New roles for nurses as approved mental health professionals in England and Wales

This paper critically discusses the challenges mental health nurses face in trying to achieve a balance between fulfilling biomedical and social roles. We suggest that dilemmas exist for nurses in attempting to combine both approaches in their practice. We present a specific example of these as occasioned by the advent of the approved mental health professional role in England and Wales. This statutory role requires the adoption of an independent social perspective as a counterbalance to the biomedical perspective brought by psychiatrists. Using the idea of occupational jurisdictions we discuss how nurses embarking on this new role are effectively crossing into territories previously occupied by the profession of social work. We also reveal the tensions for nurses who fulfil the approved mental health professional role whilst simultaneously carrying out work in other areas which demands a more overtly biomedical approach. We review critical accounts of the validity of bio-psycho-social models and concerns about maintaining positive therapeutic alliances alongside making applications for compulsory detention, assessment and treatment. We argue that the new role may become part of the professional project of mental health nursing, but also present challenges in helping redefine nursing's identity and practice

Comparing Building and Neighborhood-Scale Variability of CO₂ and O₃ to Inform Deployment Considerations for Low-Cost Sensor System Use.

The increased use of low-cost air quality sensor systems, particularly by communities, calls for the further development of best-practices to ensure these systems collect usable data. One area identified as requiring more attention is that of deployment logistics, that is, how to select deployment sites and how to strategically place sensors at these sites. Given that sensors are often placed at homes and businesses, ideal placement is not always possible. Considerations such as convenience, access, aesthetics, and safety are also important. To explore this issue, we placed multiple sensor systems at an existing field site allowing us to examine both neighborhood-level and building-level variability during a concurrent period for CO₂ (a primary pollutant) and O₃ (a secondary pollutant). In line with previous studies, we found that local and transported emissions as well as thermal differences in sensor systems drive variability, particularly for high-time resolution data. While this level of variability is unlikely to affect data on larger averaging scales, this variability could impact analysis if the user is interested in high-time resolution or examining local sources. However, with thoughtful placement and thorough documentation, high-time resolution data at the neighborhood level has the potential to provide us with entirely new information on local air quality trends and emissions

Utilization of a Low-Cost Sensor Array for Mobile Methane Monitoring

The use of low-cost sensors (LCSs) for the mobile monitoring of oil and gas emissions is an understudied application of low-cost air quality monitoring devices. To assess the efficacy of low-cost sensors as a screening tool for the mobile monitoring of fugitive methane emissions stemming from well sites in eastern Colorado, we colocated an array of low-cost sensors (XPOD) with a reference grade methane monitor (Aeris Ultra) on a mobile monitoring vehicle from 15 August through 27 September 2023. Fitting our low-cost sensor data with a bootstrap and aggregated random forest model, we found a high correlation between the reference and XPOD CH4 concentrations (r = 0.719) and a low experimental error (RMSD = 0.3673 ppm). Other calibration models, including multilinear regression and artificial neural networks (ANN), were either unable to distinguish individual methane spikes above baseline or had a significantly elevated error (RMSDANN = 0.4669 ppm) when compared to the random forest model. Using out-of-bag predictor permutations, we found that sensors that showed the highest correlation with methane displayed the greatest significance in our random forest model. As we reduced the percentage of colocation data employed in the random forest model, errors did not significantly increase until a specific threshold (50 percent of total calibration data). Using a peakfinding algorithm, we found that our model was able to predict 80 percent of methane spikes above 2.5 ppm throughout the duration of our field campaign, with a false response rate of 35 percent

Community-Based Health and Exposure Study around Urban Oil Developments in South Los Angeles.

