How do consumer leaders co-create value in mental health organisations?

Objectives Contemporary mental health policies call for consumers to be involved in decision-making processes within mental health organisations. Some organisations have embraced leadership roles for consumers, but research suggests consumers remain disempowered within mental health services. Drawing on a service-dominant logic, which emphasises the co-creation of value of services, the present study provides an overview of consumer leadership within mental health organisations in the Australian Capital Territory. Methods Mental health organisations subscribing to the local peak body mailing list were invited to complete a survey about consumer leadership. Survey data were summarised using descriptive statistics and interpreted through the lens of service-dominant logic. Results Ways in which organisations may create opportunities for consumers to co-create value within their mental health services included soliciting feedback, involving consumer leaders in service design, having consumer leaders involved in hiring decisions and employing consumer leaders as staff or on boards. Strategies that organisations used to develop consumer leaders included induction, workshops and training in a variety of organisational processes and skills. Conclusions The findings of the present study extend the application of a service-dominant logic framework to consumer leadership within mental health organisations through consideration of the diverse opportunities that organisations can provide for consumer co-creation of service offerings. What is known about the topic? Policy calls for consumer involvement in all levels of mental health service planning, implementation and delivery. The extent to which service organisations have included consumer leaders varies, but research suggests that this inclusion can be tokenistic or that organisations choose to work with consumers who are less likely to challenge the status quo. Service literature has explored the way consumers can co-create value of their own health care, but is yet to explore consumers’ co-creation of value at a systemic level. What does the paper add? This paper outlines ways in which mental health organisations report involving consumers in leadership positions, including having consumers on boards, having consumers on recruitment panels and providing leadership training for consumers. These initiatives are considered in terms of the potential value co-created within mental health services by consumers in leadership, suggesting that consumer leaders are a resource to mental health organisations in terms of the value brought to service offerings. What are the implications for practitioners? Research suggests that medical professionals have been resistant to increased consumer leadership within mental health services. The findings of the present study emphasise the value that can be brought to service organisations by consumer leaders, suggesting that mental health practitioners may reconsider their approach and attitudes towards consumer leadership in the sector. </jats:p

Wavelength dependence of angular diameters of M giants: an observational perspective

We discuss the wavelength dependence of angular diameters of M giants from an observational perspective. Observers cannot directly measure an optical-depth radius for a star, despite this being a common theoretical definition. Instead, they can use an interferometer to measure the square of the fringe visibility. We present new plots of the wavelength-dependent centre-to-limb variation (CLV) of intensity of the stellar disk as well as visibility for Mira and non-Mira M giant models. We use the terms ``CLV spectra'' and ``visibility spectra'' for these plots. We discuss a model-predicted extreme limb-darkening effect (also called the narrow-bright-core effect) in very strong TiO bands which can lead to a misinterpretation of the size of a star in these bands. We find no evidence as yet that this effect occurs in real stars. Our CLV spectra can explain the similarity in visibilities of R Dor (M8IIIe) that have been observed recently despite the use of two different passbands. We compare several observations with models and find the models generally under-estimate the observed variation in visibility with wavelength. We present CLV and visibility spectra for a model that is applicable to the M supergiant alpha Ori.Comment: 16 pages with figures. Accepted by MNRA

"I can't make all this work." : end of life care provision in natural disasters : a qualitative study

Background: Natural disasters are becoming more frequent and severe and profoundly impact the end-of-life care experience, including service provision. There is a paucity of research examining healthcare workers’ experiences in responding to care demands when disasters strike. This research aimed to fill this gap by exploring end-of-life care providers’ perceptions of the impact of natural disasters on end-of-life care. Methods: Between Feb 2021-June 2021 ten in-depth semi-structured interviews were conducted with healthcare professionals providing end-of-life care during recent natural disasters, COVID-19, and/or fires and floods. Interviews were audio-recorded, transcribed, and analysed using a hybrid inductive and deductive thematic approach. Results: The overarching theme from the healthcare workers’ accounts was of being unable to provide effective compassionate and quality care - “I can’t make all this work.” They spoke of the considerable burdens the system imposed on them, of being overextended and overwhelmed, having their roles overturned, and losing the human element of care for those at end-of-life. Conclusion: There is urgent need to pioneer effective solutions to minimise the distress of healthcare professionals in delivering end-of-life care in disaster contexts, and to improve the experience of those dying

Australian Capital Territory COVID-19 Intensive Care Triage Principles and Process: Consumer, Carer, and Community Consultation Report

