“There are carers, and then there are carers who actually care”; Conceptualizations of care among looked after children and care leavers, social workers and carers

\ua9 2019 Background: Looked after children and care leavers (LACCL) are some of the most vulnerable and marginalized young people in our communities. Existing research demonstrates that this group often interprets care in terms of genuineness and tends to feel uncared for. Less work exists from the perspective of social workers and formal carers. Objective: This study aims to explore how care is perceived and practiced among LACCL and those with a duty of care for them. We use a theoretical lens of care ethics to compare and contrast understandings in order to explore how they affect the delivery and receipt of care. Participants & setting: There were 44 participants from four local authorities in north-east England including nineteen LACCL aged 12–20, eight social workers, and nineteen formal carers. Method: Twenty-eight semi-structured 1:1 interviews, four dyad interviews and three focus group interviews. Results: LACCL desired care that felt familial, went beyond minimum standards and involved understanding. Social workers had to manage LACCL expectations and build relationships by both rationing care according to role constraints whilst sometimes going ‘above and beyond’ statutory care. Carers conceptualized care in terms of dedication and discipline but felt limited in their ability to achieve care in this way. Conclusion: Bridging different conceptualizations of care is necessary to achieve integrated support for these vulnerable young people whilst also helping them to develop key skills for later adult life. A deeper understanding of frameworks of care has implications for social worker and formal carer training and practice

Trajectories of early childhood developmental skills and early adolescent psychotic experiences: Findings from the ALSPAC UK Birth Cohort

Objective: The aim of this study was to use prospective data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine association between trajectories of early childhood developmental skills and psychotic experiences (PEs) in early adolescence. Method: This study examined data from n = 6790 children from the ALSPAC cohort who participated in a semi-structured interview to assess PEs at age 12. Child development was measured using parental report at 6, 18, 30, and 42 months of age using a questionnaire of items adapted from the Denver Developmental Screening Test - II. Latent class growth analysis was used to generate trajectories over time for measures of fine and gross motor development, social, and communication skills. Logistic regression was used to investigate associations between developmental trajectories in each of these early developmental domains and PEs at age 12. Results: The results provided evidence that decline rather than enduringly poor social (adjusted OR = 1.28, 95% CI = 1.10-1.92, p = 0.044) and communication skills (adjusted OR = 1.12, 95% CI = 1.03-1.22, p = 0.010) is predictive of suspected or definite PEs in early adolescence, than those with stable and/or improving skills. Motor skills did not display the same pattern of association; although gender specific effects provided evidence that only declining pattern of fine motor skills was associated with suspected and definite PEs in males compared to females (interaction OR = 1.47, 95% CI =1.09-1.97, p = 0.012). Conclusion: Findings suggest that decline rather than persistent impairment in social and communication skills were most predictive of PEs in early adolescence. Findings are discussed in terms of study's strengths, limitations, and clinical implications

Double Sided Incremental Forming: Capabilities and Challenges

Incremental Sheet Forming (ISF) is gaining importance because of its flexibility to form customized/low volume sheet metal parts. Out of different variants of ISF, Double Sided Incremental Forming (DSIF) is most flexible variant which uses two tools, one to form the geometry and the other to provide local support. Complex geometries with features on both sides of sheet can be formed in single setup by changing the roles of forming and supporting tools based on the geometrical characteristics. This article presents the evolution of DSIF process, machines, methodologies and strategies to form complex geometries and their prediction. A multi-stage methodology is attempted to enhance the accuracy of large components is presented. Results show that the accuracy of a 250 mm × 250 mm size conical component is enhanced by 50% (maximum error reduced from 2.9 mm to 1.4 mm) using two-stage forming

Contrasting Effects of Varicose Vein Surgery on Endothelial-dependent and -independent Cutaneous Vasodilation in the Perimalleolar Region

AbstractObjectivesTo evaluate the effects of varicose vein surgery on cutaneous microvascular perfusion and vasodilator responses to acetylcholine (Ach) and sodium nitroprusside (SNP) in the gaiter area of patients with great saphenous vein insufficiency.MethodsTwenty-nine patients with isolated great saphenous vein incompetence attended three study mornings (before surgery, and 6–8 weeks and 6 months after sapheno-femoral ligation+partial stripping) during which cutaneous microvascular responses were measured in the supine and standing positions using laser Doppler fluximetry (LDF) combined with incremental-dose iontophoretic administration of endothelial-dependent (Ach) and -independent (SNP) vasodilators.ResultsVaricose vein surgery had no significant effect on baseline cutaneous perfusion or the microvascular response to Ach: e.g. peak vasodilator responses to the 1000μC stimulus were mean 58 SEM 7, 64 SEM 6 and 65 SEM 7PU on the pre-operative, 6–8 weeks and 6 months assessments. In contrast, the corresponding responses to SNP were significantly increased following surgery: e.g. at 2000μC, mean 63 SEM 9, 142 SEM 4 and 157 SEM 9PU (p<0.0001) in the upright position.ConclusionsSapheno-femoral ligation and partial stripping in patients with great saphenous vein insufficiency improves endothelial-independent cutaneous vasodilator function at the gaiter area, which may at least partly explain the benefits of surgery in reducing the risk of venous ulceration

Effects of lower limb angioplasty on endothelial-dependent and -independent microvascular reactivity

Background: Percutaneous Transluminal Angioplasty (PTA) of the lower limb improves arterial flow and claudication symptoms, but the effects on cutaneous microvascular perfusion and reactivity have not been previously reported. Report: Cutaneous microvascular function in the feet was assessed in 12 patients with intermittent claudication before and after PTA using Laser Doppler Fluximetry (LDF) with transcutaneous iontophoretic administration of acetylcholine and sodium nitroprusside. Maximum vasodilator responses to both endothelial-dependent and independent vasodilators were increased following PTA. Conclusions: Large vessel intervention to improve macrovascular flow has additional benefits on the downstreamcutaneous microcirculation to improve vasodilator responsiveness. These effects may be clinically important to reduce the risk of ischaemic ulceration and tissue breakdown