Baseline Assessment: Alaska's Capacity and Infrastructure for Prescription Opioid Misuse Prevention

The State of Alaska Department of Health and Social Services (DHSS), Division of Behavioral Health (DBH) was awarded the Partnerships for Success (PFS) grant by the Substance Abuse and Mental Health Services Administration (SAHMSA) in 2015. DBH contracted with the Center for Behavioral Health Research and Services (CBHRS) at the University of Alaska Anchorage (UAA) to conduct a comprehensive project evaluation. As part of the evaluation, CBHRS performed a baseline assessment of the state’s capacity and infrastructure related to prescription opioid misuse prevention. Researchers conducted interviews with key stakeholders representing state government, healthcare agencies, law enforcement, substance abuse research, and service agencies. Interviews were semistructured, with questions addressing five domains of interest: (1) state climate and prevention efforts; (2) partnerships and coordinated efforts; (3) policies, practices, and laws; (4) data and data monitoring; and (5) knowledge and readiness. Thirteen interviews were conducted and analyzed using a qualitative template analysis technique combined with a SWOT analysis (i.e. strengths, weaknesses, opportunities, and threats). Emergent themes are displayed in Table 1 below. Table 1. Emergent themes from SWOT analysis Strengths Weaknesses Opportunities Threats (1) New and revised policies and guidelines (2) Activities and partnerships between state agencies and communities (3) Knowledge and awareness of state leadership (1) State policy limitations (2) Insufficient detox, treatment, and recovery support resources (3) Lack of full coordination within state agencies and with communities (1) Education enrichment (2) Policy improvements (3) Expansion of treatment, recovery, and mental health support (1) State fiscal crisis (2) Prescribing practices (3) Complexity and stigma of addiction (4) Legislative support Despite limitations in sample representativeness and interview timing, participants agreed that agencies, communities, and organizations across Alaska have demonstrated great concern about the opioid epidemic and that this concern has translated into considerable efforts to address and prevent opioid misuse. Participants also noted a variety of opportunities as targets for future work, many of which would address some of the current weaknesses that exist. Results yielded clear recommendations for increasing awareness and providing education to a variety of groups, further improving relevant policies to promote prevention, and expanding services for prevention and treatment.State of Alaska, Division of Behavioral Health Grant #SP020783Executive Summary / Introduction / Methodology / Results / Discussion / Reference

Investigation of Higher Count Rate and Helium-3 Alternative Beam Monitors for Neutron Scattering Facilities

Beam monitors are an important diagnostic tool at neutron science facilities. At high flux neutron scattering facilities, neutron beam monitors with very low intrinsic efficiency (10-5) are presently selected to keep the counting rate within a feasible range, even when a higher efficiency would improve the counting statistics and yield a better measurement of the incident beam. This report outlines a beam monitor with a parallel-plate avalanche chamber design that is capable of measuring a high count rate without saturation. Several designs of the beam monitor using different electrode materials and different neutron conversion materials were constructed and tested. The different designs had efficiencies ranging from 9.8 x 10-7 to 1.2 x 10-3 for thermal neutrons. One of the designs measured 1 x 106 cps, which means it is possible to measure neutron fluxes over 109 cps without saturation while maintaining a 10-3 efficiency

Incorporating social determinants of health into the clinical management of type 2 diabetes

Type 2 diabetes (T2DM) is increasing in global and national prevalence. It is more common among people with poor social determinants of health (SDoH). Furthermore, SDoH are known to influence health related choice, and therefore the glycaemic management of people with T2DM. There is a growing body of evidence affirming an irrefutable relationship between SDoH and T2DM. Currently SDoH are considered at a population level, whereas T2DM is usually managed individually. Assessing and addressing SDoH related barriers, at an individual, clinical level may contribute to improved glycaemic management for people with T2DM. Developing an approach to assess SDoH related management barriers, and incorporating it into usual clinical care will allow insight into ‘nonclinical’ obstacles to self-management. Additionally, investigation into strategies to address the identified barriers will extend and contextualise this approach, and could broaden and augment current efforts to improve glycaemic management for people with T2DM. An exploratory, descriptive research design will facilitate the exploration of the most appropriate methods and strategies for incorporating SDoH into clinical practice. These approaches can then be trialled and evaluated to inform an evidence-based approach for this addition to the usual clinical care of people with T2DM. This presentation will describe a current research project that is investigating how SDoH can be incorporated into the clinical management of T2DM, and discuss the findings so far

