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

Revising an Extension Education Website for Limited Resource Audiences Using Social Marketing Theory

Spend Smart Eat Smart (SSES), a unique website combining nutrition and food buying education for limited resource audiences (LRAs), was revised using social marketing theory to make it more appealing and relevant to LRAs (25-40 years). Focus groups and surveys identified the needs and preferences of LRAs. Needs were cooking, basic health, and budget-friendly nutrition ideas. Preferences were limited text, more videos, graphics, and color. Usability testing of the revised site indicated users perceived the information valuable and the design appealing. By incorporating the needs and preferences of LRAs, SSES is now perceived as appealing as well as relevant

Consumer-Centered Extension Education Website Increases Usage

Concern about young families\u27 ability to cope with rising food prices resulted in creating Spend Smart. Eat Smart (SSES), a website focused on budgetfriendly nutrition information for limited resource audiences (LRA). SSES was redesigned using LRAs needs and preferences to increase use by LRAs. SSES usage increased after it was revised to incorporate interactivity and more consumerfriendly design elements