The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods and Findings Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. Results We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. Conclusions and Implications We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed

“Top-Down-Bottom-Up” Methodology as a Common Approach to Defining Bespoke Sets of Sustainability Assessment Criteria for the Built Environment

YesThe top-down-bottom-up (TDBU) methodology for defining bespoke sets of sustainability criteria for specific civil engineering project types is introduced and discussed. The need to define sustainability criteria for specific civil engineering project types occurs mainly in one or both of the following cases: (1) when a more comprehensive and indicative assessment of the sustainability of the project type in question is required; and/or (2) there is no readily available bespoke sustainability assessment tool, or set of criteria, for assessing the sustainability of the project type. The construction of roads, buildings, airports, tunnels, dams, flood banks, bridges, water supply, and sewage systems and their supporting systems are considered to be unique civil engineering/infrastructure project types. The normative definition of sustainable civil engineering/infrastructure projects and the framework for assessing its sustainability is defined and provided by the authors. An example of the TDBU methodology being applied to define sustainability criteria for transport noise reducing devices is presented and discussed. The end result of applying the methodology is a systematically researched and industry validated set of criteria that denotes assessing the sustainability of the civil engineering/infrastructure project type. The paper concludes that the top-down-bottom-up will support stakeholders and managers involved in assessing sustainability to consider all major research methods to define general and unique sustainability criteria to assess and so maximize sustainability

Cultural Phylogenetics of the Tupi Language Family in Lowland South America

Background: Recent advances in automated assessment of basic vocabulary lists allow the construction of linguistic phylogenies useful for tracing dynamics of human population expansions, reconstructing ancestral cultures, and modeling transition rates of cultural traits over time. Methods: Here we investigate the Tupi expansion, a widely-dispersed language family in lowland South America, with a distance-based phylogeny based on 40-word vocabulary lists from 48 languages. We coded 11 cultural traits across the diverse Tupi family including traditional warfare patterns, post-marital residence, corporate structure, community size, paternity beliefs, sibling terminology, presence of canoes, tattooing, shamanism, men’s houses, and lip plugs. Results/Discussion: The linguistic phylogeny supports a Tupi homeland in west-central Brazil with subsequent major expansions across much of lowland South America. Consistently, ancestral reconstructions of cultural traits over the linguistic phylogeny suggest that social complexity has tended to decline through time, most notably in the independent emergence of several nomadic hunter-gatherer societies. Estimated rates of cultural change across the Tupi expansion are on the order of only a few changes per 10,000 years, in accord with previous cultural phylogenetic results in other languag

Incidence reduction of sexually transmitted hpv

"Through a literature review, the objective formed was to identify the optimum technique to reduce the incidence of sexually contracted HPV."--Objective