Performing an aseptic technique in a community setting : fact or fiction?

Background - Maintaining the principles of asepsis when performing wound care and other invasive procedures is one of the fundamental approaches of preventing healthcare-acquired infection. Such an approach has been advocated for community practitioners. Literature - The performance of an aseptic technique is an under-researched area. The few studies that have been conducted have identified how strict adherence to the technique is difficult and contamination of hands/gloves is common and that community nurses often have a fatalistic view about whether asepsis is possible in a community setting. Aim - The overall aim of this research project was to examine how experienced practitioners have adapted the aseptic technique within a community setting and to what extent the changed procedure still adhered to the principles of asepsis. Methods - This study used a mixture of non-participant observation and individual semi-structured interviews to examine adherence to the principles of the aseptic technique among the district nurses. Data were collected from one Trust in England with a total of 10 district nurses taking part and 30 aseptic procedures been observed. Results - The results show that almost all of the staff understood the principles of asepsis and had adapted the standard procedure for use in a patient’s home. Common challenges included wound cleaning using a single nurse procedure, the contents of the pack and the home environment. The research also identified misconceptions about clean versus aseptic procedures and a lack of training for staff. Conclusions - This study highlights the challenges of maintaining the principles of asepsis in a home environment and the fact that district nurses are often relied upon to find creative solutions to such challenges. The study also highlights issues around the implementation of evidence-based practice and the need for clearer guidance about how evidence should be used alongside existing procedures

Beyond City Living: Remaking the Inner Suburbs

This paper explores the emerging regeneration strategies for inner suburban areas. Drawing on evidence from Liverpool, Manchester and Leeds, the authors argue that regeneration of these inner areas can do more than upgrade housing and environments for existing residents; they can become more attractive to a wider range of households as convenient, accessible locations for larger, more affordable housing than is available in the city centre or the more recent suburbs. But care will be needed to create appealing, safe, walkable places; to define and deliver an attractive ‘offer’ for new residents, and to avoid displacement and tensions with existing residents. Here is a potential site for one version of ‘sustainable communities’ in the early twenty-first century, if it is approached sensitively and intelligently.cities; housing; economic development; regeneration; city centre living

Is my configuration any good: checking usability in an interactive sensor-based activity monitor

We investigate formal analysis of two aspects of usability in a deployed interactive, configurable and context-aware system: an event-driven, sensor-based homecare activity monitor system. The system was not designed from formal requirements or specification: we model the system as it is in the context of an agile development process. Our aim was to determine if formal modelling and analysis can contribute to improving usability, and if so, which style of modelling is most suitable. The purpose of the analysis is to inform configurers about how to interact with the system, so the system is more usable for participants, and to guide future developments. We consider redundancies in configuration rules defined by carers and participants and the interaction modality of the output messages.Two approaches to modelling are considered: a deep embedding in which devices, sensors and rules are represented explicitly by data structures in the modelling language and non-determinism is employed to model all possible device and sensor states, and a shallow embedding in which the rules and device and sensor states are represented directly in propositional logic. The former requires a conventional machine and a model-checker for analysis, whereas the latter is implemented using a SAT solver directly on the activity monitor hardware. We draw conclusions about the role of formal models and reasoning in deployed systems and the need for clear semantics and ontologies for interaction modalities

What about me? Factors affecting individual adaptive coping capacity across different populations

