It's what you do and where you do it: perceived similarity in household water saving behaviours

In the face of continued environmental degradation, policy makers need to accelerate public uptake of pro-environmental behaviours. Promoting behaviours which catalyse the adoption of other similar behaviours through the spillover effect has been proposed as a potential solution. This requires understanding which behaviours are seen as similar and what criteria are used to identify behavioural similarity. We used a sorting procedure with 32 householders in Melbourne, Australia, to investigate the perceived similarity of household water conservation behaviours and identify the underlying constructs used to distinguish between similar and dissimilar behaviours. Location was the primary attribute used to define behavioural similarity, specifically whether behaviours took place indoors or outdoors. Participants also distinguished between curtailment, efficiency and maintenance-type behaviours. Our findings provide empirical support for existing theoretical behaviour taxonomies. The results could inform design of future water-saving campaigns to promote catalytic behaviours, by leveraging off similar, existing behaviours for effective behaviour change results

A new approach to multi-professional end of life care training using a sequential simulation (SqS Simulation™) design: A mixed methods study

Background: A need for improved education and training for hospital staff caring for patients in the last year of life was identified at an urban UK hospital. Sequential Simulation (SqS Simulation™) is a type of simulation that recreates a patient's journey, considering the longitudinal element of care and how this might impact on the patient's experiences, wishes and needs. Objectives: The aim of this study was to investigate a new end of life care training intervention for multi-professional hospital staff, and its effect on their confidence in managing patients at the end of their life. Setting/Participants: Based on the results of a formal Training Needs Analysis, four SqS Simulation™ specialty- based courses were designed for general medical and surgical multidisciplinary teams in an acute UK hospital. Methods: Over three months, seven SqS Simulation™ sessions were attended by fifty-seven multidisciplinary healthcare professionals. A quasi-experimental mixed-methods study was conducted using open and closed-ended questionnaires, pre and post-intervention. Changes in course attendees' confidence levels were analysed and qualitative data from free-text answers informed potential reasons for any differences identified. Results: Confidence improved for all professional cohorts (p<0.001). The differences were found to be highly significant for ‘doctors’ (p<0.001), significant for ‘therapists’ (p=0.02) and not significant for the ‘nurses’ cohort (p=0.238). This was explored further using a qualitative explanatory framework. Categories included: Communicating with Families; Teamwork; Goal Planning; Do Not Attempt Cardiopulmonary Resuscitation; Course Usefulness; Prior Training; and Clinical Experience. Conclusion: This study has shown an overall improvement in confidence across disciplines after attending a SqS Simulation™ course. The differences in quantitative results between disciplines were explored through the qualitative data and revealed a difference in what the professionals gained from it. Further studies are required to assess its effectiveness in maintaining confidence of end of life care in practice, as well as its benefit to patient outcomes

Genitourinary quality-of-life comparison between urethral sparing prostate stereotactic body radiation therapy monotherapy and virtual high-dose-rate brachytherapy boost

Purpose: Although radiation dose escalation improves prostate cancer disease control, it can cause increased toxicity. Genitourinary (GU) symptoms after prostate radiation therapy affect patient health-related quality of life (QoL). We compared patient-reported GU QoL outcomes following 2 alternative urethral sparing stereotactic body radiation therapy regimens. Methods and Materials: Expanded Prostate Cancer Index Composite (EPIC)–26 GU scores were compared between 2 urethral sparing stereotactic body radiation therapy trials. The SPARK trial prescribed a “Monotherapy” dose of 36.25 Gy in 5 fractions to the prostate. The PROMETHEUS trial prescribed 2 phases: a 19- to 21-Gy in 2 fractions “Boost” to the prostate, followed by 46 Gy in 23 fractions or 36 Gy in 12 fractions. The biological effective dose (BED) for urethral toxicity was 123.9 Gy for Monotherapy and 155.8 to 171.2 Gy for Boost. Mixed effects logistic regression models were utilized to estimate the difference in the odds of a minimal clinically important change from baseline EPIC-26 GU score between regimens at each follow-up. Results: 46 Monotherapy and 149 Boost patients completed baseline EPIC-26 scoring. Mean EPIC-26 GU scores revealed statistically superior urinary incontinence outcomes for Monotherapy at 12 months (mean difference, 6.9; 95% confidence interval [CI], 1.6-12.1; P = .01) and 36 months (mean difference, 9.6; 95% CI, 4.1-15.1; P < .01). Monotherapy also revealed superior mean urinary irritative/obstructive outcomes at 12 months (mean difference, 6.9; 95% CI, 2.0-12.9; P < .01) and 36 months (mean difference, 6.3; 95% CI, 1.9-10.8; P < .01). For both domains and at all time points, the absolute differences were <10%. There were no significant differences in the odds of reporting a minimal clinically important change between regimens at any time point. Conclusions: Even in the presence of urethral sparing, the higher BED delivered in the Boost schedule may have a small adverse effect on GU QoL compared with Monotherapy. However, this did not translate to statistically significant differences in minimal clinically important changes. Whether the higher BED of the boost arm offers an efficacy advantage is being investigated in the Trans Tasman Radiation Oncology Group 18.01 NINJA randomized trial

