Psychological Approaches to Pediatric Pain Relief

This chapter details the evidence-based psychological interventions for pediatric procedural pain. At the outset, appropriate assessment of children’s medical anxiety and pain will be briefly discussed. Correlates of children’s pain will be presented to provide some context and nuances to consider when considering preparation and procedural intervention approaches. Subsequently, psychological approaches that focus on pre-procedure preparation are highlighted. Lastly, the focus will turn to the research base of psychological approaches to intervening during children’s medical procedural distress

Molecular Gas and Star Formation in the Cartwheel

Atacama Large Millimeter/submillimeter Array (ALMA) 12CO(J=1-0) observations are used to study the cold molecular ISM of the Cartwheel ring galaxy and its relation to HI and massive star formation (SF). CO moment maps find $(2.69\pm0.05)\times10^{9}$ M$_{\odot}$ of H$_2$ associated with the inner ring (72%) and nucleus (28%) for a Galactic I(CO)-to-N(H2) conversion factor ($\alpha_{\rm CO}$). The spokes and disk are not detected. Analysis of the inner ring's CO kinematics show it to be expanding ($V_{\rm exp}=68.9\pm4.9$ km s$^{-1}$) implying an $\approx70$ Myr age. Stack averaging reveals CO emission in the starburst outer ring for the first time, but only where HI surface density ($\Sigma_{\rm HI}$) is high, representing $M_{\rm H_2}=(7.5\pm0.8)\times10^{8}$ M$_{\odot}$ for a metallicity appropriate $\alpha_{\rm CO}$, giving small $\Sigma_{\rm H_2}$ ($3.7$ M$_{\odot}$ pc$^{-2}$), molecular fraction ($f_{\rm mol}=0.10$), and H$_2$ depletion timescales ($\tau_{\rm mol} \approx50-600$ Myr). Elsewhere in the outer ring $\Sigma_{\rm H_2}\lesssim 2$ M$_{\odot}$ pc$^{-2}$, $f_{\rm mol}\lesssim 0.1$ and $\tau_{\rm mol}\lesssim 140-540$ Myr (all $3\sigma$). The inner ring and nucleus are H$_2$-dominated and are consistent with local spiral SF laws. $\Sigma_{\rm SFR}$ in the outer ring appears independent of $\Sigma_{\rm H_2}$, $\Sigma_{\rm HI}$ or $\Sigma_{\rm HI+H_2}$. The ISM's long confinement in the robustly star forming rings of the Cartwheel and AM0644-741 may result in either a large diffuse H$_2$ component or an abundance of CO-faint low column density molecular clouds. The H$_2$ content of evolved starburst rings may therefore be substantially larger. Due to its lower $\Sigma_{\rm SFR}$ and age the Cartwheel's inner ring has yet to reach this state. Alternately, the outer ring may trigger efficient SF in an HI-dominated ISM.Comment: 10-pages text; 5-figure

Referral management centres as a means of reducing outpatients attendances: how do they work and what influences successful implementation and perceived effectiveness?

BACKGROUND: The rising volume of referrals to secondary care is a continuing concern in the NHS in England, with considerable resource implications. Referral management centres (RMCs) are one of a range of initiatives brought in to curtail this rise, but there is currently limited evidence for their effectiveness, and little is known about their mechanisms of action. This study aimed to gain a better understanding of how RMCs operate and the factors contributing to the achievement of their goals. Drawing on the principles of realist evaluation, we sought to elicit programme theories (the ideas and assumptions about how a programme works) and to identify the key issues to be considered when establishing or evaluating such schemes. METHODS: Qualitative study with a purposive sample of health professionals and managers involved in the commissioning, set-up and running of four referral management centres in England and with GPs referring through these centres. Semi-structured interviews were conducted with 18 participants. Interviews were audio-recorded and transcribed. Data were analysed thematically. RESULTS: Interview data highlighted the diverse aims and functions of RMCs, reflecting a range of underlying programme theories. These included the overarching theory that RMCs work by ensuring the best use of limited resources and three sub-theories, relating to how this could be achieved, namely, improving the quality of referrals and patient care, reducing referrals, and increasing efficiency in the referral process. The aims of the schemes, however, varied between sites and between stakeholders, and evolved significantly over time. Three themes were identified relating to the context in which RMCs were implemented and managed: the impact of practical and administrative difficulties; the importance and challenge of stakeholder buy-in; and the dependence of perceived effectiveness on the aims and priorities of the scheme. Many RMCs were described as successful by those involved, despite limited evidence of reduced referrals or cost-savings. CONCLUSIONS: The findings of this study have a number of implications for the development of similar schemes, with respect to the need to ensure clarity of aims and to identify indicators of success from the outset, to anticipate scheme evolution and plan for potential changes with respect to IT systems and referral processes. Also identified, is the need for further research that evaluates the effectiveness and cost effectiveness of particular models of RMC

Referral management centres as a means of reducing outpatients attendances: how do they work and what influences successful implementation and perceived effectiveness?

