Clinical Utility of the Adapted Biopsychosocial Model: An Initial Validation Through Peer Review

Background: The World Health Organization has called on health care providers to adopt a biopsychosocial approach to improve health and well-being and reduce disability. While a variety of holistic models exist in occupational therapy, none are explicitly biopsychosocial and use language consistent with both the World Health Organization’s International Classification of Functioning, Disability and Health and the Occupational Therapy Practice Framework. Following the recent introduction of the Adapted Biopsychosocial Model (A-BPSM), this study served as an initial step toward validation of this model for use in occupational therapy. Method: A qualitative descriptive design was implemented with a maximum variation purposive sample of 30 participants, including occupational therapy students, clinicians, and educators. The participants were interviewed regarding their perceptions of the utility of the A-BPSM. A thematic analysis approach was used. Results: The participant data supported three major themes relating to the participants’ perceptions of the A-BPSM: clarity, utility, and anticipated competence for application. Conclusion: The findings support an initial step toward validation of the model and serve to offer occupational therapists an adapted biopsychosocial model of care. Recommendations include further evaluation of this model in comparison with existing models, as well as the application of the model to other disciplines

Empirical assessment of beta dose heterogeneity in sediments:Implications for luminescence dating

Optically stimulated luminescence (OSL) dating of single grains is often required to determine an accurate age for partially-bleached sediment by identifying those grains with OSL signals that were well bleached prior to burial. However, single-grain De distributions are typically characterised by greater amounts of scatter in comparison to multiple grains. Here we investigate the scatter in single-grain De distributions of quartz from 56 proglacial samples associated with the retreat of the last British-Irish Ice Sheet. Our findings provide the first empirical dataset showing that beta-dose heterogeneity can impact the extrinsic scatter in single-grain De distributions, in addition to partial bleaching in nature. The additional scatter in single-grain De distributions caused by beta-dose heterogeneity suggests that it is inappropriate to apply a fixed threshold to determine between well-bleached and partially-bleached De distributions, but the skewness of the De distributions could alternatively be used. Autoradiography and QEMSCAN analyses show that there was a negative relationship between the relative standard deviation (RSD) of the beta-dose heterogeneity and the beta dose-rate. This relationship offers the opportunity to infer the RSD of the beta-dose heterogeneity for each sample using just the beta dose-rate, instead of acquiring empirical data for every sample. For this large suite of sedimentary samples, we observe a minimum OD of 20 % arising from the effects of beta-dose heterogeneity (Fig. 3e), which should be added (in quadrature) to the intrinsic OD to determine σb for the minimum age model (MAM) to calculate accurate OSL ages and prevent underestimation of the burial age

SNS programming environment user's guide

The computing environment is briefly described for the Supercomputing Network Subsystem (SNS) of the Central Scientific Computing Complex of NASA Langley. The major SNS computers are a CRAY-2, a CRAY Y-MP, a CONVEX C-210, and a CONVEX C-220. The software is described that is common to all of these computers, including: the UNIX operating system, computer graphics, networking utilities, mass storage, and mathematical libraries. Also described is file management, validation, SNS configuration, documentation, and customer services

Combining qualitative and quantitative operational research methods to inform quality improvement in pathways that span multiple settings

BACKGROUND: Improving integration and continuity of care across sectors within resource constraints is a priority in many health systems. Qualitative operational research methods of problem structuring have been used to address quality improvement in services involving multiple sectors but not in combination with quantitative operational research methods that enable targeting of interventions according to patient risk. We aimed to combine these methods to augment and inform an improvement initiative concerning infants with congenital heart disease (CHD) whose complex care pathway spans multiple sectors. METHODS: Soft systems methodology was used to consider systematically changes to services from the perspectives of community, primary, secondary and tertiary care professionals and a patient group, incorporating relevant evidence. Classification and regression tree (CART) analysis of national audit datasets was conducted along with data visualisation designed to inform service improvement within the context of limited resources. RESULTS: A 'Rich Picture' was developed capturing the main features of services for infants with CHD pertinent to service improvement. This was used, along with a graphical summary of the CART analysis, to guide discussions about targeting interventions at specific patient risk groups. Agreement was reached across representatives of relevant health professions and patients on a coherent set of targeted recommendations for quality improvement. These fed into national decisions about service provision and commissioning. CONCLUSIONS: When tackling complex problems in service provision across multiple settings, it is important to acknowledge and work with multiple perspectives systematically and to consider targeting service improvements in response to confined resources. Our research demonstrates that applying a combination of qualitative and quantitative operational research methods is one approach to doing so that warrants further consideration

Assessing the number of users who are excluded by domestic heating controls

This is the pre-print version of the Article. This Article is also referred to as: "Assessing the 'Design Exclusion' of Heating Controls at a Low-Cost, Low-Carbon Housing Development". - Copyright @ 2011 Taylor & FrancisSpace heating accounts for almost 60% of the energy delivered to housing which in turn accounts for nearly 27% of the total UK's carbon emissions. This study was conducted to investigate the influence of heating control design on the degree of ‘user exclusion’. This was calculated using the Design Exclusion Calculator, developed by the Engineering Design Centre at the University of Cambridge. To elucidate the capability requirements of the system, a detailed hierarchical task analysis was produced, due to the complexity of the overall task. The Exclusion Calculation found that the current design placed excessive demands upon the capabilities of at least 9.5% of the UK population over 16 years old, particularly in terms of ‘vision’, ‘thinking’ and ‘dexterity’ requirements. This increased to 20.7% for users over 60 years old. The method does not account for the level of numeracy and literacy and so the true exclusion may be higher. Usability testing was conducted to help validate the results which indicated that 66% of users at a low-carbon housing development could not programme their controls as desired. Therefore, more detailed analysis of the cognitive demands placed upon the users is required to understand where problems within the programming process occur. Further research focusing on this cognitive interaction will work towards a solution that may allow users to behave easily in a more sustainable manner