A novel computerized test for detecting and monitoring visual attentional deficits and delirium in the ICU

Objectives: Delirium in the ICU is associated with poor outcomes but is under-detected. Here we evaluated performance of a novel, graded test for objectively detecting inattention in delirium, implemented on a custom-built computerized device (Edinburgh Delirium Test Box–ICU). Design: A pilot study was conducted, followed by a prospective case-control study. Setting: Royal Infirmary of Edinburgh General ICU. Patients: A pilot study was conducted in an opportunistic sample of 20 patients. This was followed by a validation study in 30 selected patients with and without delirium (median age, 63 yr; range, 23–84) who were assessed with the Edinburgh Delirium Test Box–ICU on up to 5 separate days. Presence of delirium was assessed using the Confusion Assessment Method for the ICU. Measurements and Main Results: The Edinburgh Delirium Test Box–ICU involves a behavioral assessment and a computerized test of attention, requiring patients to count slowly presented lights. Thirty patients were assessed a total of 79 times (n = 31, 23, 15, 8, and 2 for subsequent assessments; 38% delirious). Edinburgh Delirium Test Box–ICU scores (range, 0–11) were lower for patients with delirium than those without at the first (median, 0 vs 9.5), second (median, 3.5 vs 9), and third (median, 0 vs 10.5) assessments (all p < 0.001). An Edinburgh Delirium Test Box–ICU score less than or equal to 5 was 100% sensitive and 92% specific to delirium across assessments. Longitudinally, participants’ Edinburgh Delirium Test Box–ICU performance was associated with delirium status. Conclusions: These findings suggest that the Edinburgh Delirium Test Box–ICU has diagnostic utility in detecting ICU delirium in patients with Richmond Agitation and Sedation Scale Score greater than –3. The Edinburgh Delirium Test Box–ICU has potential additional value in longitudinally tracking attentional deficits because it provides a range of scores and is sensitive to change

'If I do well I feel on top of the world' : investigating the impact of psychology students' academic achievement on self-esteem

Academic achievement can be thought of as the extent to which learning has been accomplished. Previous work suggests that students' self-esteem is impacted by academic achievement, though it is not entirely clear why this is. The current study therefore explored this through interviewing eight students from a Scottish university, before using Braun & Clarke's (2006) six stage reflexive thematic analysis to analyse the resultant data. Two themes of Grades and feedback and Peer comparison were identified, highlighting two important conclusions. Firstly, self-esteem is positively impacted by strong performance, and negatively impacted by poor performance but that crucially, this is mediated by others' poor performance. That is to say, good grades and feedback make students feel good, and poor grades and feedback make students feel bad, but such 'badness' is appeased if peers perform equally poorly, which has potential consequences for peer relationships. Secondly, students value feedback in order to increase their chances of academic achievement, noting the negative impact on self-esteem when feedback is not constructive, just critical. This highlights the importance of 'mindful marking' in terms of taking care to provide useful feedback to students to improve their work; something that is reported to be hugely appreciated. Implications, limitations and future research suggestions are detailed

"I just stay in the house so I don’t need to explain" : a qualitative investigation of persons with invisible disabilities

Research has shown that persons with disabilities continually face discrimination. More research attention has focused on individuals’ experiences of visible disability, despite evidence that there are higher numbers worldwide of people with invisible disabilities. As such, persons with invisible disabilities can feel underrepresented in disability literature. A qualitative study was conducted to address this. Twenty-five persons with an invisible disability were recruited to take part in focus groups and interviews aimed at understanding the lived experience of invisible disability on social life and within the workplace. Data was analyzed using Braun & Clarke’s reflexive thematic analysis [1], identifying themes of (1) Incongruity between looking and feeling, (2) The impact of others, (3), Adaptation, (4) Talking about disability, (5) (Un)supported and (un)accepted, and (6) Discrimination/ legislation. The findings indicate that the language, attitudes and behaviour of others are important to support inclusion in the social and working lives of those with invisible disabilities. Persons without a disability should be willing to talk about disability, see the strengths of those with an invisible disability and be mindful of language used around visibility. Suggestions relating to what we can do to be better support those with an invisible disability in society are discussed

Up-scaling, formative phases, and learning in the historical diffusion of energy technologies

