Saturn S-2 quality assurance techniques: Nondestructive testing processes. Volume 1: Requirements and procedures

The methods and procedures used to perform nondestructive testing inspections of the Saturn S-2 liquid hydrogen and liquid oxygen tank weldments during fabrication and after proof testing are described to document special skills developed during the program. All post-test inspection requirements are outlined including radiographic inspections procedures

Personalising psychotherapies for depression using a novel mixed methods approach: An example from Morita Therapy

This is the final version. Available on open access from BMC via the DOI in this recordBackground Current quantitative methods for personalising psychotherapies for depression are unlikely to be able to inform clinical decision-making for hundreds of years. Novel alternative methods to generate hypotheses for prospective testing are therefore required, and we showcase mixed methods as one such approach. By exploring patients’ perspectives in-depth, and integrating qualitative and quantitative data at the level of the individual, we may identify new potential psychosocial predictors of psychotherapy outcomes, potentially informing the personalisation of depression treatment in a shorter timeframe. Using Morita Therapy (a Japanese psychotherapy) as an exemplar, we thus explored how Morita Therapy recipients’ views on treatment acceptability explain their adherence and response to treatment. Methods The Morita Trial incorporated a pilot randomised controlled trial of Morita Therapy versus treatment as usual for depression, and post-treatment qualitative interviews. We recruited trial participants from General Practice record searches in Devon, UK, and purposively sampled data from 16 participants for our mixed methods analysis. We developed typologies of participants’ views from our qualitative themes, and integrated these with quantitative data on number of sessions attended and whether participants responded to treatment in a joint typologies and statistics display. We enriched our analysis using participant vignettes to demonstrate each typology. Results We demonstrate that (1) participants who could identify with the principles of Morita Therapy typically responded to treatment, regardless of how many sessions they attended, whilst those whose orientation towards treatment was incompatible with Morita Therapy did not respond to treatment, again regardless of treatment adherence; (2) participants whose personal circumstances impeded their opportunity to engage in Morita Therapy attended the fewest sessions, though still benefitted from treatment if the principles resonated with them. Conclusions We identified new potential relationships between ‘orientation’ and outcomes, and ‘opportunity’ and adherence, which could not have been identified using existing non-integrative methods. This mixed methods approach warrants replication in future trials and with other psychotherapies to generate hypotheses, based on typologies (or profiles) of patients for whom a treatment is more or less likely to be suitable, to be tested in prospective trials.National Institute for Health Research (NIHR)University of Exete

Recognition and Belonging: Engaging First Generation Students

This paper is based on a reflective journey taken by project members which offers insight into the unique challenges that first generation students face and considers the institutional responses needed to enhance their engagement and experience. The student as academic partner’s project was developed to further explore issues of recognition, belonging and engagement for first generation students - who are the first in their families to attend higher education. Whilst this group of students should be celebrated as pioneers of higher education they are more likely than their counterparts to drop out of their studies or have a difficult transition to higher education because they lack the required social capital. In the face of widening participation and increasing access to university for students from diverse backgrounds the paper will consider the tension between the need for students to adapt in order to fit the university and the university’s need to adapt in order to fit the students. We will highlight small developments that can have the largest impact on both the university and the student population. Through this research, we believe that being a first generation student is not a barrier but a real and ongoing achievement

Patients’ and nurses’ experiences of fundamental nursing care: a systematic review and qualitative synthesis