Epic, ethics and empire: rethinking Oppian's Halieutica

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Flooding treatment of phobia to having her feet touched by physiotherapists, in a young woman with Down's syndrome and a traumatic brain injury

This case study describes the treatment of a 32-year-old woman with Down's syndrome and a recent head injury, for phobia to treatment of her feet by physiotherapists. The phobia had the potential to severely limit rehabilitation progress in terms of the client regaining the ability to stand, assist with transfers (including to and from a car), and walk. A single session, in vivo, flooding intervention was used. The treatment resulted in a substantial change in tolerance of physiotherapists' touching of feet to the extent rehabilitation was able to proceed within the bounds of expectation had a phobia not been evident. Benefits were maintained at multiple follow-ups. The results of the case study extend the evidence for the utility of such behavioural interventions to people with complex disability and unusual phobias in neurological rehabilitation systems

Starting school : a strengths‐based approach towards Aboriginal and Torres Strait Islander children

This paper highlights the need for a strengths-based approach to school readiness for Aboriginal and Torres Strait Islander children, in order to recognise the skills, cultural knowledge and understandings they already have when they transition to formal learning. The study, a joint project by the Australian Council for Educational Research (ACER) and the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA), reviews the literature and uses a strength-based analysis of information from Footprints in Time: The Longitudinal Study of Indigenous Children (LSIC) to examine Aboriginal and Torres Strait Islander children’s abilities and knowledge at 4-6 years of age. The authors believe that school readiness is as much about schools recognising the existing capabilities and knowledge that Aboriginal and Torres Strait Islander children have when they arrive at school as it is about supporting children and families to become ready for formal learning. The study confirms that family support, strong cultural identity, good health, positive self-identity and engaging in shared activities such as storytelling are likely to lead to resilience in Aboriginal and Torres Strait Islander children. Furthermore, responses of LSIC parents and carers show the critical importance of family and connections to land and culture in developing children who are resilient. The authors make the point that resilience is critical for successful transitions from home to school, as Aboriginal and Torres Strait Islander children who possess the resilience attributes of social competence, autonomy, mastery, optimism and problem-solving skills are better able to adapt and learn

Screening for depression and anxiety after stroke : developing protocols for use in the community

Purpose: To develop screening protocols to detect depression and anxiety after stroke in a community setting and train therapists to administer them. Method: Psychologists and a community therapist met to design a system suitable for screening for anxiety and depression in all those with stroke, including people with cognitive and/or communication problems. Other therapists and a local user group were also consulted. Therapists were then trained in the use of the protocols. The ability to enact the protocols was assessed via case vignettes and staff experience, over a month-long trial. Results: It was considered appropriate for community therapists to screen patients and to do this within 4 weeks of first contact. Two protocols were designed, one for patients without significant communication/cognitive deficits and one for patients with these difficulties. Therapists applied the protocols with accuracy to the case vignettes and rated the training highly. No challenges in applying the protocols in the clinical setting were reported over an initial 1-month trial. Conclusion: Two protocols to screen for depression and anxiety after stroke have been developed. These appear feasible for use when trialled via case vignette and in clinical practice. Further research might consider the usefulness of the screens in detecting actual clinical disorder and developing better screens to identify anxiety after stroke, particularly in those with a cognitive and/or communication disorder. Implications for Rehabilitation Depression and anxiety are common after stroke and likely affect rehabilitation outcomes. These problems can be identified via screening protocols that include measures appropriate for use with those patients having significant cognitive and/or communication disabilities. Rehabilitation therapists can enact these protocols

Screening for depression after stroke : occupational therapists' performance to protocols

The ability of occupational therapists to enact post-stroke depression screening protocols was considered. The medical notes of 12 patients admitted to an in-patient stroke unit over a 3-month period were consulted to assess timely, appropriate administration, interpretation, and recording of the results of administering the protocols. Post-stroke depression screening by occupational therapists occurred for 83% of patients. Of the screens conducted, all of the patients were administered the correct tool. In 100% of cases screened, the outcome was recorded and in at least 80% clinicians had provided feedback to the patient on the results of the screen