CONTEXTUAL INFLUENCES ON FAMILY MANAGEMENT OF THE CHALLENGES RELATED TO DOWN SYNDROME

Having a child with Down syndrome (DS), a chromosomal abnormality causing lifelong intellectual disability, is an unexpected event that impacts the entire family. Children with DS and their families face a variety of challenges including cognitive, physical, developmental, and social challenges. It is well established that the social and cultural environment of the family has a critical influence on how families respond to the challenges associated with childhood chronic conditions; this relationship is described in Family Management Style Framework, which provided the theoretical basis for this dissertation. The purpose of this 3 paper dissertation is to explore the impact of the social and cultural context of the family on the family response to DS by comparing the experiences of families from two separate and distinct social and cultural environments: the United States and Ireland. Paper 1 (Chapter 2) is a scoping review of contextual influences on family life with DS which included 50 studies reporting on a contextual influence on the family response to DS. It was determined through this study that relatively few studies (n=4) have been conducted in recent years that are solely focused on examining contextual influences and their relationship to other child and family variables. Paper 2 (Chapter 3) and Paper 3 (Chapter 4) are data-based papers that summarize the key findings of a qualitative secondary analysis of select data from a mixed-methods cross-cultural study of adaptation and resilience in families of individuals with DS. Semi-structured interviews of mothers of children with DS from the US and Ireland were analyzed using directed content analysis based on the Family Management Framework. Contextual influences examined include: social network, healthcare and social service professionals and systems, education professionals and systems, resources, societal views on DS, written materials and internet websites, presence of people with Down syndrome in the community, work, religion/spirituality, recreation and leisure. The main differences between US and Irish mothers found in this analysis were the lack of access to state-provided healthcare and educational services described by Irish mothers, and the resulting financial strain caused by having to pay for expensive private care and services.Doctor of Philosoph

A Nursing Tool to Promote Patient- and Family-Centered Care in Adult Critical Care: The Family Care Assessment

Families of critical care patients experience stress that negatively impacts the family’s well-being and impedes the family’s ability to support the patient (Horn & Tesh, 2000). The patient- and family-centered care (PFCC) model emphasizes the importance of mutually beneficial partnerships among health care providers, patients and families, and one of the core components of PFCC is family participation (Institute for Patient and Family-Centered Care, 2010). Research indicates that involving families in providing care to critically ill patients is an effective way to meet family needs and reduce stress (Al Mutair, Plummer, O’Brien, & Clerehan, 2013). Additionally, evidence suggests that critical care nurses, families of critical care patients, and critical care patients themselves all support family participation in patient care (Garrouste-Orgeas et al, 2010). Critical care nurses are in a unique position to lead interventions to meet family needs by promoting family involvement in care. The Family Care Assessment is a tool that critical care nurses can use to assess the family’s desire to become active participants in patient care. I created this tool after conducting a review of the literature on nursing care of families of critical care patients which revealed a need for specific interventions to facilitate nurses in caring for families. The purpose of the Family Care Assessment is to facilitate a positive and productive relationship between the nurse and family, with the ultimate goal of supporting the family and improving patient care.Bachelor of Scienc

Linking the Urban Environment and Health: An Innovative Methodology for Measuring Individual-Level Environmental Exposures

Environmental exposures (EE) are increasingly recognised as important determinants of health and well-being. Understanding the influences of EE on health is critical for effective policymaking, but better-quality spatial data is needed. This article outlines the theoretical and technical foundations used for the construction of individual-level environmental exposure measurements for the population of a northern English city, Bradford. The work supports ‘Connected Bradford’, an entire population database linking health, education, social care, environmental and other local government data over a period of forty years. We argue that our current understanding of environmental effects on health outcomes is limited both by methodological shortcomings in the quantification of the environment and by a lack of consistency in the measurement of built environment features. To address these shortcomings, we measure the environmental exposure for a series of different domains including air quality, greenspace and greenness, public transport, walkability, traffic, buildings and the built form, street centrality, land-use intensity, and food environments as well as indoor dwelling qualities. We utilise general practitioners’ historical patient information to identify the precise geolocation and duration of a person’s residence. We model a person’s local neighbourhood, and the probable routes to key urban functions aggregated across the city. We outline the specific geospatial procedure used to quantify the environmental exposure for each domain and use the example of exposure to fast-food outlets to illustrate the methodological challenges in the creation of city and nationwide environmental exposure databases. The proposed EE measures will enable critical research into the relationship and causal links between the built environment and health, informing planning and policy-making