 When and why will people adapt to climate change? We conducted a number of studies examining the psychological drivers of individual adaptation to climate change across different populations. We used a variety of methodologies including interviews, surveys, survey experiments and face-to-face experiments. There was a high level of rigour involved in each of these methodologies which means that we can believe in the results. This programme of research represents one of the largest and most integrated attempts to understand some of the psychological drivers of individual-level adaptation.First, we used the most recent advances in the psychological literature of coping more generally to develop a valid scale to measure coping with climate change. Across three studies we found that our tool was both reliable and valid, providing an accurate measure of the different ways in which people cope with climate change. This tool can now be used to understand the effects of both adaptive and maladaptive coping and to understand what leads to these different ways of coping.Next, we examined adaptive capacity. We found that adaptive coping strategies were associated with perceiving climate change as a threat to oneself and one’s way of life, rating environmental goals as important, and believing that adaptive behaviours could help achieve significant personal goals. Furthermore, when looking at societal adaptive capacity (support for governmental policies) we found that not only were a threat appraisal, climate change or environmental goal, and goal connectedness related to support, but also political affiliation, perceived human contribution to climate change, (lack of) denying that climate change exists, and a number of emotions (enthusiasm, worry, (lack of) happiness, and (lack of ) embarrassment). By knowing these factors that lead to adaptive coping and support for adaptive policies we can identify strategies to improve individual adaptive capacity.Third, based on a range of psychological literature, we hypothesised that adaptive behaviour would be related to goals, goal connectedness, adaptive coping, beliefs about climate change (including denial), and emotions that create an uneasy state of activation (enthusiasm and hope combined with worry). We found support for each of these relationships. Thus, we can again identify strategies to increase adaptive climate change behaviour. Across the studies, we found that adaptive capacity and adaptive behaviours relied upon both “green” beliefs and goals and “non-green” beliefs and goals. Moreover, believing that the adaptive behaviours helped a person to achieve their goals (whether they were related to climate change or not) was strongly related to adaptive capacity and behaviour. We have therefore shown that we can improve adaptation not only in those people who want to help the environment but also in those who are less interested.Unfortunately, the goal structure of environmental goals appears difficult to change. However, making people think about politics did have an effect: Regardless of their own political orientation, a person’s belief about the degree of human contribution to climate change decreased when they were thinking about politics (compared to not thinking about politics). This has implications for how climate change adaptation is discussed in the media and by researchers.The results of our research also have implications for the communication of climate change adaptation policies. Our results show that framing the costs of reducing CO2 emissions in terms of a decrease in future gain—rather than as an opportunity-cost—renders people more willing to commit to climate change initiatives.In summary, this programme of research has taken an integrated and rigorous step towards greater understanding of some of the psychological drivers of individual adaptation to climate change. Given the complexity of the problem, more research is needed, however we believe that our research provides a good early step in this direction.Please cite as: Unsworth, K, Russell, S, Lewandowsky, S, Lawrence, C, Fielding, K, Heath, J, Evans, A, Hurlstone, M, & McNeill, I 2013 What about me? Factors affecting individual adaptive coping capacity across different populations, National Climate Change Adaptation Research Facility, Gold Coast, pp. 161. AbstractWhen and why will people adapt to climate change? We conducted a number of studies examining the psychological drivers of individual adaptation to climate change across different populations. We used a variety of methodologies including interviews, surveys, survey experiments and face-to-face experiments. There was a high level of rigour involved in each of these methodologies which means that we can believe in the results. This programme of research represents one of the largest and most integrated attempts to understand some of the psychological drivers of individual-level adaptation.First, we used the most recent advances in the psychological literature of coping more generally to develop a valid scale to measure coping with climate change. Across three studies we found that our tool was both reliable and valid, providing an accurate measure of the different ways in which people cope with climate change. This tool can now be used to understand the effects of both adaptive and maladaptive coping and to understand what leads to these different ways of coping.Next, we examined adaptive capacity. We found that adaptive coping strategies were associated with perceiving climate change as a threat to oneself and one’s way of life, rating environmental goals as important, and believing that adaptive behaviours could help achieve significant personal goals. Furthermore, when looking at societal adaptive capacity (support for governmental policies) we found that not only were a threat appraisal, climate change or environmental goal, and goal connectedness related to support, but also political affiliation, perceived human contribution to climate change, (lack of) denying that climate change exists, and a number of emotions (enthusiasm, worry, (lack of) happiness, and (lack of ) embarrassment). By knowing these factors that lead to adaptive coping and support for adaptive policies we can identify strategies to improve individual adaptive capacity.Third, based on a range of psychological literature, we hypothesised that adaptive behaviour would be related to goals, goal connectedness, adaptive coping, beliefs about climate change (including denial), and emotions that create an uneasy state of activation (enthusiasm and hope combined with worry). We found support for each of these relationships. Thus, we can again identify strategies to increase adaptive climate change behaviour. Across the studies, we found that adaptive capacity and adaptive behaviours relied upon both “green” beliefs and goals and “non-green” beliefs and goals. Moreover, believing that the adaptive behaviours helped a person to achieve their goals (whether they were related to climate change or not) was strongly related to adaptive capacity and behaviour. We have therefore shown that we can improve adaptation not only in those people who want to help the environment but also in those who are less interested.Unfortunately, the goal structure of environmental goals appears difficult to change. However, making people think about politics did have an effect: Regardless of their own political orientation, a person’s belief about the degree of human contribution to climate change decreased when they were thinking about politics (compared to not thinking about politics). This has implications for how climate change adaptation is discussed in the media and by researchers.The results of our research also have implications for the communication of climate change adaptation policies. Our results show that framing the costs of reducing CO2 emissions in terms of a decrease in future gain—rather than as an opportunity-cost—renders people more willing to commit to climate change initiatives.In summary, this programme of research has taken an integrated and rigorous step towards greater understanding of some of the psychological drivers of individual adaptation to climate change. Given the complexity of the problem, more research is needed, however we believe that our research provides a good early step in this direction

A Constraint Programming Approach to the Hospitals / Residents Problem

An instance I of the Hospitals / Residents problem (HR) involves a set of residents (graduating medical students) and a set of hospitals, where each hospital has a given capacity. The residents have preferences for the hospitals, as do hospitals for residents. A solution of I is a stable matching, which is an assignment of residents to hospitals that respects the capacity conditions and preference lists in a precise way. In this paper we present constraint encodings for HR that give rise to important structural properties. We also present a computational study using both randomly-generated and real-world instances. Our study suggests that Constraint Programming is indeed an applicable technology for solving this problem, in terms of both theory and practice