The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study.

OBJECTIVE: To identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals. DESIGN: A mixed-methods study involving interviews, questionnaires and participant observation (July 2011-March 2013). SETTING: Six acute NHS hospital trusts in England. METHODS: Reasonable adjustments for people with intellectual disabilities were identified through the literature. Data were collected on implementation and staff understanding of these adjustments. RESULTS: Data collected included staff questionnaires (n=990), staff interviews (n=68), interviews with adults with intellectual disabilities (n=33), questionnaires (n=88) and interviews (n=37) with carers of patients with intellectual disabilities, and expert panel discussions (n=42). Hospital strategies that supported implementation of reasonable adjustments did not reliably translate into consistent provision of such adjustments. Good practice often depended on the knowledge, understanding and flexibility of individual staff and teams, leading to the delivery of reasonable adjustments being haphazard throughout the organisation. Major barriers included: lack of effective systems for identifying and flagging patients with intellectual disabilities, lack of staff understanding of the reasonable adjustments that may be needed, lack of clear lines of responsibility and accountability for implementing reasonable adjustments, and lack of allocation of additional funding and resources. Key enablers were the Intellectual Disability Liaison Nurse and the ward manager. CONCLUSIONS: The evidence suggests that ward culture, staff attitudes and staff knowledge are crucial in ensuring that hospital services are accessible to vulnerable patients. The authors suggest that flagging the need for specific reasonable adjustments, rather than the vulnerable condition itself, may address some of the barriers. Further research is recommended that describes and quantifies the most frequently needed reasonable adjustments within the hospital pathways of vulnerable patient groups, and the most effective organisational infrastructure required to guarantee their use, together with resource implications

The story of the 310th infantry regiment, 78th infantry division in the war against Germany, 1942-1945

The 310th Infantry Regiment has fought in more than one war. This history is primarily an account of the present 310th Infantry Regiment in World War II, but there is a story to tell of an earlier 310th Regiment which carried the same Regimental Colors into battle against the German enemy in World War I.https://digicom.bpl.lib.me.us/ww_reg_his/1038/thumbnail.jp

Auditory-visual speech perception: The effect of visual acuity in older people

"Article Copyright 2004 The Authors." "Published edition Copyright 2004 Australian Academic Press. Published version of the paper reproduced here with permission from the publisher."This study aimed to investigate the benefit gained by older people in auditory-visual speech perception compared to auditory-only perception and to investigate the correlation between visual acuity and benefit gained. A total of 77 community-based older people participated in the study. Pure-tone audiometry showed that 36% had normal hearing, 40% had a mild hearing loss and the remainder (23%) had a moderate or greater loss. Objective easurements of corrected distance and near visual acuities were obtained using the Bailey-Lovie logMAR distance and near visual acuity tests. According to the criteria used in the present study, 34% had some distance vision impairment and 9% had some near vision impairment. The benefit gained in auditory-visual speech perception was determined by comparing auditory-only and auditory-visual performance on the Bamford-Kowal-Bench Australian Version Speech reading Test. An average visual benefit of 28.8% was achieved by the participants, and, for the vast majority of participants (86%), the benefit gained was statistically significant. A significant correlation was not found between either distance or near visual acuity and benefit gained in auditory-visual speech perception. The implications of these findings are that it is important for audiologists to recommend the use of lipreading to older clients, irrespective of their visual impairment, as the majority will gain significant benefit from the use of visual cues

Field testing a novel high residence positioning system for monitoring the fine‐scale movements of aquatic organisms

1. Acoustic telemetry is an important tool for studying the behaviour of aquatic organisms in the wild. 2. VEMCO high residence (HR) tags and receivers are a recent introduction in the field of acoustic telemetry and can be paired with existing algorithms (e.g. VEMCO positioning system [VPS]) to obtain high‐resolution two‐dimensional positioning data. 3. Here, we present results of the first documented field test of a VPS composed of HR receivers (hereafter, HR‐VPS). We performed a series of stationary and moving trials with HR tags (mean HR transmission period = 1.5 s) to evaluate the precision, accuracy and temporal capabilities of this positioning technology. In addition, we present a sample of data obtained for five European perch Perca fluviatilis implanted with HR tags (mean HR transmission period = 4 s) to illustrate how this technology can estimate the fine‐scale behaviour of aquatic animals. 4. Accuracy and precision estimates (median [5th–95th percentile]) of HR‐VPS positions for all stationary trials were 5.6 m (4.2–10.8 m) and 0.1 m (0.02–0.07 m), respectively, and depended on the location of tags within the receiver array. In moving tests, tracks generated by HR‐VPS closely mimicked those produced by a handheld GPS held over the tag, but these differed in location by an average of ≈9 m. 5. We found that estimates of animal speed and distance travelled for perch declined when positional data for acoustically tagged perch were thinned to mimic longer transmission periods. These data also revealed a trade‐off between capturing real nonlinear animal movements and the inclusion of positioning error. 6. Our results suggested that HR‐VPS can provide more representative estimates of movement metrics and offer an advancement for studying fine‐scale movements of aquatic organisms, but high‐precision survey techniques may be needed to test these systems

