Substantive theory to explain the impact of living with a chronic wound whilst receiving conflicting or inappropriate advice or care

It is estimated that over 200,000 Australians have problem or chronic wounds at any one time (Australian Wound Management Association, 2008). Over the past 4 decades while there has been significant advancement in wound care, a high proportion of wounds become chronic. Despite the availability of wound care resources and specialist services, there remains an inconsistency in the management of chronic wounds that impacts both on the quality of life of individuals with chronic wounds and the health care budget (Harding 2002). Using a Grounded theory approach, the aim of this study was to explore and describe the impact of living with a chronic wound and findings indicate that individuals living with a chronic wound are receiving conflicting or inappropriate advice and care. Individuals living with a chronic wound experience a life of uncertainty related to the struggle to endure a wounded body and the layers of professional care they receive. When they are provided with conflicting or inappropriate advice and treatment, inconsistencies of care and poor coordination of care, layers of unnecessary burden are added to their experience. The uncertainty and dissonance individuals are faced with, leads them to question their care, themselves and the expertise and professionalism of their treating health professionals. As a result, they experienced a loss of respect and trust for their treating health professionals and a loss of confidence in their care. Chronic wounds impose of individuals, an intense burden of physical suffering, cause major disruption to the normality of their lives, and often entail a constant personal struggle to secure appropriate care and understanding from their treating health professionals. In order to enable individuals living with chronic wounds to develop appropriate coping strategies, it is essential that health professionals: understand the burden of suffering associated with living with a chronic wound; ensure that they develop and maintain a high level of knowledge with regards to contemporary wound care practices; ensure that their clientele are provided with high quality care information that is based on the best available evidence; ensure continuity of care; and foster quality professional-client relationships that negates the need for individuals to have to constantly question their care

Racial stereotyping: survey of psychiatrists in the United Kingdom

No abstracts available

Examining the feasibility of an economic analysis of dyadic developmental psychotherapy for children with maltreatment associated psychiatric problems in the United Kingdom

Background: Children with maltreatment associated psychiatric problems are at increased risk of developing behavioural or mental health disorders. Dyadic Developmental Psychotherapy (DDP) was proposed as treatment for children with maltreatment histories in the USA, however, being new to the UK little is known of its effectiveness or cost-effectiveness. As part of an exploratory study, this paper explores the feasibility of undertaking economic analysis of DDP in the UK. Methods: Feasibility for economic analysis was determined by ensuring such analysis could meet key criteria for economic evaluation. Phone interviews were conducted with professionals (therapists trained and accredited or in the process of becoming accredited DDP practitioners). Three models were developed to represent alternative methods of DDP service delivery. Once appropriate comparators were determined, economic scenarios were constructed. Cost analyses were undertaken from a societal perspective. Finally, appropriate outcome measurement was explored through clinical opinion, literature and further discussions with clinical experts. Results: Three DDP models were constructed: DDP Full-Basic, DDP Home-Based and DDP Long-Term. Two potential comparator interventions were identified and defined as Consultation with Carers and Individual Psychotherapy. Costs of intervention completion per case were estimated to be: £6,700 (DDP Full-Basic), £7,100 (Consultations with Carers), £7,200 (DDP Home-Based), £11,400 (Individual Psychotherapy) and £14,500 (DDP Long-Term). None of the models of service delivery were found to currently measure effectiveness consistently. The Strengths and Difficulties Questionnaire (SDQ) was deemed an appropriate primary outcome measure, however, it does not cover all disorders DDP intends to treat and the SDQ is not a direct measure of health gain. Inclusion of quality of life measurement is required for comprehensive economic analysis. Conclusions: Economic analysis of DDP in the UK is feasible if vital next steps are taken to measure intervention outcomes consistently, ideally with a quality of life measurement. An economic analysis using the models constructed could determine the potential cost-effectiveness of DDP in the UK and identify the most efficient mode of service delivery

The feasibility of a randomised controlled trial of Dyadic Developmental Psychotherapy