Utilising clinical settings to identify and respond to the social determinants of health of individuals with type 2 diabetes - a review of the literature

Type 2 diabetes (T2DM) is increasing in global prevalence. It is more common among people with poor social determinants of health (SDoH). Social determinants of health are typically considered at a population and community level; however, identifying and addressing the barriers related to SDoH at an individual and clinical level, could improve the self-management of T2DM. This literature review aimed to explore the methods and strategies used in clinical settings to identify and address the SDoH in individuals with T2DM. A systematic search of peer-reviewed literature using the electronic databases MEDLINE, CINAHL, Scopus and Informit was conducted between April and May 2017. Literature published between 2002 and 2017 was considered. Search results (n = 1,119) were screened by title and abstract against the inclusion and exclusion criteria and n = 56 were retained for full text screening. Nine studies met the inclusion criteria. Review and synthesis of the literature revealed written and phone surveys were the most commonly used strategy to identify social determinant-related barriers to self-management. Commonly known SDoH such as; income, employment, education, housing and social support were incorporated into the SDoH assessments. Limited strategies to address the identified social needs were revealed, however community health workers within the clinical team were the primary providers of social support. The review highlights the importance of identifying current and individually relevant social determinant-related issues, and whether they are perceived as barriers to T2DM self-management. Identifying self-management barriers related to SDoH, and addressing these issues in clinical settings, could enable a more targeted intervention based on individually identified social need. Future research should investigate more specific ways to incorporate SDoH into the clinical management of T2DM

A replication of the 5–7day dream-lag effect with comparison of dreams to future events as control for baseline matching

The dream-lag effect refers to there being, after the frequent incorporation of memory elements from the previous day into dreams (the day-residue), a lower incorporation of memory elements from 2 to 4 days before the dream, but then an increased incorporation of memory elements from 5 to 7 days before the dream. Participants kept a daily diary and a dream diary for 14 days and then rated the level of matching between every dream report and every daily diary record. A significant dream-lag effect for the 5–7 day period, compared to baseline and compared to the 2–4 day period, was found. This may indicate a memory processing function for sleep, which the dream content may reflect. The paper has significant theoretical implications for the time-course of consolidating autobiographical memory

Improving type 2 diabetes care and self-management at the individual level by incorporating social determinants of health

Objective: Suboptimal social determinants of health impede type 2 diabetes self-management. They are usually considered at population and community levels, not individually. The study objective was to draw on perspectives of people who have type 2 diabetes to identify and explore the impact of social determinants on self-management and ways to incorporate them into individual care. Methods: Purposively selected participants chose to partake in focus groups or interviews. Data were analysed and themes identified through deductive and inductive thematic analysis. Results: Social issues hinder type 2 diabetes self-management. Additionally, an individual’s feelings and poor mental health, competing priorities and understanding about diabetes are important considerations. Support was provided via health professionals, community supports, financial support, personal support and informal self-management support. Conclusions: Social determinants of health could be formally incorporated into individual care for people with type 2 diabetes if a socio-ecological view of health is taken as it considers the broader social and environmental circumstances in peoples lives. Implications for public health: Care for people with type 2 diabetes could be transformed if social determinants of health are formally assessed and responded to at an individual level. A socio-ecological view of health in individual care and clinical settings would enable social determinants of health to be formally incorporated into type 2 diabetes care

Utilization of Psychotherapeutic Interventions by Pediatric Psychosocial Providers

One of the Standards of Psychosocial Care for Children with Cancer and their Families recommends that all youth with cancer and their family members have access to psychotherapeutic interventions and support throughout the cancer trajectory. This study was created to identify the psychosocial interventions and services provided to children with cancer and their family members, to ascertain whether there are differences in interventions provided by age of the patient and stage of treatment, and to learn about barriers to psychosocial service provision. An online survey was disseminated to psychosocial providers through the listservs of national and international professional organizations. The majority of the 242 respondents were either psychologists (39.3%) or social workers (26.9%) and 79.7% worked in the United States. The intervention offered most often to pediatric patients, caregivers, and siblings, at every stage of treatment, was psychoeducation (41.7–48.8%). Evidence-based interventions, including cognitive behavioral therapy (56.6%) and mindfulness-based interventions (57.9%) were reported to be frequently used with patients. Interventions designed specifically for the pediatric oncology population were not commonly endorsed. Psychosocial providers reported quality of care would be improved by additional staff, better communication/ collaboration with medical team members and increased community-based resources. Future research should focus on improving accessibility to population-specific evidenced-based interventions and translating science to practice