This is the final version. Available on open access from Wiley via the DOI in this recordAims and objectives To systematically identify, appraise and synthesise patients’, residents’, and nurses’ experiences of fundamental nursing care for nutrition, elimination, mobility, and hygiene. Background The evidence base for effective nursing behaviours to assist people with their fundamental care needs is sparse, hampering the development of effective interventions. Synthesising data on patients’ and nurses’ experiences of fundamentals of nursing care could contribute to the development of such an intervention. Methods Systematic review and synthesis of qualitative data from qualitative studies on patients’ and nurses’ experiences of fundamental nursing care behaviours addressing peoples’ nutrition, elimination, mobility, and hygiene needs. We appraised study quality and relevance and used a narrative approach to data synthesis, fulfilling PRISMA criteria (Supplementary file 1). Results We identified 22,374 papers, 47 met our inclusion criteria. Most papers were of low quality. Sixteen papers met our quality and relevance criteria and were included for synthesis. Papers were about nutrition (2) elimination (2), mobility (5), hygiene (5) and multiple care areas (2). We found nurses and patients report that fundamental nursing care practices involve strong leadership, collaborative 2 partnerships with patients and cohesive organisational practices aligned to nursing care objectives and actions. Conclusions. To improve fundamental care and interventions suitable for testing may require attention to leadership, patient-nurse relationships and organisational coherence plus the fundamentals of care nursing interventions themselves. Relevance to clinical practice. More rigorous mixed methods research about fundamental nursing care is needed to inform nursing practice and improve patient’s experience. Nursing interventions should include effective nurse leadership and nurse patient collaboration and a focus on fundamental care by the host organisation

What is Morita Therapy? The Nature, Origins, and Cross-cultural Application of a Unique Japanese Psychotherapy

This is the final version. Available on open access from Springer via the DOI in this recordMorita Therapy is a Japanese psychotherapy which contrasts with established Western approaches in teaching, through behavioural experience, that symptoms are part of the natural ecology of human experience. Morita Therapy has received increasing international interest over the decades, and the first randomized controlled trial of Morita Therapy to be published outside of China has recently demonstrated the promise of the approach in treating Western patients. To respond to the resulting interest in Morita Therapy from patients and practitioners, and facilitate further Morita Therapy research, it is necessary to provide the detailed explanation of Morita Therapy which is currently rare in the West. In this article, we fill this gap with a thorough description of Morita Therapy in terms of the key principles, objectives and processes of the approach; its basis in Eastern philosophy and naturalism; its sociohistorical context and development over a wide range of formats, patient conditions, and countries. To enable Western practitioners to appreciate and capitalize on the potential value of Morita Therapy as a distinct alternative for patients, we illustrate the approach’s unique method and objective compared to Western psychotherapies, and provide recommendations for practitioners applying Morita Therapy across cultures.University of Exete

Evolution of mammalian social structure

Social groups may be viewed as collections of individuals exhibiting nonindependent behavior and organized in a cooperative manner. The evolutionary advantage of social behavior to individuals must be measured in its relativity to other potential behaviors, the scale of competitive interactions, and under a variety of environmental and genetic constraints. A primary tenet of social evolution is that coancestry will promote the genes of related individuals. High values of coancestry, however, do not necessarily translate into evolutionary advantage unless the primary competitive interactions occur among the groups. Coancestry is affected by the breeding tactics within and rates of genetic exchange among social groups. Low rates of exchange among groups, regardless of breeding tactics, may result in high values for intragroup coancestry but may lead to inbreeding depression in progeny. Likewise, breeding tactics such as polygyny, may not impart any long-lasting evolutionary advantage if genetic exchange rates are high. The evolution of social organizations typified by different breeding and migration strategies is evaluated to determine the conditions necessary for various tactics to result in genetic contributions by individuals equal to those of monogamous mating systems. The models show that breeding and dispersal tactics have probably evolved in concert and predict that social groups which are characterized by strong gene correlations are likely to exhibit relatively low group advantage for progeny survival and breeding. There is little impetus for high gene correlations to accrue in situations where group advantage is very high relative to monogamous systems

Adherence to Recommended Risk Management among Unaffected Women with a BRCA Mutation

Identifying unaffected women with a BRCA mutation can have a significant individual and population health impact on morbidity and mortality if these women adhere to guidelines for managing cancer risk. But, little is known about whether such women are adherent to current guidelines. We conducted telephone surveys of 97 unaffected BRCA mutation carriers who had genetic counseling at least one year prior to the survey to assess adherence to current guidelines, factors associated with adherence, and common reasons for performing and not performing recommended risk management. More than half of participants reported being adherent with current risk management recommendations for breast cancer (69%, n=67), ovarian cancer (82%, n=74) and both cancers (66%, n=64). Older age (OR=10.53, p=0.001), white race (OR=8.93, p=0.019), higher breast cancer genetics knowledge (OR=1.67, p=0.030), higher cancer-specific distress (OR=1.07, p=0.002) and higher physical functioning (OR=1.09, p=0.009) were significantly associated with adherence to recommended risk management for both cancers. Responses to open-ended questions about reasons for performing and not performing risk management behaviors indicated that participants recognized the clinical utility of these behaviors. Younger individuals and those with lower physical functioning may require targeted interventions to improve adherence, perhaps in the setting of long-term follow-up at a multi-disciplinary hereditary cancer clinic