Executive Summary The ACT Clinical Health Emergency Coordination Centre engaged the research team in May 2020 to conduct a review of the ethical decision-making processes for allocating critical care resources should demand exceed supply during the global COVID-19 pandemic. ES.1 Methodology The methodology for this review broadly included undertaking a scoping review of ethical decision-making frameworks in other jurisdictions; a systematic review of consumer, carer, and community engagement in ethical decision-making frameworks; and a series of consultative processes. The outcomes from each of these activities were then integrated into the ACT Ethical Decision-Making Framework which had been drafted by the Clinical Ethics Committee of Canberra Health Services earlier in the pandemic. Based on a ‘Scoping Review of Ethical Decision-Making Frameworks’ and a ‘Systematic Review of Consumer Engagement in Ethical Decision-Making Frameworks’, a consultation process was developed whereby relevant consumer, carer, and community groups from across the ACT region were given a range of opportunities to provide input into what principles should form the basis of ethical decision-making in the context of COVID-19 should demand for acute care resources exceed capacity. ES.2 Recommendations The recommendations developed through analysis of the consultations are: 1. There should be a primacy of Human Rights underpinning decision-making processes, 2. Non-discrimination should be embedded in triage, 3. Triage should be primarily based on immediate health concerns (that is, with no assumptions or value judgements about people’s health conditions), 4. Triage processes should minimise bias, and 5. Triage processes should be transparent

Synthetic Spectra and Color-Temperature Relations of M Giants

As part of a project to model the integrated spectra and colors of elliptical galaxies through evolutionary synthesis, we have refined our synthetic spectrum calculations of M giants. After critically assessing three effective temperature scales for M giants, we adopted the relation of Dyck et al. (1996) for our models. Using empirical spectra of field M giants as a guide, we then calculated MARCS stellar atmosphere models and SSG synthetic spectra of these cool stars, adjusting the band absorption oscillator strengths of the TiO bands to better reproduce the observational data. The resulting synthetic spectra are found to be in very good agreement with the K-band spectra of stars of the appropriate spectral type taken from Kleinmann & Hall (1986) as well. Spectral types estimated from the strengths of the TiO bands and the depth of the bandhead of CO near 2.3 microns quantitatively confirm that the synthetic spectra are good representations of those of field M giants. The broad-band colors of the models match the field relations of K and early-M giants very well; for late-M giants, differences between the field-star and synthetic colors are probably caused by the omission of spectral lines of VO and water in the spectrum synthesis calculations. Here, we present four grids of K-band bolometric corrections and colors -- Johnson U-V and B-V; Cousins V-R and V-I; Johnson-Glass V-K, J-K and H-K; and CIT/CTIO V-K, J-K, H-K and CO -- for models having 3000 K < Teff < 4000 K and -0.5 < log g < 1.5. These grids, which have [Fe/H] = +0.25, 0.0, -0.5 and -1.0, extend and supplement the color-temperature relations of hotter stars presented in a companion paper (astro-ph/9911367).Comment: To appear in the March 2000 issue of the Astronomical Journal. 60 pages including 15 embedded postscript figures (one page each) and 6 embedded postscript tables (10 pages total

Intra- and inter-annual uranium concentration variability in a Belizean stalagmite controlled by prior aragonite precipitation: A new tool for reconstructing hydro-climate using aragonitic speleothems

Aragonitic speleothems are increasingly utilised as palaeoclimate archives due to their amenability to high precision U–Th dating. Proxy records from fast-growing aragonitic stalagmites, precisely dated to annual timescales, can allow investigation of climatic events occurring on annual or even sub-annual timescales with minimal chronological uncertainty. However, the behaviour of many trace elements, such as uranium, in aragonitic speleothems has not thus far been as well constrained as in calcitic speleothems. Here, we use uranium concentration shifts measured across primary calcite-to-aragonite mineralogical transitions in speleothems to calculate the distribution coefficient of uranium in aragonitic speleothems (derived DU = 3.74 ± 1.13). Because our calculated DU is considerably above 1 increased prior aragonite precipitation due to increased karst water residence time should strongly control stalagmite aragonite U/Ca values. Consequently, uranium concentrations in aragonitic speleothems should act as excellent proxies for effective rainfall. We test this using a high-resolution ICP-MS derived trace element dataset from a Belizean stalagmite. YOK-G is an aragonitic stalagmite from Yok Balum cave in Belize with an extremely robust monthly-resolved chronology built using annual δ13C cycles. We interpret seasonal U/Ca variations in YOK-G as reflecting changes in the amount and seasonality of prior aragonite precipitation driven by variable rainfall amounts. The U/Ca record strongly suggests that modern drying has occurred in Belize, and that this drying was primarily caused by a reduction in wet season rainfall. This is consistent with published stable isotope data from YOK-G also very strongly suggesting modern rainfall reductions, previously interpreted as the result of southward ITCZ displacement. Our results strongly suggest that U/Ca values in aragonitic speleothems are excellent proxies for rainfall variability. This new tool, combined with the exceptional chronological control characteristic of aragonitic stalagmites and the high spatial resolution afforded by modern microanalytical techniques, should facilitate the construction of new exquisitely resolved rainfall records, providing rare insights into seasonality changes as well as long-term changes in local recharge conditions