Critical Knowledge, Points of Confusion, and Training Recommendations for Client Referrals

The intersection of personal and professional values in relation to client referrals may cause uncertainty and confusion among counseling students. Current literature on this topic demonstrates a lack of agreement exists among student counselors about how to navigate the referral process, especially as it relates to making decisions about when to refer (Author, 2017). This content analysis examines what student counselors (N=104) perceive as critical areas of knowledge, points of confusion, and suggestions for training on ethical referrals. Emergent themes and implications for counselor education and future research are discussed

Breast cancer worry in higher-risk women offered preventive therapy: a UK multicentre prospective study

PURPOSE: Women's worry about developing breast cancer may influence their decision to use preventive therapy. However, the direction of this relationship has been questioned. We prospectively investigated the relationship between breast cancer worry and uptake of preventive therapy. The socio-demographic and clinical factors associated with high breast cancer worry were also investigated. METHODS: Women at increased risk of developing breast cancer were recruited from clinics across England (n = 408). Participants completed a survey on their breast cancer worry, socio-demographic and clinical factors. Uptake of tamoxifen was recorded at 3 months (n = 258 women, 63.2%). Both primary and sensitivity analyses were conducted using different classifications of low, medium and high worry. RESULTS: 39.5% of respondents reported medium breast cancer worry at baseline and 21.2% reported high worry. Ethnic minority women were more likely to report high worry than white women (OR = 3.02, 95%CI 1.02, 8.91, p = 0.046). Women educated below degree level were more likely to report high worry than those with higher education (OR = 2.29, 95%CI 1.28, 4.09, p = 0.005). No statistically significant association was observed between worry and uptake. In the primary analysis, fewer respondents with medium worry at baseline initiated tamoxifen (low worry = 15.5%, medium = 13.5%, high = 15.7%). In the sensitivity analysis, participants with medium worry reported the highest uptake of tamoxifen (19.7%). CONCLUSIONS: No association was observed between worry and uptake, although the relationship was affected by the categorisation of worry. Standardised reporting of the classification of worry is warranted to allow transparent comparisons across cohorts

Nitric Oxide and Oxygen Air-Contamination Effects on Extinction Limits of Non-Premixed Hydrocarbon-Air Flames for a HIFiRE Scramjet

Unique nitric oxide (NO) and oxygen air-contamination effects on the extinction Flame Strength (FS) of non-premixed hydrocarbon (HC) vs. air flames are characterized for 7 gaseous HCs, using a new idealized 9.3 mm straight-tube Opposed Jet Burner (OJB) at 1 atm. FS represents a laminar strain-induced extinction limit based on cross-section-average air jet velocity, Uair, that sustains combustion of a counter jet of gaseous fuel just before extinction. Besides ethane, propane, butane, and propylene, the HCs include ethylene, methane, and a 64 mole-% ethylene / 36 % methane mixture, the writer s previously recommended gaseous surrogate fuel for HIFiRE scramjet tests. The HC vs. clean air part of the work is an extension of a May 2008 JANNAF paper that characterized surrogates for the HIFiRE project that should mimic the flameholding of reformed (thermally- or catalytically-cracked) endothermic JP-like fuels. The new FS data for 7 HCs vs. clean air are thus consolidated with the previously validated data, normalized to absolute (local) axial-input strain rates, and co-plotted on a dual kinetically dominated reactivity scale. Excellent agreement with the prior data is obtained for all 7 fuels. Detailed comparisons are also made with recently published (Univ. Va) numerical results for ethylene extinction. A 2009-revised ethylene kinetic model (Univ. Southern Cal) led to predicted limits within approx. 5 % (compared to 45 %, earlier) of this writer s 2008 (and present) ethylene FSs, and also with recent independent data (Univ. Va) obtained on a new OJB system. These +/- 5 % agreements, and a hoped-for "near-identically-performing" reduced kinetics model, would greatly enhance the capability for accurate numerical simulations of surrogate HC flameholding in scramjets. The measured air-contamination effects on normalized FS extinction limits are projected to assess ongoing Arc-Heater-induced "facility test effects" of NO production (e.g., 3 mole-%) and resultant oxygen depletion (from 21 to 19.5 %), for testing the "64/36" surrogate fuel in Langley s Arc-Heated Scramjet Test Facility for HIFiRE engine designs. The FS results show a generally small (< 4 %) "nitric oxide enhancement" effect, relative to clean air, for up to 3 % NO (freestream Mach number up to 7 in Arc Jet testing). However, a progressively large "oxygendeficiency weakening" effect develops. For 3 % NO, a net weakening of 26 % in FS is derived for the "64/36" fuel vs. air. The corresponding net weakening for pure ethylene is 20 %. A number of practical recommendations regarding facility test effects are offered