A Systematic Review of Studies Describing the Effectiveness, Acceptability, and Potential Harms of Place-Based Interventions to Address Loneliness and Mental Health Problems

Given the links between the built environment and loneliness, there is interest in using place-based approaches (addressing built environment characteristics and related socio-spatial factors) in local communities to tackle loneliness and mental health problems. However, few studies have described the effectiveness, acceptability, or potential harms of such interventions. This review aimed to synthesize the literature describing local community-based interventions that target place-based factors to address loneliness and mental health problems, informing the development of future public health approaches. We searched PsycINFO, Medline, and Embase using a structured search strategy to identify English-language studies evaluating the effectiveness, acceptability, and potential harms of place-based community interventions in addressing loneliness and mental health problems, both in general and clinical populations. Seven studies met the inclusion criteria, classified as evaluating provision of community facilities (such as clubhouses), active engagement in local green spaces, and housing regeneration. None were randomised trials. Quantitative and qualitative findings suggested promising effects and/or acceptability of six interventions, with minimal potential harms. There is a clear need for randomised trials or quasi-experimental studies of place-based interventions to describe their effectiveness in addressing loneliness and mental health problems, as well as complementary qualitative work investigating acceptability. This will inform future policy development

Detection of untreated sewage discharges to watercourses using machine learning

Monitoring and regulating discharges of wastewater pollution in water bodies in England is the duty of the Environment Agency. Identification and reporting of pollution events from wastewater treatment plants is the duty of operators. Nevertheless, in 2018, over 400 sewage pollution incidents in England were reported by the public. We present novel pollution event reporting methodologies to identify likely untreated sewage spills from wastewater treatment plants. Daily effluent flow patterns at two wastewater treatment plants were supplemented by operator-reported incidents of untreated sewage discharges. Using machine learning, known spill events served as training data. The probability of correctly classifying a randomly selected pair of ‘spill’ and ‘no-spill’ effluent patterns was above 96%. Of 7160 days without operator-reported spills, 926 were classified as involving a ‘spill’. The analysis also suggests that both wastewater treatment plants made non-compliant discharges of untreated sewage between 2009 and 2020. This proof-of-principle use of machine learning to detect untreated wastewater discharges can help water companies identify malfunctioning treatment plants and inform agencies of unsatisfactory regulatory oversight. Real-time, open access flow and alarm data and analytical approaches will empower professional and citizen scientific scrutiny of the frequency and impact of untreated wastewater discharges, particularly those unreported by operators

Considerations in relation to off-site emergency procedures and response for nuclear accidents

The operation of nuclear facilities has, fortunately, not led to many accidents with off-site consequences. However, it is well-recognised that should a large release of radioactivity occur, the effects in the surrounding area and population will be significant. These effects can be mitigated by developing emergency preparedness and response plans prior to the operation of the nuclear facility that can be exercised regularly and implemented if an accident occurs. This review paper details the various stages of a nuclear accident and the corresponding aspects of an emergency preparedness plan that are relevant to these stages, both from a UK and international perspective. The paper also details how certain aspects of emergency preparedness have been affected by the accident at Fukushima Dai-ichi and as a point of comparison how emergency management plans were implemented following the accidents at Three Mile Island 2 and Chernobyl. In addition, the UK’s economic costing model for nuclear accidents COCO-2, and the UK’s Level-3 Probabilistic Safety Assessment code “PACE” are introduced. Finally, the factors that affect the economic impact of a nuclear accident, especially from a UK standpoint, are described