Abstract Background The rising volume of referrals to secondary care is a continuing concern in the NHS in England, with considerable resource implications. Referral management centres (RMCs) are one of a range of initiatives brought in to curtail this rise, but there is currently limited evidence for their effectiveness, and little is known about their mechanisms of action. This study aimed to gain a better understanding of how RMCs operate and the factors contributing to the achievement of their goals. Drawing on the principles of realist evaluation, we sought to elicit programme theories (the ideas and assumptions about how a programme works) and to identify the key issues to be considered when establishing or evaluating such schemes. Methods Qualitative study with a purposive sample of health professionals and managers involved in the commissioning, set-up and running of four referral management centres in England and with GPs referring through these centres. Semi-structured interviews were conducted with 18 participants. Interviews were audio-recorded and transcribed. Data were analysed thematically. Results Interview data highlighted the diverse aims and functions of RMCs, reflecting a range of underlying programme theories. These included the overarching theory that RMCs work by ensuring the best use of limited resources and three sub-theories, relating to how this could be achieved, namely, improving the quality of referrals and patient care, reducing referrals, and increasing efficiency in the referral process. The aims of the schemes, however, varied between sites and between stakeholders, and evolved significantly over time. Three themes were identified relating to the context in which RMCs were implemented and managed: the impact of practical and administrative difficulties; the importance and challenge of stakeholder buy-in; and the dependence of perceived effectiveness on the aims and priorities of the scheme. Many RMCs were described as successful by those involved, despite limited evidence of reduced referrals or cost-savings. Conclusions The findings of this study have a number of implications for the development of similar schemes, with respect to the need to ensure clarity of aims and to identify indicators of success from the outset, to anticipate scheme evolution and plan for potential changes with respect to IT systems and referral processes. Also identified, is the need for further research that evaluates the effectiveness and cost effectiveness of particular models of RMC

Balancing Influence in a Shifting Scholarly Communication Landscape: Creating Library-Owned, Community-Aligned Infrastructure Through Individual, Local, and Community Action

With the acquisition and creation of scholarly communication platforms/infrastructure by major commercial entities, the balance of influence continues to shift. The ACRL/SPARC Forum at the 2018 ALA Midwinter Meeting brought together library stakeholders for a conversation about how the library community can reassert its influence to shape the open access publishing landscape. Panelists focused on 1) Individual action: “What can one person do?” 2) Local coordinated action: “How can one group or institution effect change?” and 3) Collective action: “How can libraries work together to provide sustainable alternatives?

The experience of couples being given an oxygen concentrator to use at home: A longitudinal interpretative phenomenological analysis

This longitudinal study explores the lived experience of four couples where one person from each couple is prescribed an oxygen concentrator to use at home. Transcripts were analysed using interpretative phenomenological analysis. The findings reported here focus on two super-ordinate themes: ‘the journey of acceptance’ and ‘negotiating changing relationships’. Participants described a gradual process of accepting the device into their lives, the impact on couple’s relationships and the role that expectations have in mediating that process. These themes suggest that patient education that considers the psychological and social issues may prove useful in facilitating the acceptance process

Needs of parents and carers of children and young people with mental health difficulties: protocol for a systematic review

Introduction Having a child or young person (CYP) with mental health problems can be highly distressing for parents/carers. The impact can include parental/carer depression, anxiety, lost productivity and poor family relationships. Currently, there is no synthesis of this evidence, which is needed to provide clarity around what support parents/carers may need, to meet the needs of family mental health. This review aims to identify the needs of the parents/carers of CYP who are receiving mental health services. Methods and analysis A systematic review will be conducted to identify potentially relevant studies that provide evidence concerning the needs and impact on parents/carers linked to their CYP having mental health difficulties. CYP mental health conditions included are anxiety disorders, depression, psychoses, oppositional defiant and other externalising disorders, labels of emerging personality disorders, eating disorders and attention deficit (hyperactive) disorders. The following databases were searched on November 2022 with no date restriction applied: Medline; PsycINFO; CINAHL; AMED; EMBASE; Web of Science; Cochrane Library; WHO International Clinical Trials Registry Platform; Social Policy and Practice; Applied Social Sciences Index and Abstracts; and Open Grey. Only studies reported in English will be included. The quality of the included studies will be assessed using Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies and the Newcastle Ottawa Scale for quantitative studies. Qualitative data will be analysed thematically and inductively

Quantifying the effect of microbial diversity and plant roots on soil structural development

Soil is one of the most complex ecosystems in the environment and changes to microbial diversity are thought to affect the physical structure (and vice versa). A fundamental question addressed in this research, is how microbial communities influence the functioning of soil, particularly with respect to the development and maintenance of a soil’s physical structure. Using micro- and macrocosms of sieved (and therefore structureless) soil, the effects of time, soil texture, manipulated background microbial diversity, and Plantago lanceolata (± mycorrhizal fungi) on the development of soil structure were determined. Background microbial diversity was manipulated using the dilution technique to give a low (101) dilution or a high (106) dilution of the original soil. This resulted in greater bacterial diversity in the lower (101) dilution than in the higher (106) dilution when in the presence of mycorrhizal plants. However, background diversity was the same irrespective of dilution in soils with non-mycorrhizal plants (and reversed within the bare soil). Micro- and macrocosms were continually assessed during controlled incubation periods ranging from 7 weeks to 15 months. Of the soil textures analysed (clay loam, loamy sand and sandy loam), loamy sand displayed the highest overall porosity as well as a noteworthy development in porosity throughout the incubation period. Mycorrhizal and nonmycorrhizal plants increased the speed of soil structural development by 5 months relative to unplanted soils. Although mycorrhizal fungi stunted root growth initially, aggregates within mycorrhizal planted treatments were smaller but nonetheless more stable than those in bare soil. Increasing mycorrhizal fungal species richness enhanced root and shoot biomass and reduced aggregate size and total porosity. There was a positive relationship between total porosity and numbers of culturable bacteria and fungi. In soils containing a lower microbial diversity, an increase in porosity, mean pore size, aggregate size and pore perimeter was observed. Results obtained were dependent on incubation conditions, planting regime and mycorrhizal status. Therefore, the effects of reducing microbial species diversity on soil structure parameters are idiosyncratic, with the presence of plant roots acting as a key factor