Specialist community teams for adults with learning disabilities: referrals to a countywide service in England

Purpose – While “generic” community teams for adults with learning disabilities (CTs) are well-established in the UK, very little recent evidence is available about any aspect of their work. As part of a larger project about the role, structure and functioning of CTs, the purpose of this paper is to provide data about referrals. Design/methodology/approach – Over threemonths, the authors obtained data about 270 consecutive new referrals to five CTs in a countywide integrated health (NHS) and care management (local authority) service. Findings – The 270 referrals related to 255 individuals, mainly already service users, with almost a third (30 per cent, n=204) described as people with severe or profound disabilities. Consistent with the reported living arrangements (residential accommodation or with one or more family members (87 per cent, n=270)), referrals were most often made by social care staff, General Practitioners or carers. The referrals related to a wide range of issues including mental health and/or behavioural needs, physical health and skills, and independence. The major group, however, were requests about a person’s entitlement to specialist learning disability services and/or reviews of an existing social care package. Research limitations/implications – The focus on new referrals and the exclusion of intra-team referrals mean that the data are not representative of a CT’s caseload and cannot be used as a basis for resourcing. Nevertheless, the findings emphasise the heterogeneity of the population, and the long-term and varied nature of their needs, meaning that CTs require access to a range of expertise and, often, an inter-agency approach. The implications for service design are considered. Originality/value – This is the first empirical study of referrals to specialist integrated (health and care management) community learning disabilities teams in England

‘Is she alive? Is she dead?’ Representations of chronic disorders of consciousness in Douglas Coupland's Girlfriend in a Coma

Depictions of coma have come to dominate literary and filmic texts over the last half century, a phenomenon coinciding with advancements in medical technology that have led to remarkable increases in the survival rates of patients with chronic disorders of consciousness. Authors of coma fiction are preoccupied with the imagined subjective experience of coma, often creating complex, dream-like worlds from which the protagonist must escape if survival is to be achieved. However, such representations appear to conflict with medical case studies and patient narratives that reveal that most often survivors of coma have no recollection of the coma itself. Providing a close reading of Douglas Coupland's Girlfriend in a Coma (1998) against the context of medical literature and diagnoses, this article examines how the coma patient is represented, often depicting the realities of a prolonged vegetative state, in contrast with other popular representations of coma. It explores how the author develops a work of ‘fantastic’ fiction (a genre defined by the structuralist critic Tzvetan Todorov), using the condition of coma as a metaphor for a postmodern existential crisis, while simultaneously employing mimetic techniques that raise important medical, ethical and philosophical questions surrounding the ontological status of the comatose patient. It is argued that coma fiction, even in its misrepresentation of the condition, can help us to engage with and interrogate how we think about chronic disorders of consciousness, thereby providing a valuable insight into our attitudes towards illness and mortality

Technology Enhanced Writing Therapy for People with Aphasia: Results of a Quasi-Randomised Waitlist Controlled Study

