Discovery awareness for staff supporting individuals with intellectual disabilities and challenging behaviour: is it helpful and does it increase self-efficacy?

Objectives: Discovery Awareness (DA) is an approach to using video within structured meetings to help staff become more mindful, aware and interested in a client they are supporting who has intellectual disabilities and challenging behaviour. The objective was to evaluate whether, and how, DA is helpful for staff in both inpatient and community settings, and whether it increases self-efficacy in working with people with challenging behaviour. Methods: A two-phase mixed method design was employed. For phase one, forty staff who took part in one of seven single DA meetings completed the Challenging Behaviour Self-Efficacy Scale pre- and post- DA. In addition, post- DA, participants completed an Adapted Helpful Aspects of Therapy Scale (AHAT). For phase two, six participants completed a follow-up Change Interview; three to 12 weeks after DA. Results: Descriptive statistics reveal participants found events in the DA ‘greatly helpful’. The changes identified varied in whether they were expected or not, but were unlikely to occur without DA and ‘very important’. Statistical analysis showed no significant changes in self-efficacy following the DA. A thematic analysis on the qualitative data generated by the change interviews and AHAT identified three main themes: Impact on interaction; DA is unique and valuable; and The power of the process. The latter had three subthemes: a structure to facilitate change, making use of the content and reflective space to promote learning. Conclusion: Attendance at a single DA meeting does not increase staff perceptions of self-efficacy, however, staff find the process of DA helpful as it encourages reflection on their interactions with individuals with ID and challenging behaviour and attuning of their interactions, though further research is needed

Introduction to the Heijkoop approach to challenging behaviour in ID

The Heijkoop method is used widely in ID challenging behaviour services across Northern Europe; the lack of an English-language account has inhibited its uptake in the UK. The method is fundamentally experiential and aimed at understanding the ‘Who’ of the client to complement the objectified ‘What’ knowledge of standard diagnostics. It is conceptually grounded in developmental psychology, focusing on interpersonal relationships and intersubjectivity, in particular Daniel Stern’s combination of clinical and empirical perspectives on attachment and the emerging sense of self. This working paper is informed by 5 years’ clinical use in Nottingham of Discovery Awareness, a process of video-analysis that is the core instrument in Heijkoop’s approach. Heijkoop introduced and developed this during three separate week-long periods of service consultancy into two NHS Assessment and Treatment Units within Nottinghamshire Healthcare NHS Trust’s specialist service for adults with ID

Extended Thromboprophylaxis following Major Open Abdominopelvic Surgery for Malignancy: A Review of Efficacy, Safety and Economic Impact

The primary aim of this project was to perform a systematic review and meta-analysis of the currently available literature, comparing the effectiveness and safety of inpatient versus extended venous thromboembolism (VTE) prophylaxis with heparin following major open abdominal or pelvic surgery for malignancy. A secondary aim was to use the results of this review to evaluate the economic implications of providing extended pharmacological VTE prophylaxis in this population. A protocol for a systematic review of the literature was first developed, registered and published. Systematic literature review and meta-analysis were then performed in accordance with the protocol, and the results published. Finally, the results of the literature review were compared to literature estimates of the incidence and cost of VTE events in the absence of pharmacological prophylaxis, and current cost of Enoxaparin on the Pharmaceutical Benefits Scheme (PBS) in Australia, and a further manuscript produced which is currently submitted for consideration of publication. The result of the literature review was that no significant difference was found in either postoperative VTE rates or bleeding complications when comparing patients receiving extended duration versus inpatient only heparin VTE prophylaxis following major open abdominopelvic surgery for malignancy. However, the available contemporaneously published evidence was limited and of poor quality so this finding must be interpreted with caution. Regarding the secondary aim, cost analysis based on results of the literature review found the cost of providing extended duration heparin VTE prophylaxis to be less than that of treating predicted VTE events without prophylaxis, and therefore financially justifiable. However, if the initial finding of no significant difference in postoperative VTE events with extended compared to inpatient prophylaxis is assumed to be correct, on a purely financial basis inpatient only duration prophylaxis may be a more efficient use of resources.Thesis (MPhil) -- University of Adelaide, Adelaide Medical School, 202

Plan-of-the-Day Adaptive Radiotherapy for Locally Advanced Cervical Cancer

In this thesis locally advanced cervical cancer patients were treated with adaptive radiotherapy in an online plan-of-the-day protocol. A daily in-room CBCT scan is used to select from a patient specific plan library a treatment plan that best fits the observed anatomy for that day. Main goal is to reduce unnecessary radiation dose to healthy tissue. Different aspects were investigated

An Assessment of Regional ICESat-2 Sea-Level Trends

Sea-level rise is an important indicator of ongoing climate change and well observed by satellite altimetry. However, observations from conventional altimetry degrade at the coast where regional sea-level changes can deviate from the open-ocean and impact local communities. With the 2018 launch of the laser altimeter onboard ICESat-2, new high-resolution observations of ice, land, and ocean elevations are available. Here we assess the potential benefits of sea level measured by ICESat-2 by comparing to data from Jason-3 and tide gauges. We find good agreement in the linear rates computed from the independent observations, with an absolute average residual of 3.60 ± 0.03 cm yr−1 between global ICESat-2 and Jason-3 observations at a 1° posting. The recent La Niña is clearly evident in ICESat-2 observations, as well as small-scale features. By demonstrating the quality of the ICESat-2-measured sea level, we provide support for integrating it into the existing suite of sea-level observations

