Elements of care that matter:Perspectives of families with multiple problems

The severe and often persistent problems of families with multiple problems (FMP) call for better understanding of how interventions can improve outcomes in these families. Perspectives of FMP on the crucial elements of interventions may strongly support improvement by providing cues on how to realize positive change. We therefore explored the views of parents and children in FMP regarding helpful and less helpful elements of various interventions. We interviewed 24 parents and 4 children about their perspectives, using a semi-structured interview guide comprising themes that were chosen by the target group. Participants reported 11 elements that contribute to the effectiveness of care, categorized under three main themes: the characteristics of the practitioner, the content of interventions, and the structure of interventions. The perspectives of FMP show the following activities to be promising: routine reflection on the non-judgmental and positive approach of practitioners, more direct focus on children, focus on the underlying cause of behavior, activation of families’ social network, the school and other professionals around the family, and creation of more possibilities for long-term and flexible support. Perspectives of FMP on the content and provision of care should be better embedded in interventions. This may help to tailor interventions to their wishes and needs, which in turn can contribute to more positive outcomes of care

Using delta channel width to estimate paleodischarge in the rock record: geometric scaling and practical sampling criteria

Quantifying paleodischarge from geological field observations remains a key research challenge. Several scaling relationships between paleodischarge and channel morphology (width; depth) have been developed for rivers and river deltas. Previous paleodischarge scaling relationships were based on discharge-catchment area scaling and an empirical flow velocity estimate (e.g. Chézy, Manning formulae) multiplied by channel cross-sectional area to derive discharge. In deltas, where marine (wave, tide) energy causes bidirectional flow within distributary channels, the available paleodischarge scaling relationships are not applicable due to their unidirectional flow assumption. Here, the spatial variability of distributary channel widths from a database of 114 global modern river deltas is assessed to understand the limit of marine influence on distributary channel widths. Using 6213 distributary channel width measurements, the median channel widths of distributary channels for each delta were correlated with bankfull discharge for river-, tide- and wave-dominated deltas, the latter two including the effect of bidirectional flow. Statistically significant width-discharge scaling relationships are derived for river- and wave-dominated deltas, with no significant relationships identified for tide-dominated deltas. By reverse bootstrapping the channel widths measured from modern deltas, the minimum number of width measurements needed to apply width-discharge scaling relationships to ancient deltaic deposits is estimated as 3 and 4 for the upstream parts of river- and wave-dominated deltas, respectively, increasing to 30 in the downstream parts of river-dominated deltas. These estimates will guide sedimentological studies that often have limited numbers of distributary channel widths exposed in the rock record. To test the reliability of these alternative width-discharge scaling relationships in the rock record, paleodischarges were estimated for the well-studied Cretaceous lower Mesa Rica Sandstone Formation, USA . Comparison of these results with the more complex Chézy-derived method suggests that these new scaling relationships are accurate. Hence, it is proposed that the scaling relationships obtained from modern deltas can be applied to the rock record, requiring fewer, and easier to measure, data inputs than previously published methods

Adsorption and two-body recombination of atomic hydrogen on 3^3He-4^4He mixture films

We present the first systematic measurement of the binding energy $E_a$ of hydrogen atoms to the surface of saturated $^3$He-$^4$He mixture films. $E_a$ is found to decrease almost linearly from 1.14(1) K down to 0.39(1) K, when the population of the ground surface state of $^3$He grows from zero to $6\times10^{14}$ cm$^{-2}$, yielding the value $1.2(1)\times 10^{-15}$ K cm$^2$ for the mean-field parameter of H-$^3$He interaction in 2D. The experiments were carried out with overall $^3$He concentrations ranging from 0.1 ppm to 5 % as well as with commercial and isotopically purified $^4$He at temperatures 70...400 mK. Measuring by ESR the rate constants $K_{aa}$ and $K_{ab}$ for second-order recombination of hydrogen atoms in hyperfine states $a$ and $b$ we find the ratio $K_{ab}/K_{aa}$ to be independent of the $^3$He content and to grow with temperature.Comment: 4 pages, 4 figures, all zipped in a sigle file. Submitted to Phys. Rev. Let

Content and Quality of Motor Initiatives in the Support of People With Profound Intellectual and Multiple Disabilities