Background: Acquired writing impairment, or dysgraphia, is common in aphasia. It affects both handwriting and typing, and may recover less well than other aphasic symptoms. Dysgraphia is an increasing priority for intervention, particularly for those wishing to participate in online written communication. Effective dysgraphia treatment studies have been reported, but many did not target, or did not achieve, improvements in functional writing. Functional outcomes might be promoted by therapies that exploit digital technologies, such as voice recognition and word prediction software. Aims: This study evaluated the benefits of technology enhanced writing therapy for people with acquired dysgraphia. It aimed to explore the impact of therapy on a functional writing activity, and to examine whether treatment remediated or compensated for the writing impairment. The primary question was: Does therapy improve performance on a functional assessment of writing; and, if so, do gains occur only when writing is assisted by technology? Secondary measures examined whether therapy improved unassisted written naming, functional communication, mood and quality of life. Methods & Procedures: The study employed a quasi randomised waitlist controlled design. 21 people with dysgraphia received 12 hours of writing therapy, either immediately, or after a 6 week delay. The primary outcome measure was a functional assessment of writing, which was administered in handwriting and on a computer with assistive technology enabled. Secondary measures were: The Boston Naming Test (written version), Communication Activities of Daily Living - 2, Visual Analogue Mood Scales (Sad question), and the Assessment of Living with Aphasia. ANOVA analyses were used to examine change on the outcome measures over two time points, between which the immediate group had received therapy, but the delayed group had not. Pre therapy, post therapy and follow up scores on the measures were also examined for all participants. Outcomes & Results: Time x group interactions in the ANOVA analyses showed that therapy improved performance on the functional writing assessment. Further interactions with condition showed that gains occurred only when writing was assisted by technology. There were no significant interactions in the analyses of the secondary outcome measures. A treatment effect on these measures was therefore unconfirmed. Conclusions & Implications. This study showed that 21 people with dysgraphia improved on a functional writing measure following therapy using assistive technology. The results suggest that treatment compensated for, rather than remediated the impairment, given that unassisted writing did not change. Further studies of technology enhanced writing therapy are warranted. What this paper adds What is known already: Writing abilities are typically impaired in aphasia, and may recover less well than other language modalities. Many previous writing therapy studies did not achieve functional gains on everyday writing tasks. What this study adds: This study shows that mainstream digital technologies, such as speech to text software, can be used in therapy to help compensate for writing impairments. Gains were shown on a functional task (writing emails) after 12 hours of treatment. Clinical implications: With specific training, people with aphasia can learn to use mainstream technologies in order to support writing. Greater use of such technologies could be made in practice

Who Commits to the Rule of Law? Constrained Government and Foreign Direct Investment in Postcommunist States

Research linking credible commitments to the rule of law in terms of property rights and contract enforcement is a hallmark of recent efforts to explain economic growth and development. However, many postcommunist states have had difficulty making such commitments and spurring growth. Many argue political polarization prevents states from reforming laws and protecting property rights in some countries whereas single-party governance renders state promises incredible in others. I analyze pooled cross-sectional time-series data for twenty-four postcommunist countries and provide evidence effective constraints among elected officials act as democratic commitment mechanisms rendering government policies credible

Development of a microminiature sorption cooler

The development of a microcooler for operations below 80 K, for low temperature electronic devices requiring small cooling powers of the order of 10 mW is described. A sorption compressor combined with Joule-Thomson (JT) expansion was selected for miniaturization. The advantage of the system is considered to be its absence of moving parts, with the exception of the check valves. This facilitates the scaling down of the system, minimizes interferences and contributes to a long lifetime. The requirements for small scale cooling of low temperature electronics are listed. The sorption compressor and the JT expansion are described. A parameter study is reviewed together with the scaling of the sorption compressor

What are the important factors in health-related quality of life for people with aphasia? A systematic review

Objective: To determine factors associated with or predictive of poor health-related quality of life (HRQL) in people with aphasia poststroke. Better understanding of these factors can allow better targeting of rehabilitation programs. Data Sources: Electronic databases, covering medical (eg, Medline, Excerpta Medica Database, Evidence-Based Medicine Reviews, Cumulative Index to Nursing and Allied Health Literature, Ovid, Allied and Complementary Medicine Database) and social sciences (eg, PsycINFO) were searched and key experts were approached. Study Selection: Studies including specific information on the HRQL of people with aphasia poststroke using validated HRQL measures or established ways of analyzing qualitative data were included. Two reviewers independently screened studies against the eligibility criteria. Data Extraction: This was undertaken independently by 2 reviewers. Discrepancies were resolved by consensus. Quantitative studies were assessed for quality with Counsell and Dennis' critical appraisal tool for systematic review of prognostic models in acute stroke; qualitative studies with the Critical Appraisal Skills Program tool for qualitative research. Data Synthesis: Fourteen research reports met the eligibility criteria. Because of their high heterogeneity, the data synthesis was narrative. The evidence is not strong enough to determine the main predictors of HRQL in people with aphasia. Still, emotional distress/depression, severity of aphasia and communication disability, other medical problems, activity limitations, and aspects of social network and support were important factors. Conclusions: Emotional distress, aphasia severity, communication and activity limitations, other medical problems, and social factors affect HRQL. Stroke HRQL studies need to include people with aphasia and report separately on them, in order to determine the main predictors of their HRQL and to identify what interventions can best address them

“It Was Only Harmless Banter!” The development and preliminary validation of the moral disengagement in sexual harassment scale.