Diffusing an Innovation: Clinician Perceptions of Continuous Predictive Analytics Monitoring in Intensive Care

Background The purpose of this article is to describe neonatal intensive care unit clinician perceptions of a continuous predictive analytics technology and how those perceptions influenced clinician adoption. Adopting and integrating new technology into care is notoriously slow and difficult; realizing expected gains remain a challenge. Methods Semistructured interviews from a cross-section of neonatal physicians (n ¼ 14) and nurses (n ¼ 8) from a single U.S. medical center were collected 18 months following the conclusion of the predictive monitoring technology randomized control trial. Following qualitative descriptive analysis, innovation attributes from Diffusion of Innovation Theory-guided thematic development. Results Results suggest that the combination of physical location as well as lack of integration into work flow or methods of using data in care decisionmaking may have delayed clinicians from routinely paying attention to the data. Once data were routinely collected, documented, and reported during patient rounds and patient handoffs, clinicians came to view data as another vital sign. Through clinicians’ observation of senior physicians and nurses, and ongoing dialogue about data trends and patient status, clinicians learned how to integrate these data in care decision making (e.g., differential diagnosis) and came to value the technology as beneficial to care delivery. Discussion The use of newly created predictive technologies that provide early warning of illness may require implementation strategies that acknowledge the risk–benefit of treatment cliniciansmust balance and take advantage of existing clinician trainingmethods

The Development of Whole Sporozoite Vaccines for Plasmodium falciparum Malaria

Each year malaria kills hundreds of thousands of people and infects hundreds of millions of people despite current control measures. An effective malaria vaccine will likely be necessary to aid in malaria eradication. Vaccination using whole sporozoites provides an increased repertoire of immunogens compared to subunit vaccines across at least two life cycle stages of the parasite, the extracellular sporozoite, and intracellular liver stage. Three potential whole sporozoite vaccine approaches are under development and include genetically attenuated parasites, radiation attenuated sporozoites, and wild-type sporozoites administered in combination with chemoprophylaxis. Pre-clinical and clinical studies have demonstrated whole sporozoite vaccine immunogenicity, including humoral and cellular immunity and a range of vaccine efficacy that depends on the pre-exposure of vaccinated individuals. While whole sporozoite vaccines can provide protection against malaria in some cases, more recent studies in malaria-endemic regions demonstrate the need for improvements. Moreover, challenges remain in manufacturing large quantities of sporozoites for vaccine commercialization. A promising solution to the whole sporozoite manufacturing challenge is in vitro culturing methodology, which has been described for several Plasmodium species, including the major disease-causing human malaria parasite, Plasmodium falciparum. Here, we review whole sporozoite vaccine immunogenicity and in vitro culturing platforms for sporozoite production

Figurational Dynamics and Parliamentary Discourses of Living Standards in Ireland

While the concept of living standards remains central to political debate, it has become marginal in sociological research compared to the burgeoning attention given to the topic of consumer culture in recent decades. However, they both concern how one does and should consume, and, indeed, behave at particular times. I use the theories of Norbert Elias to explain the unplanned but structured (ordered) changes in expected standards of living over time. This figurational approach is compared to other alternative explanations, particularly those advanced by Bourdieu, Veblen and Baudrillard. Though these offer some parallels with Elias’s theories, I argue that consumption standards are produced and transformed through the changing dependencies and power relations between social classes. They cannot be reduced to the intentions, interests or ambitions of particular elites, nor to the needs of social systems. Using qualitative data from parliamentary debates in Ireland to trace changing norms and ideals of consumption, as well as historical data to reconstruct shifts in social interdependencies, I further contend that discourses of living standards and luxury are vital aspects of the growing identification and empathy between classes, which in turn encourages greater global integration in the face of emigration and national decline