Recovery experiences of forensic mental health service users

Background: Current models of recovery are based on forensic mental health service users’ experiences. However, there is a lack of research into the experiences of those from ethnic backgrounds, despite being over-represented within forensic mental health settings. Aim: This research aimed to develop a framework for understanding the recovery experiences of forensic mental health service users of ethnic background. Methods: Upon gaining ethical approval, semi-structured interviews were held with 10 participants. The data were analysed using a critical realist approach to Grounded Theory. Findings: Five core categories were identified; the self, the network, the institution, recovery as a process, and the individual context. Similarities were drawn to existing models in which the self, network and institution interact to influence recovery. Differences were found regarding stigma. Individual context influenced the process, with cultural considerations regarding food, alternative treatments and spiritual beliefs playing an important role, as well as individuals’ experiences of adversity. Implications: It is concluded that the developed framework provides an initial understanding of the recovery experiences of this subgroup that can be used to develop services to meet the unique needs of this subgroup. Future research expanding on these findings is discussed

The reported expression of pain and distress by people with an intellectual disability

Aims and objectives.  To explore the assumption that people with ID are unable to communicate effectively about pain by examining the extent to which they were reported as using language and behaviour that was readily understandable to others to communicate pain as distinct from distress. Background.  The healthcare needs of people with an intellectual disability (ID) are frequently overlooked or dealt with inappropriately. One proposed reason is the difficulty that such individuals have in communicating about their pain. Design.  A postal questionnaire-based mixed method design was used. Methods.  Data from carer reports (n = 29) of the ways people with ID supported expressed pain and distress were categorised and analysed using descriptive statistics and thematic content analysis. Results.  Nineteen of the 22 people who used verbal communication were reported to express pain using words that would be understandable to someone else, often accompanied by behavioural indications of the location of the pain. The language and behaviour that were reported as being used to express distress was more idiosyncratic, and there was little overlap between this and the ways in which pain was expressed. Conclusion.  The results provide some challenges to the view that people with ID are necessarily unable to communicate effectively about their pain and support the view that pain and distress can be conceptually distinguished and differentially communicated by some people with ID. Relevance to clinical practice.  The results suggest that many people with ID can be active participants in describing their experience of pain and that nurses should attempt to obtain this information directly from the individual during the diagnostic process. Nurses should be mindful of the distinction between pain and distress and should not respond to signs of distress in this group as being indicative of pain, without carrying out further assessment

Charge Distribution Near Oxygen Vacancies in Reduced Ceria

Understanding the electronic charge distribution around oxygen vacancies in transition metal and rare earth oxides is a scientific challenge of considerable technological importance. We show how significant information about the charge distribution around vacancies in cerium oxide can be gained from a study of high resolution crystal structures of higher order oxides which exhibit ordering of oxygen vacancies. Specifically, we consider the implications of a bond valence sum analysis of Ce$_{7}$O$_{12}$ and Ce$_{11}$O$_{20}$. To illuminate our analysis we show alternative representations of the crystal structures in terms of orderly arrays of co-ordination defects and in terms of flourite-type modules. We found that in Ce$_{7}$O$_{12}$, the excess charge resulting from removal of an oxygen atom delocalizes among all three triclinic Ce sites closest to the O vacancy. In Ce$_{11}$O$_{20}$, the charge localizes on the next nearest neighbour Ce atoms. Our main result is that the charge prefers to distribute itself so that it is farthest away from the O vacancies. This contradicts \emph{the standard picture of charge localisation} which assumes that each of the two excess electrons localises on one of the cerium ions nearest to the vacancy. This standard picture is assumed in most calculations based on density functional theory (DFT). Based on the known crystal structure of Pr$_{6}$O$_{11}$, we also predict that the charge in Ce$_{6}$O$_{11}$ will be found in the second coordination shell of the O vacancy. Although this review focuses on bulk cerium oxides our approach to characterising electronic properties of oxygen vacancies and the physical insights gained should also be relevant to surface defects and to other rare earth and transition metal oxides.Comment: 20 pages, 23 figures. The replacement file has a new format for the figures are the document layout but no change in content. v3 has the following main changes: 1. The abstract and introduction were extensively revised. 2. Sec. IV was removed. 3. The Conclusion was rewritte

Financial aspects: emergency facilities

Thesis (M.B.A.)--Boston Universit

Psychoanalytic psychotherapy with depressed older adults. A qualitative research study