Background: Maltreated children have significant and complex problems which clinicians find difficult to diagnose and treat. Previous US pilot work suggests that Dyadic Developmental Psychotherapy (DDP) may be effective; however, rigorous evidence from a randomised controlled trial (RCT) is lacking. The purpose of this study is to establish the feasibility of an RCT of DDP by exploring the ways that DDP is operating across different UK sites and the impacts of current practice on the potential set-up of an RCT. Methods: Qualitative methods (interviews, focus groups and teleconferences) were used to explore trial feasibility with therapists and service managers from teams implementing both DDP and possible control interventions. Data were analysed thematically and related to various aspects of trial design. Results: DDP was commonly regarded as having a particular congruence with the complexity of maltreatment-associated problems and a common operating model of DDP was evident across sites. A single control therapy was harder to establish, however, and it is likely to be a non-specific and context-dependent intervention/s offered within mainstream Child and Adolescent Mental Health Services (CAMHS). Because a ‘gold standard’ Treatment as Usual (TAU) does not currently exist, randomisation between DDP and TAU (CAMHS) therefore looks feasible and ethical. The nature of family change during DDP was regarded as multi-faceted, non-linear and relationship-based. Assessment tools need to be carefully considered in terms of their ability to capture change that covers both individual child and family-based functioning. Conclusions: An RCT of DDP is feasible and timely. This study has demonstrated widespread interest, support and engagement regarding an RCT and permissions have been gained from sites that have shown readiness to participate. As maltreated children are among the most vulnerable in society, and as there are currently no treatments with RCT evidence, such a trial would be a major advance in the field

The effects of small ice crystals on the infrared radiative properties of cirrus clouds

To be successful in the development of satellite retrieval methodologies for the determination of cirrus cloud properties, we must have fundamental scattering and absorption data on nonspherical ice crystals that are found in cirrus clouds. Recent aircraft observations (Platt et al. 1989) reveal that there is a large amount of small ice particles, on the order of 10 micron, in cirrus clouds. Thus it is important to explore the potential differences in the scattering and absorption properties of ice crystals with respect to their sizes and shapes. In this study the effects of nonspherical small ice crystals on the infrared radiative properties of cirrus clouds are investigated using light scattering properties of spheroidal particles. In Section 2, using the anomalous diffraction theory for spheres and results from the exact spheroid scattering program, efficient parameterization equations are developed for calculations of the scattering and absorption properties for small ice crystals. Parameterization formulas are also developed for large ice crystals using results computed from the geometric ray-tracing technique and the Fraunhofer diffraction theory for spheroids and hexagonal crystals. This is presented in Section 3. Finally, applications to the satellite remote sensing are described in Section 4

Stratocumulus cloud height variations determined from surface and satellite observations

Determination of cloud-top heights from satellite-inferred cloud-top temperatures is a relatively straightforward procedure for a well-behaved troposphere. The assumption of a monotonically decreasing temperature with increasing altitude is commonly used to assign a height to a given cloud-top temperature. In the hybrid bispectral threshold method, or HBTM, Minnis et al. (1987) assume that the lapse rate for the troposphere is -6.5/Kkm and that the surface temperature which calibrated this lapse rate is the 24 hour mean of the observed or modeled clear-sky, equivalent blackbody temperature. The International Satellite Cloud Climatology Project (ISCCP) algorithm (Rossow et al., 1988) attempts a more realistic assignment of height by utilizing interpolations of analyzed temperature fields from the National Meteorological Center (NMC) to determine the temperature at a given level over the region of interest. Neither these nor other techniques have been tested to any useful extent. The First ISCCP Regional Experiment (FIRE) Intensive Field Observations (IFO) provide an excellent opportunity to assess satellite-derived cloud height results because of the availability of both direct and indirect cloud-top altitude data of known accuracy. The variations of cloud-top altitude during the Marine Stratocumulus IFO (MSIFO, June 29 to July 19, 1987) derived from surface, aircraft, and satellite data are examined

Preliminary Report: Impact of Differential Privacy & the 2020 Census on Latinos, Asian Americans and Redistricting

The Constitution requires a census every ten years in order to determine the number of seats each state will have in the U.S. House of Representatives. In addition to determining this reapportionment of House seats, Census data are also used for purposes of redistricting, distribution of federal funding, and assisting policy makers, businesses, and other interested stakeholders in assessing and addressing community needs.The Census Bureau has utilized different methods to meet its federal-law statutory mandate to protect respondents' privacy and confidentiality in published statistics. For the 2020 census, the Census Bureau will use a new methodology for this purpose – "differential privacy." Differential privacy is a mathematical method that uses statistical noise, or false information, to alter data so that the link between the data and specific persons or households cannot be ascertained. How the Census Bureau implements differential privacy could negatively affect civil rights enforcement for the next decade, including with respect to redistricting and voting rights.This preliminary report – the first such report from civil rights organizations on this topic – compares the demonstration products (which tested different configurations of differential privacy using 2010 Census data) to published 2010 Census data in an effort to assess the impact of differential privacy on a) total population and racial/ethnic populations and b) redistricting