Sexual harassment represents aggressive behavior that is often enacted instrumentally, in response to a threatened sense of masculinity and male identity. To date, however, theoretical attention to the social cognitive processes that regulate workplace harassment is scant. This article presents the development and preliminary validation of the Moral Disengagement in Sexual Harassment Scale (MDiSH); a self-report measure of moral disengagement in the context of hostile work environment harassment. Three studies (total N = 797) document the excellent psychometric properties of this new scale. Male U.K. university students (Study 1: N = 322) and U.S. working males (Studies 2 and 3: N = 475) completed the MDiSH and an array of measures for construct validation. The MDiSH exhibited positive correlations with sexual harassment myth acceptance, male gender identification, and hostile sexism. In Study 3, participants were exposed to a fictitious case of hostile work environment harassment. The MDiSH attenuated moral judgment, negative emotions (guilt, shame, and anger), sympathy, and endorsement of prosocial behavioral intentions (support for restitution) associated with the harassment case. Conversely, the MDiSH increased positive affect (happiness) about the harassment and attribution of blame to the female complainant. Implications for practice and future research avenues are discussed

“I Think I Became a Swimmer Rather than Just Someone with a Disability Swimming Up and Down”: Paralympic Athletes Perceptions of Self and Identity Development

This is an Accepted Manuscript of an article published by Taylor & Francis Group in Disability and Rehabilitation on 27 September 2016, available online at:DOI: https://doi.org/10.1080/09638288.2016.1217074.Purpose: The purpose of this study was to explore the role of swimming on Paralympic athletes’ perceptions of self and identity development. Method: A hermeneutic phenomenological approach was taken. During semi-structured interviews five Paralympic swimmers (aged 20-24 years) were asked questions about their swimming career, perceptions of self, integration, and impairment. Interviews were audio-recorded and transcribed verbatim. Results: An Interpretative Phenomenological Analysis1 yielded three superordinate themes: a) ‘One of the crowd’; none of the participants viewed themselves as disabled, nor as supercrips; these perceptions stemmed from family-, school-, and swimming- related experiences, b) ‘Becoming me’; participation in swimming facilitated self- and social-acceptance, and identity development, and c) ‘A badge of honour’; swimming presented opportunity to present and reinforce a positive identity. Conclusions: Swimming experiences enabled the participants to enhance personal and social identities, integrate through pro-social mechanisms, and to develop a career path following retirement from competition.through pro-social mechanisms, and to develop a career path following retirement from competition.Peer reviewe

Modelling impacts of atmospheric deposition and temperature on long-term DOC trends

It is increasingly recognised that widespread and substantial increases in Dissolved organic carbon (DOC) concentrations in remote surface, and soil, waters in recent decades are linked to declining acid deposition. Effects of rising pH and declining ionic strength on DOC solubility have been proposed as potential dominant mechanisms. However, since DOC in these systems is derived mainly from recently-fixed carbon, and since organic matter decomposition rates are considered sensitive to temperature, uncertainty persists over the extent to which other drivers that could influence DOC production. Such potential drivers include fertilization by nitrogen (N) and global warming. We therefore ran the dynamic soil chemistry model MADOC for a range of UK soils, for which time series data are available, to consider the likely relative importance of decreased deposition of sulphate and chloride, accumulation of reactive N, and higher temperatures, on soil DOC production in different soils. Modelled patterns of DOC change generally agreed favourably with measurements collated over 10-20 years, but differed markedly between sites. While the acidifying effect of sulphur deposition appeared to be the predominant control on the observed soil water DOC trends in all the soils considered other than a blanket peat, the model suggested that over the long term, the effects of nitrogen deposition on N-limited soils may have been sufficient to raise the “acid recovery DOC baseline” significantly. In contrast, reductions in non-marine chloride deposition and effects of long term warming appeared to have been relatively unimportant. The suggestion that future DOC concentrations might exceed preindustrial levels as a consequence of nitrogen pollution has important implications for drinking water catchment management and the setting and pursuit of appropriate restoration targets, but findings still require validation from reliable centennial-scale proxy records, such as those being developed using palaeolimnological techniques