Acceptability and implementation challenges of smartphone-based training of community health nurses for visual inspection with acetic acid in Ghana : mHealth and cervical cancer screening

Unidad de excelencia María de Maeztu MdM-2015-0552Objective To explore acceptability and feasibility of smartphone-based training of low-level to mid-level health professionals in cervical cancer screening using visual inspection with acetic acid (VIA)/cervicography. Design In 2015, we applied a qualitative descriptive approach and conducted semi-structured interviews and focus groups to assess the perceptions and experiences of community health nurses (CHNs) (n=15) who performed smartphone-based VIA, patients undergoing VIA/cryotherapy (n=21) and nurse supervisor and the expert reviewer (n=2). Setting Community health centres (CHCs) in Accra, Ghana. Results The 3-month smartphone-based training and mentorship was perceived as an important and essential complementary process to further develop diagnostic and management competencies. Cervical imaging provided peer-to-peer learning opportunities, and helped better communicate the procedure to and gain trust of patients, provide targeted education, improve adherence and implement quality control. None of the patients had prior screening; they overwhelmingly accepted smartphone-based VIA, expressing no significant privacy issues. Neither group cited significant barriers to performing or receiving VIA at CHCs, the incorporation of smartphone imaging and mentorship via text messaging. CHNs were able to leverage their existing community relationships to address a lack of knowledge and misperceptions. Patients largely expressed decision-making autonomy regarding screening. Negative views and stigma were present but not significantly limiting, and the majority felt that screening strategies were acceptable and effective. Conclusions Our findings suggest the overall acceptability of this approach from the perspectives of all stakeholders with important promises for smartphone-based VIA implementation. Larger-scale health services research could further provide important lessons for addressing this burden in low-income and middle-income countries

‘The International Teacher Leadership project,’ a case of international action research.

Copyright CARNThe paper arises from the International Teacher Leadership project, a research and development project involving researchers and practitioners in 14 European countries. The paper provides a conceptual exploration of the idea of teacher leadership and its role in educational reform, central to which is the idea that teachers, regardless of their level of power and organisational position, can engage in the leadership of enquiry-based development activity aimed at influencing their colleagues and embedding improved practices in their schools. The paper provides an outline of the project’s methodology which builds on that used in the Carpe Vitam Leadership for Learning project (Frost, 2008a). It is a form of collaborative action research which is highly developmental and discursive. It seeks to identify principles, strategies and tools that can be applied in a range of cultural settings. The paper includes a thematic analysis of the cultural contexts and policy environments of the participating countries in order to identify the obstacles to teacher leadership and to inform the nature of the support strategies employed

Adaptation and Extension of the European Recommendations (EACD) on Developmental Coordination Disorder (DCD) for the UK context

Background: Developmental Coordination Disorder (DCD) affects the learning and performance of everyday motor skills. It commonly co-occurs with other 10 developmental disorders and a range of associated psycho-social impairments. Recent evidence-based guidelines on diagnosis, assessment, and intervention provide valuable information for practitioners. However these are directed primarily at German speaking countries and focus on work with children. Aim: The aim of this project was to consider the application of these guidelines in the UK and to extend them for use 15 with adults with DCD. Methods: Individuals with DCD, parents, and professionals from a wide range of disciplines were invited to two workshops to discuss and debate the guidelines, to adapt them for the UK and produce dissemination materials. Results: A working definition of DCD was agreed, minor revisions were made to the guidelines to reflect the UK context, an extension for adults was compiled and a series of leaflets 20 was produced to disseminate this information to health and education professionals, parents, and employers. Conclusions: This work will raise awareness of the condition across different professional groups. It provides information to help those working with children and adults with DCD in the UK to assist in the process of diagnosis, assessment, and intervention