They’re NICE and neat, but are they useful? A grounded theory of clinical psychologists’ beliefs about, and use of NICE guidelines

Guidelines are ubiquitous but inconsistently used in UK mental health services. Clinical psychologists are often influential in guideline development and implementation, but opinion within the profession is divided. This study utilised grounded theory methodology to examine clinical psychologists’ beliefs about, and use of NICE guidelines. Eleven clinical psychologists working in the NHS were interviewed. The overall emerging theme was; NICE guidelines are considered to have benefits but to be fraught with dangers. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, due to the pressures and dominant discourses within services they tended to practice in ways that prevent these skills from being recognised. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. To our knowledge, the theoretical framework presented in this paper is the first that attempts to explain why NICE guidelines are not consistently utilised in UK mental health services. The current need for services to demonstrate ‘NICE compliance’ may be leading to a perverse incentive for clinical psychologists in particular to do one thing but say another and for specialist skills to be obscured. If borne out by future studies, this represents a threat to continued quality improvement and also to the profession

Inter-rater reliability of treatment fidelity and therapeutic alliance measures for psychological therapies for anxiety in young people with autism spectrum disorders

Objectives: This article presents work undertaken to establish inter-rater reliability for a measure of treatment fidelity and a measure of therapeutic alliance for therapies for anxiety for young people with autism spectrum disorders. The discussion and decision-making processes behind achieving consensus of raters are rarely published. Margolin et al. (1998) have highlighted this issue and called for researchers to communicate the details of their observational and rating procedures. This article is a response to their call for greater transparency so that these methods are readily accessible for comparison with other studies. Methods: Participants were young people with autism spectrum disorders receiving treatment for anxiety, clinical staff treating these young people and the independent raters assessing the treatment sessions. We report: (i) the processes involved in establishing inter-rater reliability for two instruments, (ii) the results obtained with a sample of young people with autism spectrum disorders using these instruments. Results and conclusions: Results demonstrate that it was possible to attain satisfactory inter-rater reliability with each of these two instruments with a client group with autism spectrum disorders, even though the instruments were originally designed for typically-developing populations

Inter-rater reliability of treatment fidelity and therapeutic alliance measures for psychological therapies for anxiety in young people with autism spectrum disorders

Objectives: This article presents work undertaken to establish inter-rater reliability for a measure of treatment fidelity and a measure of therapeutic alliance for therapies for anxiety for young people with autism spectrum disorders. The discussion and decision-making processes behind achieving consensus of raters are rarely published. Margolin et al. (1998) have highlighted this issue and called for researchers to communicate the details of their observational and rating procedures. This article is a response to their call for greater transparency so that these methods are readily accessible for comparison with other studies. Methods: Participants were young people with autism spectrum disorders receiving treatment for anxiety, clinical staff treating these young people and the independent raters assessing the treatment sessions. We report: (i) the processes involved in establishing inter-rater reliability for two instruments, (ii) the results obtained with a sample of young people with autism spectrum disorders using these instruments. Results and conclusions: Results demonstrate that it was possible to attain satisfactory inter-rater reliability with each of these two instruments with a client group with autism spectrum disorders, even though the instruments were originally designed for typically-developing populations

Determination of the degree of reaction of fly ash in blended cement pastes

This paper gives a review over methods to determine the degree of reaction for supplementary cementitious materials (SCMs) with focus on Portland cement - fly ash blends only and summarizes and highlights the most important findings which are detailed in a parallel paper published in Materials and Structures. Determination of the extent of the reaction of SCMs in mixtures is complicated for several reasons: (1) the physical presence of SCMs affects the rate and extent of the reaction of the ground clinker component – the so called “filler effect”; (2) SCMs are usually amorphous with complex and varied mineralogy which make them difficult to quantify by many classical techniques such as X-ray diffraction; (3) the rate of reaction of SCMs in a cement blend may be quite different from its rate of reaction in systems containing simply alkali or lime. From this review it is clear that measuring the degree of reaction of SCMs remains challenging. Nevertheless progress has been made in recent years to offer alternatives to the traditional selective dissolution methods. Unfortunately some of these – image analysis and EDS mapping in the scanning electron microscope, and NMR - depend on access to expensive equipment and are time consuming. With regard to fly ashes, NMR seems to be reliable but limited to fly ash with low iron content. New methods with quantitative EDS mapping to segment fly ash particles from the hydrated matrix and to follow the reaction of glass groups of disparate composition separately look very promising, but time consuming. Sources with a high proportion of fine particles will have higher errors due to lower limit of resolution (1-2 μm). Whereas for SCMs which react relatively fast (e.g. slag, calcined clay) the methods based on calorimetry and chemical shrinkage seem promising on a comparative basis, the very low reaction degree of fly ashes before 28 days means that the calorimetry method is not practical. There is a lack of data to assess the usefulness of long term chemical shrinkage measurements. The possibility to quantify the amorphous phase by XRD is promising as this is a widely available and rapid technique which can at the same time give a wealth of additional information on the phases formed. However, the different reaction rates of different glasses in compositionally heterogeneous fly ashes will need to be accounted for and may strongly reduce the accuracy of the profile decomposition method. This paper is the work of working group 2 of the RILEM TC 238-SCM “Hydration and microstructure of concrete with supplementary cementitious materials”

