What makes a looked after child happy and unhappy?

What is good for a looked after child is usually decided by adults with the child’s voice often peripheral. One way to make the child central to decision-making is to ask them what makes them happy or unhappy. In doing this, the definition of happiness has to be neither a description of what has gone well in life nor an immediate state of mind, but should encompass the Aristotelian concept of eudaimonia. This is often translated as happiness but also incorporates notions of well-being and flourishing. The study reported here was undertaken as part of a children’s health needs assessment in an English local authority. It sought to understand why looked after children experience such high levels of poor mental health and make growing demands on therapeutic services. The proportion of young people displaying above average scores on validated measures, such as the Strengths and Difficulties Questionnaire (SDQ), is growing each year. The aim was to find out what looked after children say makes them happy and unhappy and what they see as likely to increase their well-being, and to compare their suggestions with those of the professionals and carers involved in their lives. Focus groups with children and professionals then discussed the same question, with the professionals also examining their understanding of SDQ results and their relevance to practice. The study found significant differences between the views of the children and professionals in both the range and emphasis of what is seen as important. Moreover, these adult assumptions were rarely tested by meaningful discussions with young people when key decisions were made; indeed, these seemed to be made about rather than with the children. In addition, the SDQ was not widely used by professionals to assess children’s emotional health and well-being needs. The study concluded that discussions about happiness can usefully support holistic understandings of looked after children’s experiences and aid planning and practice development

Pain management for chronic musculoskeletal conditions : the development of an evidence-based and theory-informed pain self-management course

Objective: To devise and test a self-management course for chronic pain patients based on evidence and underpinned by theory using the Medical Research Council (MRC) framework for developing complex interventions. Design: We used a mixed method approach. We conducted a systematic review of the effectiveness of components and characteristics of pain management courses. We then interviewed chronic pain patients who had attended pain and self-management courses. Behavioural change theories were mapped onto our findings and used to design the intervention. We then conducted a feasibility study to test the intervention. Setting: Primary care in the inner city of London, UK. Participants: Adults (18 years or older) with chronic musculoskeletal pain. Outcomes: Related disability, quality of life, coping, depression, anxiety, social integration and healthcare resource use. Results: The systematic reviews indicated that group-based courses with joint lay and healthcare professional leadership and that included a psychological component of short duration (<8 weeks) showed considerable promise. The qualitative research indicated that participants liked relaxation, valued social interaction and course location, and that timing and good tutoring were important determinants of attendance. We used behavioural change theories (social learning theory and cognitive behaviour approaches (CBA)) to inform course content. The course addressed: understanding and accepting pain, mood and pain, unhelpful thoughts and behaviour, problem solving, goal setting, action planning, movement, relaxation and social integration/reactivation. Attendance was 85%; we modified the recruitment of patients, the course and the training of facilitators as a result of testing. Conclusions: The MRC guidelines were helpful in developing this intervention. It was possible to train both lay and non-psychologists to facilitate the courses and deliver CBA. The course was feasible and well received

Hiding the squid:patterns in artificial cephalopod skin

Cephalopods employ their chromomorphic skins for rapid and versatile active camouflage and signalling effects. This is achieved using dense networks of pigmented, muscle-driven chromatophore cells which are neurally stimulated to actuate and affect local skin colouring. This allows cephalopods to adopt numerous dynamic and complex skin patterns, most commonly used to blend into the environment or to communicate with other animals. Our ultimate goal is to create an artificial skin that can mimic such pattern generation techniques, and that could produce a host of novel and compliant devices such as cloaking suits and dynamic illuminated clothing. This paper presents the design, mathematical modelling and analysis of a dynamic biomimetic pattern generation system using bioinspired artificial chromatophores. The artificial skin is made from electroactive dielectric elastomer: a soft, planar-actuating smart material that we show can be effective at mimicking the actuation of biological chromatophores. The proposed system achieves dynamic pattern generation by imposing simple local rules into the artificial chromatophore cells so that they can sense their surroundings in order to manipulate their actuation. By modelling sets of artificial chromatophores in linear arrays of cells, we explore the capability of the system to generate a variety of dynamic pattern types. We show that it is possible to mimic patterning seen in cephalopods, such as the passing cloud display, and other complex dynamic patterning

Fidelity in complex behaviour change interventions : a standardised approach to evaluate intervention integrity

Objectives: The aim of this study was to (1) demonstrate the development and testing of tools and procedures designed to monitor and assess the integrity of a complex intervention for chronic pain (COping with persistent Pain, Effectiveness Research into Self-management (COPERS) course); and (2) make recommendations based on our experiences. Design: Fidelity assessment of a two-arm randomised controlled trial intervention, assessing the adherence and competence of the facilitators delivering the intervention. Setting: The intervention was delivered in the community in two centres in the UK: one inner city and one a mix of rural and urban locations. Participants: 403 people with chronic musculoskeletal pain were enrolled in the intervention arm and 300 attended the self-management course. Thirty lay and healthcare professionals were trained and 24 delivered the courses (2 per course). We ran 31 courses for up to 16 people per course and all were audio recorded. Interventions: The course was run over three and a half days; facilitators delivered a semistructured manualised course. Outcomes: We designed three measures to evaluate fidelity assessing adherence to the manual, competence and overall impression. Results: We evaluated a random sample of four components from each course (n=122). The evaluation forms were reliable and had good face validity. There were high levels of adherence in the delivery: overall adherence was two (maximum 2, IQR 1.67–2.00), facilitator competence exhibited more variability, and overall competence was 1.5 (maximum 2, IQR 1.25–2.00). Overall impression was three (maximum 4, IQR 2.00–3.00). Conclusions: Monitoring and assessing adherence and competence at the point of intervention delivery can be realised most efficiently by embedding the principles of fidelity measurement within the design stage of complex interventions and the training and assessment of those delivering the intervention. More work is necessary to ensure that more robust systems of fidelity evaluation accompany the growth of complex interventions

Evaluation of Agricultural Statistics for ADAP

The Agricultural Development in the American Pacific (ADAP) Directors requested that the USDA, National Agricultural Statistics Service (NASS) extend its statistical program to the ADAP region: American Samoa, the Federated States of Micronesia (FSM), Palau, the Republic of the Marshall Islands (RMI), Guam, and the Commonwealth of the Northern Marianas (CNMI).This is the final report on the feasibility of, and our recommendations on establishing agricultural statistics in the region. The current section presents material that is generally applicable over the region, with separate sections containing relevant notes for each jurisdictionFunded through the US Department of Agriculture Cooperative Extension Service Grant Number 92-EXCA-1-0187