Protocol for the economic evaluation of a complex intervention to improve the mental health of maltreated infants and children in foster care in the UK (The BeST? services trial)

Introduction: Children who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout life. This places an enormous burden on individuals, families and society in terms of health services, education, social care and judiciary sectors. Evidence suggests that early intervention can mitigate the negative consequences of child maltreatment, exerting long-term positive effects on the health of maltreated children entering foster care. However, evidence on cost-effectiveness of such complex interventions is limited. This protocol describes the first economic evaluation of its kind in the UK. Methods and analysis: An economic evaluation alongside the Best Services Trial (BeST?) has been prospectively designed to identify, measure and value key resource and outcome impacts arising from the New Orleans intervention model (NIM) (an infant mental health service) compared with case management (CM) (enhanced social work services as usual). A within-trial economic evaluation and long-term model from a National Health Service/Personal Social Service and a broader societal perspective will be undertaken alongside the National Institute for Health Research (NIHR)–Public Health Research Unit (PHRU)-funded randomised multicentre BeST?. BeST? aims to evaluate NIM compared with CM for maltreated children entering foster care in a UK context. Collection of Paediatric Quality of Life Inventory (PedsQL) and the recent mapping of PedsQL to EuroQol-5-Dimensions (EQ-5D) will facilitate the estimation of quality-adjusted life years specific to the infant population for a cost–utility analysis. Other effectiveness outcomes will be incorporated into a cost-effectiveness analysis (CEA) and cost-consequences analysis (CCA). A long-term economic model and multiple economic evaluation frameworks will provide decision-makers with a comprehensive, multiperspective guide regarding cost-effectiveness of NIM. The long-term population health economic model will be developed to synthesise trial data with routine linked data and key government sector parameters informed by literature. Methods guidance for population health economic evaluation will be adopted (lifetime horizon, 1.5% discount rate for costs and benefits, CCA framework, multisector perspective). Ethics and dissemination: Ethics approval was obtained by the West of Scotland Ethics Committee. Results of the main trial and economic evaluation will be submitted for publication in a peer-reviewed journal as well as published in the peer-reviewed NIHR journals library (Public Health Research Programme). Trial registration number: NCT02653716; Pre-results

SAM: The School Attachment Monitor

Secure Attachment relationships have been shown to minimise social and behavioural problems in children and boosts resilience to risks later on such as antisocial behaviour, heart pathologies, and suicide. Attachment assessment is an expensive and time-consuming process that is not often performed. The School Attachment Monitor (SAM) automates Attachment assessment to support expert assessors. It uses doll-play activities with the dolls augmented with sensors and the child's play recorded with cameras to provide data for assessment. Social signal processing tools are then used to analyse the data and to automatically categorize Attachment patterns. This paper presents the current SAM interactive prototype

Practical Application of NASA-Langley Advanced Satellite Products to In-Flight Icing Nowcasts

Experimental satellite-based icing products developed by the NASA Langley Research Center provide new tools to identify the locations of icing and its intensity. Since 1997, research forecasters at the National Center for Atmospheric Research (NCAR) have been helping to guide the NASA Glenn Research Center's Twin Otter aircraft into and out of clouds and precipitation for the purpose of characterizing in-flight icing conditions, including supercooled large drops, the accretions that result from such encounters and their effect on aircraft performance. Since the winter of 2003-04, the NASA Langley satellite products have been evaluated as part of this process, and are being considered as an input to NCAR s automated Current Icing Potential (CIP) products. This has already been accomplished for a relatively straightforward icing event, but many icing events have much more complex characteristics, providing additional challenges to all icing diagnosis tools. In this paper, four icing events with a variety of characteristics will be examined, with a focus on the NASA Langley satellite retrievals that were available in real time and their implications for icing nowcasting and potential applications in CIP