Lessons from mixing OR methods in practice : using DES and SD to explore a radiotherapy treatment planning process

Mixing Operational Research (OR) methods is becoming more commonplace. Discrete-Event Simulation (DES) and System Dynamics (SD) are popular modelling methods previously applied to a range of situations for various purposes, which are starting to be mixed in healthcare. However, the practicalities of mixing DES and SD in practice remain unclear. Radiotherapy treatment is a complex multi-stage process where technology and best practice continue to evolve. This paper describes a project undertaken to explore the treatment planning process using mixed OR methods. It presents insights obtained through mixing OR methods within a real world project. The model development process, the role of each modelling method, and the benefits of undertaking a mixed OR methods project design are described. Lessons for mixing DES and SD, and more generally mixing OR methods, are discussed

Understanding the structural basis of corneal refractive function and its modification via novel therapeutic approaches

The studies comprising this thesis were conducted to further understand how structural changes to the corneal extracellular matrix can affect the cornea’s unique properties, with the ultimate goal of improving novel treatments and their outcomes. Following refractive surgery, changes in matrix structure can cause loss of structural integrity and transparency, which may adversely affect the surgical outcome. The first objective was to define what governs corneal shape and ultrastructural organisation by analysing the abnormal post-hatch corneal collagen arrangement in an avian model (beg). Structural information was also obtained post-in vivo microwave keratoplasty to assess the treatment as a suitable alternative to more invasive correction procedures. In addition, modifying the resident cell type as a means of improving post-treatment wound healing following LASIK was also investigated using corneal stromal stem cells. Finally, the efficiency of transepithelial riboflavin/UVA collagen cross-linking in terms of riboflavin uptake and post-treatment corneal stiffness, was evaluated. X-ray scattering studies revealed that corneal flattening in beg chickens is related to biomechanical changes brought about by an alteration in collagen arrangement at the corneal periphery. This highlights the importance of the limbal fibril annulus in corneal shape preservation. X-ray studies also revealed that microwave keratoplasty may impact on peripheral vision by introducing spatial disruption of stromal collagen, resulting in localised corneal opacity in the treatment area. Loss of fibrillar structure and order could also have further implications for corneal biomechanics and shape. The application of human corneal stromal stem cells under LASIK-like flaps was revealed to be a promising approach for increasing flap adherence strength whilst maintaining corneal clarity. Introducing these cells in the early stages of flap-healing appears to improve the repair process, conceivably through an embryonic-like mechanism. Lastly, stress-strain and riboflavin uptake results for transepithelial riboflavin delivery during corneal cross-linking were encouraging, however refinements to the testing procedure are required to fully assess the treatment efficacy. Collectively these findings accentuate the importance of the precise stromal collagen fibril arrangement and composition for maintaining corneal transparency, shape and general functionality. All these factors must be taken into consideration when implementing novel correction procedures or modifying existing treatments for corneal defects

THE SYRIAN REFUGEES’ NEED FOR TRAUMA-BASED SERVICES, A SURVEY OF MENTAL HEALTH PROFESSIONALS

Background: Trauma Aid UK (previously HAP UK &Ireland) conducted three EMDR trainings in Turkey: the first was in Istanbul on 28th November 2013. Aim: The purpose of this study is to assess the needs of the Syrian Refugees for trauma services training and provision as assesses by mental health professionals who work with them. Subjects and methods: Amongst the 62 participants of two Istanbul EMDR trainings organised by HAP, 53% were Syrian. We felt it is a unique opportunity to assess the needs of Syrian refugees they are working with. We asked all the participants who are all mental health professionals to complete an Arabic translation of \u27The Need for Trauma-based Services Questionnaire\u27 in these trainings. The rest of the participants on the course were from Iraq (18%), Jordan (16%), Egypt (7%) and others from Palestine, Sudan & Libya (6%). All participants completed questionnaires. Results: The results of comparing the needs reported by Syrian mental health professionals showed higher prevalence of PTSD seen by the Syrian mental health professionals (72% compared with 56% in the clients seen by the rest of participants). Also, the Syrian mental health professionals could only meet 34% (SD=17.1) of the needs of their client who suffer from PTSD. The unmet need for trauma therapy was reported as 100% by these professionals. Conclusions: This study highlighted the high need for trauma mental health services of the Syrian refugees as reported by mental health professionals working in the neighbouring countries. The needs of the Syrian refugees, arriving to the UK because of the very difficult situations, these refugees are coming from, may be met with EMDR therapy. EMDR can be used to help these refugees to be a productive part of the British society