RamStart

According to the 2015 Bureau of Labor Statistics, nationally, students with disabilities are less likely to graduate with a bachelor’s degree and more likely to be unemployed.1 At VCU, these students are served by the Student Accessibility and Educational Opportunity Office (SAEO), which currently has only two case managers for 1500 registered students while the Association for Higher Education and Disabilities (AHEAD) recommends an individual case load of 350 or fewer students. While these students attend New Student Orientation, there are currently no programs or sessions specifically designed to address their needs. RamStart is a model for presemester transition workshops for new students who have been granted accommodations through SAEO for disabilities and their families which is designed to provide them with tools for self-advocacy and independence. The goal of these workshops is to help ease the students’ transition to VCU by educating them and their parents about SAEO’s services, their rights and responsibilities, Family Educational Rights and Privacy Act (FERPA), campus resources, and University policies and procedures to improve their chances of success

Using trace element and halide isotopes to understand salinization mechanisms of groundwaters from an arid aquifer

Saline groundwaters are common to inland Australia, yet many aspects of their hydrochemical evolution remain uncertain. The saline groundwaters in the alluvial aquifers of the Darling River have previously been found to exhibit broad similarity in traditional hydrochemical and isotopic tracers. By contrast, trace element isotopes (δ7Li, δ11B and 87Sr/86Sr) and halide isotopes (δ37Cl and δ81Br) provide evidence of more complex hydrogeochemical processes.Hydrochemical evolution was found to be dependent on proximity to theDarling River and depth even though all groundwaters from this aquifer were found to be saline. The differing signatures highlighted the discovery of adeeper palaeo-groundwater system containing heavier trace element and halide isotope values. The measurement of these isotopes has permitted delineation of groundwater end-members and salinization mechanisms that would have otherwise not been identified

Is touch gating due to sensory or cognitive interference?

Touch gating, the attenuation of tactile sensitivity in the presence of pain, is a well-documented phenomenon but its mechanism is unknown. The ability of pain to capture attention suggests that touch gating may be an example of distraction; but the fact that pain raises tactile but not auditory thresholds argues that touch gating is a form of somatosensory interaction. Therefore, the present study was carried out to determine whether touch gating is the result of sensory or cognitive interference. Touch gating was repeatedly produced by delivering a co-localized painful heat stimulus (45°C) during forced-choice measurements of vibration threshold on the palm. Noxious heat significantly increased thresholds compared to those measured at normal skin temperature, and this interference did not decline over the course of an extended series of experiments during which pain intensity significantly habituated. Touch gating was thus related to the constant physical intensity, rather than the changing subjective intensity, of the noxious stimulus. For comparison, a form of unambiguously cognitive interference, the Stroop effect, was also measured repeatedly; it declined significantly across sessions, unlike touch gating interference. Finally, touch gating was not correlated with measures of participants’ distractibility, fear of pain, hypervigilance, or anxiety – variables previously found to influence pain on a cognitive level. Taken together, the results suggest that touch gating is a robust, stimulus-locked form of sensory interaction, rather than a transitory result of distraction or other cognitive processes

Contact Force and Scanning Velocity during Active Roughness Perception

Haptic perception is bidirectionally related to exploratory movements, which means that exploration influences perception, but perception also influences exploration. We can optimize or change exploratory movements according to the perception and/or the task, consciously or unconsciously. This paper presents a psychophysical experiment on active roughness perception to investigate movement changes as the haptic task changes. Exerted normal force and scanning velocity are measured in different perceptual tasks (discrimination or identification) using rough and smooth stimuli. The results show that humans use a greater variation in contact force for the smooth stimuli than for the rough stimuli. Moreover, they use higher scanning velocities and shorter break times between stimuli in the discrimination task than in the identification task. Thus, in roughness perception humans spontaneously use different strategies that seem effective for the perceptual task and the stimuli. A control task, in which the participants just explore the stimuli without any perceptual objective, shows that humans use a smaller contact force and a lower scanning velocity for the rough stimuli than for the smooth stimuli. Possibly, these strategies are related to aversiveness while exploring stimuli

The neural basis of perceived intensity in natural and artificial touch

Electrical stimulation of sensory nerves is a powerful tool for studying neural coding because it can activate neural populations in ways that natural stimulation cannot. Electrical stimulation of the nerve has also been used to restore sensation to patients who have suffered the loss of a limb. We have used long-term implanted electrical interfaces to elucidate the neural basis of perceived intensity in the sense of touch. To this end, we assessed the sensory correlates of neural firing rate and neuronal population recruitment independently by varying two parameters of nerve stimulation: pulse frequency and pulse width. Specifically, two amputees, chronically implanted with peripheral nerve electrodes, performed each of three psychophysical tasks-intensity discrimination, magnitude scaling, and intensity matching-in response to electrical stimulation of their somatosensory nerves. We found that stimulation pulse width and pulse frequency had systematic, cooperative effects on perceived tactile intensity and that the artificial tactile sensations could be reliably matched to skin indentations on the intact limb. We identified a quantity we termed the activation charge rate (ACR), derived from stimulation parameters, that predicted the magnitude of artificial tactile percepts across all testing conditions. On the basis of principles of nerve fiber recruitment, the ACR represents the total population spike count in the activated neural population. Our findings support the hypothesis that population spike count drives the magnitude of tactile percepts and indicate that sensory magnitude can be manipulated systematically by varying a single stimulation quantity