Motor activation is rarely integrated into the support of people with profound intellectual and multiple disabilities (PIMD), which might be the result of the limited evidence‐based knowledge in this field. Practitioners have recently been developing several motor initiatives for people with PIMD, but it remains unclear about what core elements the motor initiatives actually consist of and to what level of quality it is implemented in practice. This study aims to offer an overview and analysis of the content and quality of motor initiatives actually in use for people with PIMD. Motor initiatives were explored by asking practitioners to complete an online inventory form. Documents, expert knowledge, and observations were used to collect data about the characteristics of the motor initiatives. The quality of the motor initiatives which met our eligibility criteria, was analyzed on the basis of the level of evidence for their effectiveness. The inventory yielded 118 motor initiatives of which 17 met the eligibility criteria. We identified four motor initiatives reflecting an approach to motorically activate people with PIMD within various activities, three including power‐assisted exercises, three with aquatic exercises, two frameworks which integrated motor activities into their daily programs, two methods which included small‐scale activities, two rhythmic movement therapies, and one program including gross motor activities. We found limited indications for descriptive evidence from 17 initiatives, limited or no indications for theoretical evidence from 12 and five initiatives respectively, and none of the initiatives provided a causal level of evidence for effectiveness. A wide variety of motor initiatives is used in current practice to activate persons with PIMD, although their effectiveness is actually unproven. Science and practice should cooperate to develop an evidence‐based understanding to ensure more evidence‐based support for the motor activation of people with PIMD in the future

Exploring what works in art therapy with children with autism:Tacit knowledge of art therapists

Children with Autism Spectrum Disorders (ASD) are often referred to art therapy. To investigate what works in art therapy with these children 'tacit knowledge' of eight well experienced art therapists was explored. Promising components were arranged into the Context and Outcomes of Art Therapy (COAT) model. According to the respondents art therapy contributes with children with ASD to become more flexible and expressive, more relaxed, and more easy talking about their problems in the therapeutic setting as well as in their home situation. Considering the type of evidence in this study, further empirical research into the process and outcomes of art therapy with ASD children is strongly recommended

First evaluation of the Youth Act.:After the transition comes the transformation

Background Rates of colonization and infection with multidrug-resistant (MDR) bacteria are increasing worldwide, in both acute care hospitals and long-term care facilities (LTCFs). Italy has one of the highest prevalence of MDR bacteria in European countries, especially with regard to methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase (ESBL) or carbapenemase producing Enterobacteriaceae (CPE). Method Review of studies on colonization by MDR bacteria from Italian LTCFs, risk factors for colonization and molecular characteristics of surveillance and clinical isolates, compared with other European countries. Results High variability of MDR colonization has been reported within and especially between European countries. Only a few surveillance studies have been performed in Italian LTCFs; these show MRSA colonization prevalence of 7.8–38.7 % for residents and 5.2–7.0 % for staff members, ESBL prevalence of 49.0–64.0 % for residents and 5.2–14.5 % for staff and prevalence of CPE of 1.0–6.3 % for residents and 0.0–1.5 % for staff. In Italian LTCFs, as well as in other European countries, the most prevalent ESBLs from surveillance or clinical Escherichia coli isolates were found to be CTX-M-type enzymes, particularly CTX-M-15, expressed by the pandemic ST131 clonal group; this lineage also expresses carbapenemase genes of the bla VIM and bla KPC types. Various risk factors for colonization of residents by MDR bacteria were identified. Conclusions The limited data from Italian LTCFs confirms these settings as important reservoirs for MDR organisms, allowing important considerations regarding the infection risk by these organisms. Nevertheless, more extended and countrywide screening studies for MDR colonization in Italian LTCFs are required. To promote further studies of various microbiological aspects related to LTCFs, the Association of Italian Clinical Microbiologists (Associazione Microbiologi Clinici Italiani; AMCLI) in 2016 has set up a new Working Group for the Study of Infections in LTCFs (Gruppo di Lavoro per lo Studio delle Infezioni nelle Residenze Sanitarie Assistite e Strutture Territoriali assimilabili; GLISTer), consisting of Clinical Microbiologists represented by the authors of this review article