Adrodd ar dlodi: naratif y cyfryngau newyddion a chyfathrebiadau’r trydydd sector yng Nghymru

Mae’r llyfr hwn yn archwilio darllediadau newyddion cyfoes am dlodi yng Nghymru yn systematig, gan edrych ar arferion a chynnwys newyddiaduraeth yn Saesneg ac yn Gymraeg. Mae’r llyfr hwn yn archwilio’n feirniadol y berthynas rhwng newyddiaduraeth a’r trydydd sector o ran adrodd ar dlodi, gan amlygu sut mae gwaith cyfathrebu elusennau yn chwarae rôl allweddol wrth adrodd am yr hyn sy’n cynrychioli profiadau pob dydd o dlodi ar draws Cymru ond sy’n aml yn cael ei ‘guddio’

THE NEED FOR TRAUMA THERAPY FOR VICTIMS OF MAN-MADE TRAUMA COMPARED TO THOSE OF NATURAL DISASTER, A SURVEY OF HEALTH PROFESSIONALS

Trauma Aid UK (previously HAP UK & Ireland) conducted three EMDR trainings in Turkey: the first was in Istanbul on 28th November 2013. Since then, 3 groups of mental health trainees attending part 1 of 3 parts EMDR training. In total, 86 clinicians were trained. Also, in June 2016, the first part of a three-part EMDR training in Nepal was completed following the Nepal Earthquake in 2015. The purpose of this study is to assess, analyse and understand the needs of Syrian refugees, who have being experiencing man made trauma since 2011, with Nepalese people who were exposed to the earthquake on 25/4/2015, in their needs for trauma services, training and provision as assessed by mental health professionals working with both groups of people

THE NEED FOR TRAUMA THERAPY FOR VICTIMS OF MAN-MADE TRAUMA COMPARED TO THOSE OF NATURAL DISASTER, A SURVEY OF HEALTH PROFESSIONALS

Trauma Aid UK (previously HAP UK & Ireland) conducted three EMDR trainings in Turkey: the first was in Istanbul on 28th November 2013. Since then, 3 groups of mental health trainees attending part 1 of 3 parts EMDR training. In total, 86 clinicians were trained. Also, in June 2016, the first part of a three-part EMDR training in Nepal was completed following the Nepal Earthquake in 2015. The purpose of this study is to assess, analyse and understand the needs of Syrian refugees, who have being experiencing man made trauma since 2011, with Nepalese people who were exposed to the earthquake on 25/4/2015, in their needs for trauma services, training and provision as assessed by mental health professionals working with both groups of people

DEVELOPMENT OF EMDR IN BOSNIA AND HERZEGOVINA - FROM AN IDEA TO THE FIRST EMDR CONFERENCE

Introduction: The needs for EMDR (eye movement desensitization and reprocessing) treatment of Bosnia-Herzegovina (BH) citizens, affected by 1992–1995 war, increased. The Trauma Aid UK (former Humanitarian Assistance Programs UK & Ireland) works in partnership with mental health professionals in BH. Aim: We aim to build an environment in which qualified and experienced professionals trained in EMDR may establish and sustain complete EMDR education and to keep international standards of EMDR practice. Method: Authors described the history of idea and its realization of EMDR education considering all needed phases that were provided from the Trauma Aid UK with non profit, humanitarian approach in sharing skills of EMDR to mental health therapists in BH. Results: The trainers from Trauma Aid UK completed five EMDR trainings in Bosnia-Herzegovina for recruited trainees from different cities and entities in BH. For continual professional development (CPD) all of these mental health professionals need to be active participants in professional and scientific meetings. Though, Association of Bosnia and Herzegovina EMDR Therapists, member of EMDR Europe, organized the First EMDR conference in Bosnia-Herzegovina sponsored by Trauma Aid UK under the patronage of EMDR Association of UK & Ireland. Conclusion: Five training of Bosnia-Herzegovina mental health workers to effectively use EMDR with enthusiastic help of EMDR trainers from Trauma Aid UK resulted with European accredited EMDR practitioners, one European accredited EMDR consultant and the first EMDR conference in BH. This will keep national development of psychotherapy capacities in post-war BH