How can malaria rapid diagnostic tests achieve their potential? A qualitative study of a trial at health facilities in Ghana.

BACKGROUND: Rapid diagnostic tests (RDTs) for malaria are at the early stages of introduction across malaria endemic countries. This is central to efforts to decrease malaria overdiagnosis and the consequent overuse of valuable anti-malarials and underdiagnosis of alternative causes of fever. Evidence of the effect of introducing RDTs on the overprescription of anti-malarials is mixed. A recent trial in rural health facilities in Ghana reduced overprescription of anti-malarials, but found that 45.5% patients who tested negative with RDTs were still prescribed an anti-malarial. METHODS: A qualitative study of this trial was conducted, using in-depth interviews with a purposive sample of health workers involved in the trial, ranging from those who continued to prescribe anti-malarials to most patients with negative RDT results to those who largely restricted anti-malarials to patients with positive RDT results. Interviews explored the experiences of using RDTs and their results amongst trial participants. RESULTS: Meanings of RDTs were constructed by health workers through participation with the tests themselves as well as through interactions with colleagues, patients and the research team. These different modes of participation with the tests and their results led to a change in practice for some health workers, and reinforced existing practice for others. Many of the characteristics of RDTs were found to be inherently conducive to change, but the limited support from purveyors, lack of system antecedents for change and limited system readiness for change were apparent in the analysis. CONCLUSIONS: When introduced with a limited supporting package, RDTs were variously interpreted and used, reflecting how health workers had learnt how to use RDT results through participation. To build confidence of health workers in the face of negative RDT results, a supporting package should include local preparation for the innovation; unambiguous guidelines; training in alternative causes of disease; regular support for health workers to meet as communities of practice; interventions that address negotiation of health worker-patient relationships and encourage self-reflection of practice; feedback systems for results of quality control of RDTs; feedback systems of the results of their practice with RDTs; and RDT augmentation such as a technical and/or clinical troubleshooting resource

Resilience in Caregivers of Partners With Young Onset Dementia: A Concept Analysis

Introduction: Over 200,000 Americans diagnosed with young onset dementia (YOD), dementia diagnosed prior to age 65, are cared for by family members. This can be costly to caregivers’physical and psychological health. Some adapt well to the caregiver role and are said to be resilient. Aim/Question: This paper builds on current understanding of the concept of resilience and applies this to caregivers of partners diagnosed with YOD. Method: Concept analysis. Results: Resilient caregivers exhibit attributes including determination, flexibility, positive thinking, self-efficacy, resourcefulness, social support and spirituality. Discussion: YOD affects caregiver’s health. Much research has been done on interventions for dementia caregivers. These interventions do not necessarily meet the needs of YOD caregivers as they do not account for dynamics in the family. By recognizing what is resiliency in YOD caregivers, interventions can be developed that focus on characteristics that build these attributes. Implications for Practice: Understanding the concept of resilience related to caregiving for a partner diagnosed with YOD allows for future development, measurement, and evaluation of nursing interventions. Nursing staff are in a strategic position to provide effective interventions to enhance resilience among caregivers of YOD

Factors affecting the success of intellectually handicapped people placed in unsheltered employment : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University

This study aimed at providing some initial information about those variables associated with 'success' of intellectually handicapped people working in unsheltered jobs in New Zealand. Subjects were selected from clients of the local Branch of the New Zealand Society for the Intellectually Handicapped using vocational status and supervisor consensus. Two groups of 18 subjects each were compared on demographic, social and vocational variables while controlling for sex and secondary handicap. For one assessment instrument, it was also necessary to control for the independence of subscale pairs. Results indicated that further refinement of the Adaptive Functioning Index scales was required but that programmes designed to improve social problem solving ability and communication skills may aid in placing and maintaining trainees in unsheltered jobs. The adherance to a client-centered placement procedure was advocated together with increases in the documentation of training programmes. These steps would allow the expansion of the present study to one with improved control procedures and wider scope

Forecasting in the light of Big Data

Predicting the future state of a system has always been a natural motivation for science and practical applications. Such a topic, beyond its obvious technical and societal relevance, is also interesting from a conceptual point of view. This owes to the fact that forecasting lends itself to two equally radical, yet opposite methodologies. A reductionist one, based on the first principles, and the naive inductivist one, based only on data. This latter view has recently gained some attention in response to the availability of unprecedented amounts of data and increasingly sophisticated algorithmic analytic techniques. The purpose of this note is to assess critically the role of big data in reshaping the key aspects of forecasting and in particular the claim that bigger data leads to better predictions. Drawing on the representative example of weather forecasts we argue that this is not generally the case. We conclude by suggesting that a clever and context-dependent compromise between modelling and quantitative analysis stands out as the best forecasting strategy, as anticipated nearly a century ago by Richardson and von Neumann