Oilfield-adjacent communities often report symptoms such as headaches and/or asthma. Yet, little data exists on health experiences and exposures in urban environments with oil and gas development. In partnership with Promotoras de Salud (community health workers), we gathered household surveys nearby two oil production sites in Los Angeles. We tested the capacity of low-cost sensors for localized exposure estimates. Bilingual surveys of 205 randomly sampled residences were collected within two 1500 ft. buffer areas (West Adams and University Park) surrounding oil development sites. We used a one-sample proportion test, comparing overall rates from the California Health Interview Survey (CHIS) of Service Planning Area 6 (SPA6) and Los Angeles County for variables of interest such as asthma. Field calibrated low-cost sensors recorded methane emissions. Physician diagnosed asthma rates were reported to be higher within both buffers than in SPA6 or LA County. Asthma prevalence in West Adams but not University Park was significantly higher than in Los Angeles County. Respondents with diagnosed asthma reported rates of emergency room visits in the previous 12 months similar to SPA6. 45% of respondents were unaware of oil development; 63% of residents would not know how to contact local regulatory authorities. Residents often seek information about their health and site-related activities. Low-cost sensors may be useful in highlighting differences between sites or recording larger emission events and can provide localized data alongside resident-reported symptoms. Regulatory officials should help clarify information to the community on methods for reporting health symptoms. Our community-based participatory research (CBPR) partnership supports efforts to answer community questions as residents seek a safety buffer between sensitive land uses and active oil development

Where the wicked problems are: The case of mental health

Objective To use system ideas and the concept of ‘wicked problems’ to frame examination of a decade-and-a-half of UK mental health policy. Methods Theoretically informed policy analysis. Results Modern health care is complex, and mental health care particularly so. In the UK the mental health system has also become a policymaking priority. Features of this system mean that many of the problems policymakers face are of the ‘wicked’ variety. Wicked problems are resistant. Problem formulations and their solutions are contestable. Solutions which have ‘worked’ in one setting may not ‘work’ in another, and evidence to guide change is open to challenge. Actions trigger waves with widespread system consequences. In the case of the UK's mental health field significant shifts have taken place in formulations of ‘the problem’ to which actions have been directed. These have included assessments of community care failure, formulations emphasising problems with the professions and, most recently, the need for action to promote mental health and wellbeing. Conclusions In their efforts to secure improvement in a neglected field UK policymakers have unleashed a torrent of top-down actions. Attention needs to be paid to constructing strong, system-wide, partnerships and to examining the cumulative impact of policy actions

Low-Cost Air Quality Monitoring Tools: From Research to Practice (A Workshop Summary).

In May 2017, a two-day workshop was held in Los Angeles (California, U.S.A.) to gather practitioners who work with low-cost sensors used to make air quality measurements. The community of practice included individuals from academia, industry, non-profit groups, community-based organizations, and regulatory agencies. The group gathered to share knowledge developed from a variety of pilot projects in hopes of advancing the collective knowledge about how best to use low-cost air quality sensors. Panel discussion topics included: (1) best practices for deployment and calibration of low-cost sensor systems, (2) data standardization efforts and database design, (3) advances in sensor calibration, data management, and data analysis and visualization, and (4) lessons learned from research/community partnerships to encourage purposeful use of sensors and create change/action. Panel discussions summarized knowledge advances and project successes while also highlighting the questions, unresolved issues, and technological limitations that still remain within the low-cost air quality sensor arena

Health Professionals and Public Awareness of Carbon Monoxide Poisoning in Vermont

Introduction. Carbon monoxide (CO) is the second leading cause of non-medical poisoning death in the United States. Between 1999 and 2012, Vermont saw the highest rates of CO poisoning deaths in New England. Public education and the use of CO alarms have been identified as important prevention strategies. We developed and distributed a survey to assess public and health professional knowledge of CO. Methods. A 21-question survey was designed, based on the validated Chicago Lead Knowledge Test, to assess knowledge about sources of CO exposure and symptoms and treatment of poisoning. Fifteen additional questions collected occupational and demographic information and preferred sources of educational information. Surveys were distributed over two months to the public, healthcare professionals, and emergency responders within Chittenden County, as well as physicians throughout Vermont. Survey responses were analyzed using SPSS. Results. There were 256 respondents. Healthcare professionals performed better than public respondents overall (public: mean correct=15.69, SD= 2.83, N=104; healthcare provider and emergency responder: mean correct= 17.5, SD= 2.23, N= 152). The survey questions which were most frequently answered incorrectly related to treatment and sources of exposure, as well as the similarity of CO poisoning to symptoms of influenza. Respondents preferred to receive information from printed and internet sources. Discussion. Medical professionals are more knowledgeable about carbon mon- oxide than the general public. Public education should include printed and online for- mats, focusing on important sources of exposure (particularly ice rinks), seeking treatment following symptoms, and similarity to flu symptoms.https://scholarworks.uvm.edu/comphp_gallery/1267/thumbnail.jp