CCD Photometric Investigation of A W UMa-Type Binary GSC 0763-0572

A photometric solution of an A-type W UMa binary, GSC 0763-0572 is examined with a revised orbital period. The overcontact degree is found to be $f$ = 40.66%, with a low mass ratio of $q$ = 0.2554. The result demonstrates an unambiguous increase in the orbital period with a relative period change of \Delta P\slash P = +5.69\times10^{-7} d yr$^{-1}$. This indicates that GSC 0763-0572 is undergoing a process of mass transfer from the secondary component to the primary one with a rate of relative mass change of $\Delta$$m_1$\slash$m$ $=+5.18\times10^{-8}$ yr$^{-1}$, for a conservative model of mass transfer. We find that GSC 0763-0572 might transform into a rapidly rotating star, if total spin angular momentum increases until it is greater than one-third of the orbital angular momentum, without breaking the contact configuration

Comparing usage of a web and app stress management intervention : an observational study

Choices in the design and delivery of digital health behaviour interventions may have a direct influence on subsequent usage and engagement. Few studies have been able to make direct, detailed comparisons of differences in usage between interventions that are delivered via web or app. This study compared the usage of two versions of a digital stress management intervention, one delivered via a website (Healthy Paths) and the other delivered via an app (Healthy Mind). Design modifications were introduced within Healthy Mind to take account of reported differences in how individuals engage with websites compared to apps and mobile phones. Data were collected as part of an observational study nested within a broader exploratory trial of Healthy Mind. Objective usage of Healthy Paths and Healthy Mind were automatically recorded, including frequency and duration of logins, access to specific components within the intervention and order of page/screen visits. Usage was compared for a two week period following initial registration. In total, 381 participants completed the registration process for Healthy Paths (web) and 162 participants completed the registration process for Healthy Mind (app). App users logged in twice as often (Mdn = 2.00) as web users (Mdn = 1.00), U = 13,059.50, p ≤ 0.001, but spent half as much time (Mdn = 5.23 min) on the intervention compared to web users (Mdn = 10.52 min), U = 19,740.00, p ≤ 0.001. Visual exploration of usage patterns over time revealed that a significantly higher proportion of app users (n = 126, 82.35%) accessed both types of support available within the intervention (i.e. awareness and change-focused tools) compared to web users (n = 92, 40.17%), χ2(1, n = 382) = 66.60, p < 0.001. This study suggests that the digital platform used to deliver an intervention (i.e. web versus app) and specific design choices (e.g. navigation, length and volume of content) may be associated with differences in how the intervention content is used. Broad summative usage data (e.g. total time spent on the intervention) may mask important differences in how an intervention is used by different user groups if it is not complemented by more fine-grained analyses of usage patterns over time. Trial registration number: ISRCTN67177737

Are we asking the right questions? Working with the LGBTQ+ community to prioritise healthcare research themes.