'Go to the forest and move': 1960s American rock music as electronic pastoral

In his song ‘Hijack’ (1970), the Jefferson Airplane’s Paul Kantner demanded “free minds, free dope, free bodies, free music.” Expressed in this way, the preoccupations of the 1960s counterculture were largely humanist and anthropocentric. Yet allied to these concerns was a mystical view of the natural world, bordering on pantheism, which anticipated the more biocentric ecological concerns associated with the deep ecology movement of the 1970s. ‘Flower power’ was a Romantic desire to return to what was perceived as a simpler, more natural form of social life, based on the communal patterns of pre-modern, tribal societies. The rock music associated with the hippy counterculture was integral to this newly emerging subculture of radical environmentalism. Indeed, several of the leading figures in the sixties rock scene went on to become environmental activists in the decades that followed. Joe McDonald became involved in animal rights and whale conservation; after two decades of environmental activism in his own locality, Ed Sanders of the Fugs founded the Woodstock Journal in 1995 with his wife, the writer and painter Miriam R. Sanders; Stewart Brand, former member of Ken Kesey’s Merry Pranksters, founded the Whole Earth Catalog in the fall of 1968, and in 1996 became a founder member of the Long Now Foundation, an organisation = dedicated to promoting long-term thinking about the future of global ecosystems

“Waiting for Chronic”: Time, cannabis and counterculture in Hawai‘i

What does it mean not to wait? It is possible to live in ways which do not entail waiting? Through close examination of time and its articulations among a group of US 1960s-generation ‘hippies’ and younger ‘drop outs’ in a rural backwater of Hawai‘i, I argue in this paper that it is possible to live without waiting. Drawing on Beckett’s Waiting for Godot (1953) and Baba Ram Dass’ countercultural invocation to ‘remember, be here now’, I explore unexpected interruptions to anticipated temporal flows. Structured around three vignettes on failing to hitchhike, learning to do ethnographic fieldwork through stopping trying to do ethnographic fieldwork and an unexpected interruption in the supermarket, this paper builds up a picture of non-waiting in action. Located against a backdrop of waiting as temporal interruption and affective mode, I argue that this group sought to collectively disrupt the affective modes of indifference and/or frustration they grew up with in urban mainland America. Through new forms of affective engagement they became able to collectively reframe temporal interruption as existing within rather than without local temporal flows, interruptions ceased to be ruptures to temporal textures but part of their very fabric. Located within temporal flows, they did not force individuals out of a moral community of (time is money) efficient, productive citizens but reframed productivity itself in terms of producing sociality, positive affective experience and communitas. Out of a multitude of moments of not waiting, a temporal texture of American counterculture emerges

The Rise and Fall of the Jumbo Breakfast Roll: How a Sandwich Survived the Decline of the Irish Economy

This paper examines a specific food item - the Jumbo Breakfast Roll [JBR] - through a sociological lens, in order to trace the factors that contributed to its rise to prominence in Irish food culture in the 'Celtic Tiger' period of the late 20th/early 21st century. It also examines the development of these factors in the period following the crash of the Irish bubble economy. It is argued that the JBR arose at the intersection of a number of key trends in the food technology, retail, transport, distribution and construction sectors. Yet the JBR also had its antecedents in established foodways and traditions. It reflects on how the JBR could be interpreted as a 'national dish' that symbolised a particular moment in contemporary Irish society, and raises the possibility that a sociologically-informed analysis of such emblematic dishes allows us to explore aspects of national society, culture and economy within a globalised world.Fast Food; Ireland; Culture; Economic Conditions; Celtic Tiger; Convenience Stores; Baking Technology; Sandwich

Persuasive design of a mobile energy conservation game with direct feedback and social cues

Pervasive gaming has the potential of transforming the home into a persuasive environment in which the user can learn about appliances and their electricity consumption. Power Explorer is a mobile game with a special sensing approach that provides real-time electricity measurements and feedback when the user switches on and off devices in the home. The game was developed based on persuasive principles to provide an engaging means to learn about energy with positive and negative feedback and social feedback from peers on real energy actions in the home. We present the design and rationale of this game and discuss how pervasive games can be viewed from a persuasive and learning point of view

There’s no apprenticeship for Alzheimer’s: The caring relationship when an older person experiencing dementia falls

© Cambridge University Press 2011Older people experiencing dementia are twice as likely to fall with consequences of serious injury, reduction in everyday activity, admission to long-term care and mortality. Carers of people with dementia are themselves at greater risk of physical and mental ill health, which increases as the dementia progresses. Unsurprisingly, carer burden also increases when a care-recipient falls. The aim of this study was to explore the experiences of falling of community-living older people with dementia and their carers. A qualitative approach was taken using interpretative phenomenological analysis. Nine older people with predominantly Alzheimer's disease and their ten carers were recruited from a large mental health National Health Service trust and participated in one-to-one and joint in-depth interviews. Three dyads participated in repeat interviews. Three focus groups were also carried out, with nine older people experiencing memory problems and 12 carers from a local Alzheimer's Society branch. The antecedents, falls events and consequences of falls were discussed. This paper reports specifically on the impact of falls on the caring relationship. Three themes emerged: ‘learning as you go’, ‘we're always together’, ‘nobody was interested’. The findings demonstrate how falling accentuates the impact of dementia on the dyad. Spouse-carers' discussion of their own falls emphasise the need for joint assessment of health and wellbeing to reduce carer burden and preserve the couplehood of the dyad.The South West London NHS Mental Health Care Trust which part-funded this researc