Beginner's user guide for the MAGTF tactical Warfare Simulation

The MAGTF Tactical Warfare Simulator (MTWS) is a multi-sided computer based gaming system, currently in use by the Marine Corps. Marine operations typically involve movement over land, sea, and air, and sustained operations often involve interaction with other services. MTWS's complexity supports the joint warfare nature of Marine operations. This capability and complexity makes it ideally suited for an academic environment, and at the Naval Postgraduate School MTWS introduces students to a current service simulation, reinforces student course work, and facilitates student research and experimentation. The drawback of a system so complex, though not difficult to learn how to use, is that MTWS is not always intuitive. While extensive documentation exists to support the system, it is for experienced users of the system. This thesis is tailored toward beginning users, no matter their level of operational experience, and will bridge the gap to the advanced documentation. It will provide an overview of the system, explain graphical user interfaces (GUIs), provide instructions to develop and utilize units in the simulation, and provide reference charts for current U.S. weapon systemshttp://www.archive.org/details/beginnersusergui00scriU.S. Navy (U.S.N.) author

APPLIED GEOLOGICAL MAPPING SOUTHAMPTON AREA: area covered by 1:50,000 Geological sheet No. 315 (Southampton) OS 1:10,000 sheets SU31 and 41, and parts of SU20, 21, 22, 30, 32, 40, 42, 50, 51 and 52

This study was commissioned by the Department of the Environment to develop and apply techniques of applied geological mapping for the purposes of land-use planning and development. It covers the area of the British Geological Survey (BGS) 1:50,000 geological map of Southampton. The study involved the computer manipulation of existing geological, geotechnical, hydrogeological and mineral resource data. The objectives were to develop the methodology, and to provide an archive of information, a set of applied geological maps, and descriptive reports in a form appropriate to all potential users. The computer is a powerful tool for bringing together spatially referenced information from many sources. There was collaboration with the Ordnance Survey and also with the Soil Survey of England and Wales who have been commissioned to undertake a study in the same area

The co-construction and emotion management of hope within psychosis services

There is a growing acknowledgement of the salience of hope for mental health service-users, in influencing care outcomes and recovery. Understandings of the processes through which hopes are co-constructed, alongside specific conceptualisations of experiences of hoping, remain limited however. This qualitative study explored how a range of stakeholders experienced and dealt with uncertainty within three purposively selected psychosis services in southern England. In this article we focus particularly on the co-construction of hope within participants’ narratives and how this emotion work shaped experiences of hoping. In-depth interviews (n=23) with service-users, professionals, managers and other stakeholders were analysed following a phenomenological approach. Hope was spontaneously identified by participants as a fundamental mechanism through which service-users and professionals managed uncertainty when vulnerable. Professionals were influential in shaping users’ hopes, both intentionally and unwittingly, while some professionals also referred to managing their own hopes and those of colleagues. Such management of expectations and emotions enabled motivation and coping amidst uncertainty, for users and professionals, but also entailed difficulties where hope was undermined, exaggerated, or involved tensions between desires and expectations. Whereas hope is usually reflected in the caring studies literature as distinctly positive, our findings point to a more ambivalent understanding of hope, as reflected in the accounts of both service-users and professionals where elevated hopes were described as unrealistic and harmful, to the well-being of professionals as well as of service-users. It is concluded that a greater awareness within care contexts of how hopes are co-constructed by professionals and service-users, explicitly and implicitly, can assist in improving health care and healthcare outcomes