Bacterial Mutagenicity of Urban Organic Aerosol Sources in Comparison to Atmospheric Samples

The bacterial mutagenicity of a comprehensive set of urban particulate air pollution source samples is examined using the Salmonella typhimurium forward mutation assay. Each of the combustion source samples examined, including the exhaust from catalyst-equipped autos, noncatalyst autos, heavy-duty diesel trucks, plus natural gas, distillate oil, and wood combustion sources, is mutagenic in this assay, with a response per microgram of organic carbon in these samples generally greater than that of cigarette smoke aerosol. The noncombustion source samples tested generally are not mutagenic at the levels examined. The specific mutagenicity (mutant fraction per microgram of organic carbon) of ambient aerosol samples collected in southern California is compared to a weighted average of the specific mutagenicity of the primary source samples assembled in proportion to their emission rates in the Los Angeles area. In most cases where a comparison can be made, the specific mutagenicity of the source composites and the ambient samples are of similar magnitude, with the exception that the -PMS mutagenicity of the aerosol at Long Beach, CA, during the first half of the calendar year 1982 and at Azusa, CA, during the April-June 1982 period is much higher than can be explained by direct emissions from the sources studied here

Seasonal and Spatial Variation of the Bacterial Mutagenicity of Fine Organic Aerosol in Southern California

The bacterial mutagenicity of a set of 1993 urban particulate air pollution samples is examined using the Salmonella typhimurium TM677 forward mutation assay. Ambient fine particulate samples were collected for 24 hr every sixth day throughout 1993 at four urban sites, including Long Beach, central Los Angeles, Azusa, and Rubidoux, California, and at an upwind background site on San Nicolas Island. Long Beach and central Los Angeles are congested urban areas where air quality is dominated by fresh emissions from air pollution sources; Azusa and Rubidoux are located farther downwind and receive transported air pollutants plus increased quantities of the products of atmospheric chemical reactions. Fine aerosol samples from Long Beach and Los Angeles show a pronounced seasonal variation in bacterial mutagenicity per cubic meter of ambient air, with maximum in the winter and a minimum in the summer. The downwind smog receptor site at Rubidoux shows peak mutagenicity (with postmitochondrial supernatant but no peak without postmitochondrial supernatant) during the September-October periods when direct transport from upwind sources can be expected. At most sites the mutagenicity per microgram of organic carbon from the aerosol is not obviously higher during the summer photochemical smog period than during the colder months. Significant spatial variation in bacterial mutagenicity is observed: mutagenicity per cubic meter of ambient air, on average, is more than an order of magnitude lower at San Nicolas Island than within the urban area. The highest mutagenicity values per microgram of organics supplied to the assay are found at the most congested urban sites at central Los Angeles and Long Beach. The highest annual average values of mutagenicity per cubic meter of air sampled occur at central Los Angeles. These findings stress the importance of proximity to sources of direct emissions of bacterial mutagens and imply that if important mutagen-forming atmospheric reactions occur, they likely occur in the winter and spring seasons as well as the photochemically more active summer and early fall periods

Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study

Background In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in community mental health care and identify factors that facilitate or act as barriers to personalised, collaborative, recovery-focused care. Methods We conducted a cross-national comparative study employing a concurrent transformative mixed-methods approach with embedded case studies across six service provider sites in England and Wales. The study included a survey of views on recovery, empowerment and therapeutic relationships in service users (n = 448) and recovery in care coordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117) and a review of care plans (n = 33). Quantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and framework method. Results Significant differences were found across sites for scores on therapeutic relationships. Variation within sites and participant groups was reported in experiences of care planning and understandings of recovery and personalisation. Care plans were described as administratively burdensome and were rarely consulted. Carers reported varying levels of involvement. Risk assessments were central to clinical concerns but were rarely discussed with service users. Service users valued therapeutic relationships with care coordinators and others, and saw these as central to recovery. Conclusions Administrative elements of care coordination reduce opportunities for recovery-focused and personalised work. There were few common understandings of recovery which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work. Research to investigate innovative approaches to maximise staff contact time with service users and carers, shared decision-making in risk assessments, and training designed to enable personalised, recovery-focused care coordination is indicated