BackgroundConversations about research priorities with members of the public are rarely designed specifically to include people who identify as Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) and are not researchers.MethodsGenerally, to address this gap, and specifically, to inform future research for CLS, we carried out a rapid review of published research priority sets covering LGBTQ+ topics, and an online workshop to prioritise identified themes.ResultsRapid review: results. The rapid review identified 18 LGBTQ+ research priority sets. Some focussed on specific populations such as women or men, younger or older people or people living within families. Five addressed transgender and gender non- conforming populations. All of the research priority sets originated from English-speaking, high and middle-income countries (UK, US, Canada, and Australia), and date from 2016 onwards. Prioritization approaches were wide-ranging from personal commentary to expert workshops and surveys. Participants involved in setting priorities mostly included research academics, health practitioners and advocacy organisations, two studies involved LGBTQ+ public in their process. Research priorities identified in this review were then grouped into themes which were prioritised during the workshop. Workshop: results. For the workshop, participants were recruited using local (Cambridge, UK) LGBTQ+ networks and a national advert to a public involvement in research matching website to take part in an online discussion workshop. Those that took part were offered payment for their time in preparing for the workshop and taking part. Participants personal priorities and experiences contributed to a consensus development process and a final ranked list of seven research themes and participants' experiences of healthcare, mental health advocacy, care homes, caring responsibilities, schools and family units added additional context.ConclusionsFrom the workshop the three research themes prioritised were: healthcare services delivery, prevention, and particular challenges / intersectionality of multiple challenges for people identifying as LGBTQ+. Research themes interconnected in many ways and this was demonstrated by the comments from workshop participants. This paper offers insights into why these priorities were important from participants' perspectives and detail about how to run an inclusive and respectful public involvement research exercise. On a practical level these themes will directly inform future research direction for CLS

Management of postpartum haemorrhage: from research into practice, a narrative review of the literature and the Cardiff experience

Postpartum haemorrhage (PPH) is caused by obstetric complications but may be exacerbated by haemostatic impairment. In a ten year programme of research we have established that haemostatic impairment is uncommon in moderate PPH and that fibrinogen falls earlier than other coagulation factors. Laboratory Clauss fibrinogen and the point of care surrogate measure of fibrinogen (Fibtem® A5 measured on the ROTEM® machine) are predictive biomarkers for progression from early to severe PPH, the need for blood transfusion and invasive procedures to control haemorrhage. Fibrinogen replacement is not required in PPH unless the plasma level falls below 2 g/L or the Fibtem A5 is below 12mm. Deficiencies of coagulation factors other than fibrinogen are uncommon even during severe PPH, and ROTEM monitoring can inform withholding FFP safely in most women. In the absence of placental abruption, clinically significant thrombocytopenia is uncommon unless the platelet count is low before the bleed started, or very large bleeds (>5000 mL) occur. Measuring blood loss is feasible in routine practice during PPH and is more accurate than estimation. These research findings have been collated to design an ongoing quality improvement programme for all maternity units in Wales called OBS Cymru (Wales) (The Obstetric Bleeding Strategy for Wales)

Managing the coagulopathy of postpartum hemorrhage: an evolving role for viscoelastic hemostatic assays

Postpartum hemorrhage (PPH) is usually caused by obstetrical complications but may be exacerbated by hemostatic impairment. Standard laboratory tests of coagulation often take too long to become available to inform treatment in a rapidly changing clinical situation. The role of point-of-care viscoelastic hemostatic assays (VHAs) in monitoring hemostatic impairment and guiding procoagulant blood product replacement during PPH is evolving, although these technologies are not available in most maternity units. We have used VHAs during PPH in our institution for the last 8 years and have developed a simple algorithm to direct blood component replacement. VHAs are useful for reassuring clinicians that hemostasis is adequate and that procoagulant blood products are not required and an obstetrical cause for bleeding needs to be sought. VHAs can be used to detect hypofibrinogenemia due to dilution or acute obstetrical coagulopathy and to guide fibrinogen replacement. The role of VHAs in guiding fresh frozen plasma infusion is less clear, but normal results suggest that fresh frozen plasma is not required. In this review, we describe 3 cases of postpartum hemorrhage to illustrate different hemostatic scenarios and discuss the controversies and evidence gaps related to each case