Vollenhoven. Het ontstaan van een lusthof op de Utrechtse Heuvelrug in de eerste helft van de negentiende eeuw

Vollenhoven in De Bilt is one of the country estates that earned the region between Utrecht and Wageningen the name 'Stichtse Lustwarande' (pleasure grounds). The country estate consists of a distinguished residence, a landscape park with various ancillary buildings such as an orangery, a coach house and an ice house, the house of the master carpenter, as well as a very beautiful vegetable garden with glasshouses. Vollenhoven has had a long series of proprietors; it seldom remained in one and the same family for longer than one generation. As many of the proprietors contributed to the development of the country estate, its history cannot be summarized in a few lines. However, two of the earlier proprietors have particularly left their mark on the country estate and the structures erected on it: Pieter de Smeth van Alphen and Goderd van der Capellen van Berkenwoude. Until recently little was known about the development of the country estate in the nineteenth century. From the seventeenth century there had already been a building here, a small farmhouse. It is assumed that the house in its present appearance was realized in the nineteenth century. B.W.H. Ziesenis, who worked in the region around 1800, is suggested as the architect. Hendrik van Lunteren seems to be the most likely architect of the landscape park, but there was no solid evidence of this. His name was correctly linked with it, as appears from Van Lunteren’s original draft map for the landscape park from around 1828, which was discovered in the attic of Vollenhoven in 2005. It also appeared that there had been a park with a landscape layout previously. This raises new questions, for instance, whether several layers are to be distinguished in the landscape park and when it started to acquire the qualities of a landscape. Among the residents of Vollenhoven tradition has it that in the early nineteenth century Pieter de Smeth was the founder of the house and the park and that Goderd van der Capellen expanded and completed the country estate. In this article the development of Vollenhoven from a simple farmhouse into a pleasure garden is described on the basis of records, inventories and comparisons of historical maps and literature

Third-party prosocial behavior in adult female rats is impaired after perinatal fluoxetine exposure

SSRIs are commonly used to treat pregnant women with depression. However, SSRIs can cross the placenta and affect the development of the fetus. The effects of perinatal SSRI exposure, and especially the effects on social behavior, are still incompletely documented. This study first aims to investigate whether rats show prosocial behavior in the form of consolation behavior. Secondly, it aims to investigate whether perinatal SSRI exposure affects this prosocial behavior. At last, we investigate whether the behavior changed after the rats had been exposed to an additional white-noise stressor. Rat dams received 10 mg/kg/d fluoxetine (FLX) or vehicle (CTR) via oral gavage from gestational day 1 until postnatal day 21. At adulthood, the rat offspring were housed in four cohorts of 4 females and 4 males in a seminatural environment. As prosocial behaviors are more prominent after stressful situations, we investigated the behavioral response of rats immediately after natural aggressive encounters (fights). Additionally, we studied whether a stressful white-noise exposure would alter this response to the aggressive encounters. Our study indicates that CTR-female rats are able to show third party prosocial behavior in response to witnessing aggressive encounters between conspecifics in a seminatural environment. In addition, we showed that perinatal FLX exposure impairs the display of prosocial behavior in female rats. Moreover, we found no signs of prosocial behavior in CTR- and FLX-males after natural aggressive encounters. After white-noise exposure the effects in third party prosocial behavior of CTR-females ceased to exist. We conclude that female rats are able to show prosocial behavior, possibly in the form of consolation behavior. In addition, the negative effects of perinatal fluoxetine exposure on prosocial behavior could provide additional evidence that SSRI treatment during pregnancy could contribute to the risk for social impairments in the offspring

Effect of Polymer Composition on the Optical Properties of a New Aggregation-Induced Emission Fluorophore:A Combined Experimental and Computational Approach

Nowadays, fluorophores with a tetraphenylethylene (TPE) core are considered interesting due to the aggregation-induced emission (AIE) behavior that enables their effective use in polymer films. We propose a novel TPE fluorophore (TPE-BPAN) bearing two dimethylamino push and a 4-biphenylacetonitrile pull moieties with the typical AIE characteristics in solution and in the solid state, as rationalized by DFT calculations. Five different host polymer matrices with different polarity have been selected: two homopolymers of poly(methylmethacrylate) (PMMA) and poly(cyclohexyl methacrylate) (PCHMA) and three copolymers at different compositions (P(MMA-co-CHMA) 75:25, 50:50, and 25:75 mol%). The less polar comonomer of CHMA appeared to enhance TPE-BPAN emission with the highest quantum yield (QY) of about 40% measured in P(MMA-co-CHMA) 75:25. Further reduction in polymer polarity lowered QY and decreased the film stability and adhesion to the glass surface. LSC performances were not significantly affected by the matrix’s polarity and resulted in around one-third of the state-of-the-art due to the reduced QY of TPE-BPAN. The theoretical investigation based on density functional theory (DFT) calculations clarified the origin of the observed AIE and the role played by the environment in modulating the photophysical behavior.</p