The 20th century has witnessed wholesale transformation in the energy system marked by the pervasive diffusion of both energy supply and end-use technologies. Just as whole industries have grown, so too have unit sizes or capacities. Analysed in combination, these unit level and industry level growth patterns reveal some consistencies across very different energy technologies. First, the up-scaling or increase in unit size of an energy technology comes after an often prolonged period of experimentation with many smaller-scale units. Second, the peak growth phase of an industry can lag these increases in unit size by up to 20 years. Third, the rate and timing of up-scaling at the unit level is subject to countervailing influences of scale economies and heterogeneous market demand. These observed patterns have important implications for experience curve analyses based on time series data covering the up-scaling phases of energy technologies, as these are likely to conflate industry level learning effects with unit level scale effects. The historical diffusion of energy technologies also suggests that low carbon technology policies pushing for significant jumps in unit size before a ‘formative phase’ of experimentation with smaller-scale units are risky

Provision of foot health services for people with rheumatoid arthritis in New South Wales: a web-based survey of local podiatrists

Background: It is unclear if podiatric foot care for people with rheumatoid arthritis (RA) in New South Wales (NSW) meets current clinical recommendations. The objective of this study was to survey podiatrists' perceptions of the nature of podiatric foot care provision for people who have RA in NSW.Methods: An anonymous, cross-sectional survey with a web-based questionnaire was conducted. The survey questionnaire was developed according to clinical experience and current foot care recommendations. State registered podiatrists practising in the state of NSW were invited to participate. The survey link was distributed initially via email to members of the Australian Podiatry Association (NSW), and distributed further through snowballing techniques using professional networks. Data was analysed to assess significant associations between adherence to clinical practice guidelines, and private/public podiatry practices.Results: 86 podiatrists participated in the survey (78% from private practice, 22% from public practice). Respondents largely did not adhere to formal guidelines to manage their patients (88%). Only one respondent offered a dedicated service for patients with RA. Respondents indicated that the primary mode of accessing podiatry was by self-referral (68%). Significant variation was observed regarding access to disease and foot specific assessments and treatment strategies. Assessment methods such as administration of patient reported outcome measures, vascular and neurological assessments were not conducted by all respondents. Similarly, routine foot care strategies such as prescription of foot orthoses, foot health advice and footwear were not employed by all respondents.Conclusions: The results identified issues in foot care provision which should be explored through further research. Foot care provision in NSW does not appear to meet the current recommended standards for the management of foot problems in people who have RA. Improvements to foot care could be undertaken in terms of providing better access to examination techniques and treatment strategies that are recommended by evidence based treatment paradigms. © 2013 Hendry et al.; licensee BioMed Central Ltd

The strong emergence of molecular structure

One of the most plausible and widely discussed examples of strong emergence is molecular structure. The only detailed account of it, which has been very influential, is due to Robin Hendry and is formulated in terms of downward causation. This paper explains Hendry’s account of the strong emergence of molecular structure and argues that it is coherent only if one assumes a diachronic reflexive notion of downward causation. However, in the context of this notion of downward causation, the strong emergence of molecular structure faces three challenges that have not been met and which have so far remained unnoticed. First, the putative empirical evidence presented for the strong emergence of molecular structure equally undermines supervenience, which is one of the main tenets of strong emergence. Secondly, it is ambiguous how the assumption of determinate nuclear positions is invoked for the support of strong emergence, as the role of this assumption in Hendry’s argument can be interpreted in more than one way. Lastly, there are understandings of causation which render the postulation of a downward causal relation between a molecule’s structure and its quantum mechanical entities, untenable

Investigating the challenges of teaching sex education to autistic learners : a qualitative exploration of teachers' experiences

Background Sex education is essential as it equips individuals with the knowledge to live independent and safe sex lives. However, in the United Kingdom, sex education is not particularly accessible for autistic learners which may lead to a lack of knowledge around appropriate sexual behaviours. Aims The current study focusses on the challenges of teaching sex education to autistic learners. Methods and procedures The data was produced through one-to-one interviews with thirteen educational practitioners that have experienced delivering sex education to autistic learners. Outcomes and results Reflexive thematic analysis (Braun & Clarke, 2006) was used to interpret the data, producing themes of (1) Pedagogical Restrictions, and (2) Sexual Impulses. Conclusions and implications These findings demonstrated that the main challenges of teaching sex education to autistic learners pertained to Pedagogical Restrictions in the classroom, and learners’ own sexual impulses. These findings are a positive step towards understanding how to adapt sex education lessons to make them more inclusive and accessible for learners with autism. This study contributes to developing understanding around how to support autistic learners, highlighting gaps in the current sex education curriculum for policy makers, and enabling those surrounding autistic individuals to best support them with body transformations