and thanks -Paediatric OT and portable touch screens in early development – Should OTs be taking a tablet? 

One of the common goals for Lothian’s Communication Technology service (Keycomm), and the Paediatric OT service at the Sick Children’s hospital in Edinburgh is to provide support for young children with complex disabilities to learn and develop through play. In Keycomm, I work predominantly with the under fives, or those at a very early developmental level, using technology and adapted or switch accessible toys to support access to play. I am increasingly aware how many children have regular access to touch screen devices.

ipad mum and toddler

At home they may relax with youtube clips on Mum’s ipad; While waiting for an appointment, they watch or listen to music on Dad’s iphone; and almost every nursery/school has access to touch screen tablets, ipads or smart boards. Apple sold 3 million ipads in 3 days in 2012 and sales have continued to soar. There are a vast array of apps tailored for children, both with and without disabilities and many specifically geared to the interests and learning styles of children with conditions such as Autism Spectrum Disorders and Down Syndrome.

There is an ongoing debate at many levels about the impact of “screen time” on the youngest learners. In October 2013, the American Academy of Paediatrics’ position statement, based on analysis of existing research, re-asserted that television and similar entertainment media should be avoided for children under 2. Key researchers like D Christakis (2009) support this with convincing arguments, concerned about the way in which television in particular is experienced as a passive, isolated activity for so many children. However, there is also support for the argument that video, television and touch screens (in particular) have potential for learning. There is admittedly little robust research in this area, but some studies have concluded that because the interaction required from the user of a touch screen device may enhance the potential for learning and may counteract at least some of the concerns around passive viewing e.g with a standard television. Stephenson and Limbrick (2013) have published a meta-analysis of studies with (mostly older) individuals with learning disabilities which may be of interest to readers.

ipad toddler tongue out

There is little or no substitute for interpersonal play. However, we must accept that touch screens are part of everyday experience for even the youngest children. In my experience, considered use, facilitated by an adult play partner and requiring response and interaction from the child, has little potential for harm, and strong possibility for good. Certainly, OT’s in our paediatric service and no doubt many others are embracing it, as we always do, with our analytic and pragmatic, solution focus.

Asking the question “how can this tool help to achieve our goals?”

For learners at early developmental stages, touch screen “Apps” have advantages. The high contrast, movement rich, audio-visual mix seems to promote attention and concentration in children who are otherwise hard to engage. Apps certainly suit visual learners, including those with Autistic Spectrum disorder and the huge variety of free or almost free apps increases the chances of finding something that really captures the special interests of the child. Apps can reward simply making a sound (e.g. apps like “furry friend”, sock puppets, Speak up*). For those who, perhaps with postural support, can control a reach or touch with even 2-3 fingers together on the screen there are visual and auditory rewards (apps like Electra*, imeba*, play piano and magic piano) and for children with the motor control to touch a target area, repeat a touch, swipe and drag a whole world of possibilities for learning and play are available. This seems particularly pertinent for those children whose access to a wider world of experience is restricted by illness or physical fragility.

There are of course drawbacks – touching over a larger surface area or “swiping” can unintentionally close the app or activate unwanted functions. However, guided access and other accessibility settings on ipads and iphones can help reduce these problems. An array of robust cases and screen protectors are now available too, thus avoiding very expensive accidents! The conclusion I have reached is that when the right apps are offered to any child they provide immediate and consistent feedback in a variety of forms (sound, colour, visual movement, etc), and are often very motivating, because, as one parent put it “they are just built to be great fun.”

(*from Sensory App House),

Through discussion with many parents, educators, speech therapists and other OTs. I have compiled a list of apps for developing early interaction and touch screen skills. This is available on Keycomm’s website at and is very much an evolving document with hyperlinks to (as far as possible) free apps. To promote goal centred use of apps, they are arranged in an approximately developmental sequence, starting with those that seem most effective at developing attention, then those for children who show desire to interact with the screen by making a sound or touching. Later apps encourage more precise touch, repeated touch, swiping and dragging. Currently the list also includes apps which develop skills for early writing/hand control and some fine motor skill apps for more advanced learners, but these may be re-located in their own advice sheets soon.

With such a multitude of apps available, including supporting daily living, social and behaviour skills, personal organisation, communication, etc, finding the right one for individual learning needs and preferences can seem a daunting task. Many apps seem to be marketed for a target audience, e.g. “for children with autism” but may be inappropriate for the age and stage of a particular child with that condition. It can be hard to find quality sources of unbiased, professionally qualified, pragmatic advice. I and colleagues have found Ian Bean to be an excellent UK authority on applying apps for early learners in special education. His website has links to his facebook and twitter accounts which are very regularly updated with new ideas for apps, as well as lots of other ideas for using ICT with children with additional needs. In the US, Kate Ahern manages a very active blog at ‎. This has links to so many other useful sources I feel obliged to give the warning to only open it when you have at least an hour to spare!!

Touch screen technologies are here (and there and everywhere!) to stay. I would love to inspire interest and an ongoing discussion about how we as a profession access and harness their potential across our diverse areas of practice.


Christakis, D (2009) The effects of infant media usage: what do we know and what should we learn? Acta PaediatricaVolume 98, Issue 1, pages 8–16, January

American Academy of Pediatrics (2013) “Media and children”

Apple Press Info. (2012). Apple sells three million iPads in three days. Accessed 14 February 2014.

Stephenson J • Limbrick L (2013) A Review of the Use of Touch-Screen Mobile Devices by People with Developmental Disabilities J Autism Dev Disord, July 2013