How and why community hospital clinicians document a positive screen for intimate partner violence: a cross-sectional study

BACKGROUND: This two-part study examines primary care clinicians' chart documentation and attitudes when confronted by a positive waiting room screen for intimate partner violence (IPV). METHODS: Patients at community hospital-affiliated health centers completed a screening questionnaire in waiting rooms that primary care providers (PCPs) were subsequently given at the time of the visit. We first reviewed the medical records of patients who screened positive for IPV, evaluating the presence and quality of documentation. Next we administered a survey to PCPs that measured their knowledge, attitudes and practice regarding IPV. RESULTS: Seventy-two percent of charts contained some documentation of IPV, however only 10% contained both a referral and safety plan. PCPs were more likely to refer patients (p < .05) who screened positively for mood or anxiety disorders, disclosed that they feared for their safety or were economically disadvantaged. Those that feared for their safety or endorsed mood or anxiety disorders were more likely to have notation of a safety plan in their records. When surveyed, 81.6% of clinicians strongly agreed that it is their role to inquire about IPV, but only 68% expressed confidence in their ability to manage it. In contrast, 93% expressed confidence in managing depression. Sixty-seven percent identified time constraints as a barrier to care. Predictors of PCP confidence in treating patients who have experienced IPV (p < .05) included hours of recent training and clinical experience with IPV. CONCLUSION: Mandatory waiting room screening for IPV does not result in high levels of referral or safety planning by PCPs. Despite the implementation of a screening process, clinicians lack confidence and time to address IPV in their patient populations suggesting that alternative methods of training and supporting PCPs need to be developed

The training needs of Turkish emergency department personnel regarding intimate partner violence

<p>Abstract</p> <p>Background</p> <p>Violence against females is a widespread public health problem in Turkey and the lifetime prevalence of IPV ranges between 34 and 58.7%. Health care workers (HCW) sometimes have the unique opportunity and obligation to identify, treat, and educate females who are abused. The objective of this study was to evaluate the knowledge, attitudes, and experiences of the emergency department (ED) staff regarding intimate partner violence (IPV) at a large university hospital in Turkey.</p> <p>Methods</p> <p>A cross-sectional study was conducted in a large university hospital via questionnaire. The study population consisted of all the nurses and physicians who worked in the ED during a two month period (n = 215). The questionnaire response rate was 80.5% (41 nurses and 132 physicians). The main domains of the questionnaire were knowledge regarding the definition of IPV, clinical findings in victims of IPV, legal aspects of IPV, attitudes towards IPV, knowledge about the characteristics of IPV victims and abusers, and professional and personal experiences and training with respect to IPV.</p> <p>Results</p> <p>One-half of the study group were females, 76.3% were physicians, and 89.8% had no training on IPV. The majority of the nurses (89.5%) and physicians (71.1%) declared that they were aware of the clinical appearance of IPV. The mean of the knowledge scores on clinical knowledge were 8.84 ± 1.73 (range, 0–10) for acute conditions, and 4.51 ± 3.32 for chronic conditions. The mean of the knowledge score on legal procedures and the legal rights of the victims was 4.33 ± 1.66 (range, 0–7). At least one reason to justify physical violence was accepted by 69.0% of females and 84.7% of males, but more males than females tended to justify violence (chi square = 5.96; p = 0.015). However, both genders accepted that females who experienced physical violence should seek professional medical help.</p> <p>Conclusion</p> <p>The study participants' knowledge about IPV was rather low and a training program is thus necessary on this issue. Attention must be given to the legal aspects and clinical manifestations of IPV. The training program should also include a module on gender roles in order to improve the attitudes towards IPV.</p