This thesis is a qualitative investigation of once-weekly psychoanalytic psychotherapy practised by the researcher over a period of one year with a sample of six patients, all of whom were over 65 at the beginning of their treatment and had been previously diagnosed by clinical referrers as depressed. The purpose of the study was to explore whether psychotherapy could alleviate their distress and enhance the quality of their later life. It was also to investigate if there were other reasons for depression in later life than the failure to mourn early losses. In an earlier study I had applied the method of psychoanalytic infant observationto the study of aged adults suffering from dementia, both to learn about their states of mind and to study their responses to this kind of close observational attention. This new study brings my training and experience as a child and adult psychotherapist to bear on the experience of older adults. I adopted a qualitative method of research, applying a form of Grounded Theory to the analysis of clinical data which I wrote up in detail after each clinical session. I sought to identify themes which explained the origins of depression in later life in otherwise well-functioning adults both from thematic analysis of the separate case studies and by comparing them, In a follow-up review meeting three months after the completion of treatment research patients completed a questionnaire which enabled me to assess the changes which had taken place as a consequence of clinical treatment. These results and the outcomes of the CORE measures, an independent assessment, indicated significant improvements in the states of mind of all the patients since the beginning of their psychotherapy. The context for this qualitative clinical study is provided by a chapter which reviews the literature on the psychology and especially the psychoanalytic study of old age, identifying earlier theoretical contributions beginning with the work of Freud which were formative to my work. A central finding of my study was that losses, sometimes from childhood, remained the significant unrecognized sources of depression, and that enabling patients to reflect on aspirations which were no longer attainable could bring them relief from depression and a renewed interest in life. Most previous psychoanalytic writing in this field is based on single clinical cases. My study is original both in its systematic comparison of six cases of depression in old age and in its adoption of an explicitly qualitative research method adapted to clinical data. A further context for my investigation is provided by a chapter in which my research methodology is described. A chapter on the social context of old age is included, which takes note of the growing proportion of aged people in the population and the demands placed on social provision to meet their physical needs as well as their mental well being. The final chapter draws some further conclusions and recommendations from the study

An investigation and examination of the levels and types of bacterial contamination on the surface of clean room operators' garments.

The contamination of sterile pharmaceutical products is a serious event which has in the worst case scenario led to patient death. Operators are the primary source of clean room contamination, with the majority of their detritus being identified as skin squames and their related microorganisms. The ability of operator associated bacterial contamination to disseminate through specialist garments worn in the clean room environment is apparent in the literature. However, despite the fibres of such garments being identified as a suitable substrate for bacteria to adhere to and grow upon, the bacterial bioburden of the surface of clean room operators garments is an area which severely lacks in published research. Reported here is the recovery, enumeration and comparison of the levels of bacteria on the surface of reusable antistatic carbon filament polyester clean room garments, using the direct agar contact method, following their laundering with and without terminal gamma sterilisation, immediately following their donning with operators dressing wearing either no gloves, non “ sterile gloves or sterile clean room gloves, and following their wear within the clean room environment, with respect to gender. The aforementioned method, with its recovery efficiency shown to be unaffected by agar composition (NA or TSA), recovered bacteria from the surface of garments laundered with and without gamma sterilisation. Such terminal decontamination was shown to reduce the surface bacterial bioburden of the garments, especially at the chest and umbilicus regions, which were shown to harbour higher levels of bacteria than the other sites tested. The direct agar contact method, showing an increase in recovery efficiency following a 48 hour agar incubation period as opposed to a 24 hour period, also recovered bacteria from the surface of clean room garments donned by operators dressing wearing either no gloves, non “ sterile gloves and sterile clean room gloves. Bacteria were transferred onto the surface of these garments via the hand borne route, with the chest and oral cavity regions being found to harbour more bacteria than the other sites tested. Overall, glove type was shown to have no effect upon the resultant bacterial bioburden of the surface of the garments, suggesting expensive clean room gloves could be substituted for their cheaper non “ sterile equivalents or no gloves during the donning process without subsequently increasing the surface bacterial bioburden of the garment. The direct agar contact method also recovered bacteria from the surface of clean room garments worn by male and female operators, following their working period within a clean room environment. Gender was found to significantly affect the surface bacterial bioburden of the garments, with the surface of those garments worn by male operators being more contaminated than the surface of those worn by their female counterparts. In addition, the donning of a clean room hood was shown to reduce the levels of bacteria at the chest and posterior cervicis regions of suits worn by both genders. Overall, the direct agar contact method was identified as a successful tool to recover, enumerate and estimate the surface bacterial bioburden of reusable antistatic polyester carbon filament clean room garments. Finally, using 16S rRNA gene sequencing, found to be more reliable and accurate at identifying unknown isolates than traditional phenotypic first - stage tests, which were subsequently found to misidentify > 85 % of the isolates tested, a self - selected representative number of isolates recovered from the surface of garments during the laundering and gender comparison studies were predominantly identified as skin commensal species of Staphylococcus and Micrococcus, as well as environmental species of Bacillus. The knowledge contained within this thesis, with respect to clean room operators and their specialist garments, contributes towards improving contamination control standards within clean room facilities