Experiences of care continuity and recovery for people at the interface of primary and secondary mental health care in Wales: a thematic discourse analytic approach

This study explores talk about experiences of care continuity and recovery for people with serious mental health issues at the interface of primary and secondary mental healthcare in Wales. The approach adopted was qualitative, employing a methodology of thematic discourse analysis of talk generated by in-depth, semi-structured interviews. The study was conducted in two phases, the first round involving (n = 16) service users who had transited from secondary to primary care, and the second round involving (n = 16) workers and practitioners involved in supporting service users at the primary-secondary interface. The main findings were first that participants’ expectations were misaligned with transforming service structures and interfaces. Second, participants constructed competing versions of recovery in their talk. Third, analysis of talk revealed experiences of care discontinuities in multiple areas, concentrated particularly at the primary level. On this basis, it is argued that a proliferation of competing recovery versions, and misaligned expectations of transforming services, are closely allied with escalating service system complexity and fragmentation, with detrimental implications for care continuity and coordination. The role of neoliberalist, policy-based recovery versions such as the Mental Health (Wales) Measure 2010, is highlighted in colonising the recovery concept. The social theory of system versus lifeworld is used to provide a theoretical context for understanding recovery colonisation, potential distortion of the concept, and how this may be an additional factor for systemic complexity and fragmentation. In order to contain escalating service complexity, a balance needs to be struck between top-down, colonised implementations of recovery and bottom-up recovery versions rooted in the individual lived experience of the service user. The notion of the public sphere is also employed as a basis for study implications, to articulate a context for ideal speech situations where there is free function of communicative action at the intersubjective level of the lifeworld. Peer support groups, recovery colleges and online forums may serve as instances of a public sphere within which fruitful opportunities for education and construction of recovery approaches may be reclaimed. User / survivor activism may also have a role in securing this vital context for recovery construction

Duality in Digital Discourse: The History and Future of the American Public Forum

From the onset of the republic, the liberty to speak freely and debate openly has stood guard and helped preserve all other American rights. While this concept has endured, the means by which it exists in society has changed immensely. As the public forum has evolved to fit the modern needs of the citizenry, political discourse has become less a defense against tyranny and more a chaotic space of conflicting opinions. In the United States, privately-owned social media companies have grown at an unprecedented rate, yet lawmakers have been slow to exercise any authority to regulate these corporations. For public officials posting information and interacting with their constituents on social platforms, the guidelines regulating their actions are, at best, ambiguous and, at worst, dangerous. When officials such as former President Donald Trump began conducting what the courts deemed official state business on their personal Twitter accounts, questions were raised regarding the legal status and legitimacy of government activity on social media websites. Following a literature review of the history of public fora and potential policy solutions, this paper will present an understanding of the current rules that apply to the communication activities of public officials in digital spaces. The final section will propose a new series of regulations intended to clarify the rights and responsibilities of public officials who desire to communicate with the public over social platforms. Insights from this research should be considered by lawyers, judges, policymakers, and government agents attempting to reap the benefits of mass communication without infringing on the historic and traditional freedom of expression established under the First Amendment and relevant precedents

The Case for a General and Interaction-based Third-party Cookie Policy

The privacy implications of third-party tracking is a well-studied problem. Recent research has shown that besides data aggregators and behavioral advertisers, online social networks also act as trackers via social widgets. Existing cookie policies are not enough to solve these problems, pushing users to employ blacklist-based browser extensions to prevent such tracking. Unfortunately, such approaches require maintaining and distributing blacklists, which are often too general and adversely affect non-tracking services for advertisements and analytics. In this paper, we propose and advocate for a general third-party cookie policy that prevents third-party tracking with cookies and preserves the functionality of social widgets without requiring a blacklist and adversely affecting non-tracking services. We implemented a proof-of-concept of our policy as browser extensions for Mozilla Firefox and Google Chrome. To date, our extensions have been downloaded about 11.8K times and have over 2.8K daily users combined.Comment: In Proceedings of the 9th Workshop on Web 2.0 Security and Privacy (W2SP) 201

A Churn for the Better: Localizing Censorship using Network-level Path Churn and Network Tomography

Recent years have seen the Internet become a key vehicle for citizens around the globe to express political opinions and organize protests. This fact has not gone unnoticed, with countries around the world repurposing network management tools (e.g., URL filtering products) and protocols (e.g., BGP, DNS) for censorship. However, repurposing these products can have unintended international impact, which we refer to as "censorship leakage". While there have been anecdotal reports of censorship leakage, there has yet to be a systematic study of censorship leakage at a global scale. In this paper, we combine a global censorship measurement platform (ICLab) with a general-purpose technique -- boolean network tomography -- to identify which AS on a network path is performing censorship. At a high-level, our approach exploits BGP churn to narrow down the set of potential censoring ASes by over 95%. We exactly identify 65 censoring ASes and find that the anomalies introduced by 24 of the 65 censoring ASes have an impact on users located in regions outside the jurisdiction of the censoring AS, resulting in the leaking of regional censorship policies

Thermodynamic characterisation and simulation for the electrolytic extraction of titanium from oxide melts.

This thesis investigates the use of electrolytic methods on high temperature oxide melts to reduce TiO₂ into metallic Ti. Initially, a slag by-product from New Zealand Steel containing Al2O3-CaO-MgO-SiO₂-TiO₂ was considered due to it containing a high TiO2 content (32 wt%). Thermodynamic characterisation was then performed on this slag system to aid in the selection of an appropriate thermodynamic soft- ware for the investigation of extraction from this system. FactSage was then chosen as an appropriate software package and was used to predict the required reduction potentials of components in the system. This model accounts for the impact of the activities of the oxide components within the molten system which has not been ac- counted for in any previous studies. Simulations predicted that the presence of SiO₂ in the slag solution inhibits the production of pure Ti and suggests that SixTiy alloys will instead be the primary product. Simulations were then run at different slag compositions to investigate if it was possible to use this melt for the deposition of pure Ti with little success. A combination of simulation and experimental work was then performed to find a suitable metal oxide to act as an electrolyte and allow the electrolytic deposition of Ti. In this investigation three potential electrolytes Na2O, MgO and CaO were identified using FactSage and Na2O was then experimented upon. Metallic titanium was successfully deposited into a Pt-Rh working electrode from the oxide melt by applying a slight negative potential of 0.1-0.2 V against a Ti reference electrode. This resulted in a Ti-Pt-Rh alloy with 20-25 At% Ti with an overall calculated deposition efficiency of 1.0±0.8%

Escalating complexity and fragmentation of mental health service systems: the role of recovery as a form of moral communication

Purpose Theoretical generalisation provides the basis for tackling problems of service complexity, fragmentation and disrupted care pathways. Design/methodology/approach Recent mental health service transformation in Wales, United Kingdom, has been stimulated by a policy programme underpinned by person-centred recovery values. This paper offers analysis informed by the perspectives of Niklas Luhmann and other noted theorists to examine escalating service system complexity related to this transformation. Analysis builds upon the findings of a qualitative study employing thematic discourse analysis of talk of people with mental illness and associated workers. Findings In total, three themes were constructed in participants' talk: “Competing versions of recovery”, “Misaligned service expectations” and “Disrupted care pathways.” Recovery may be understood as a form of moral communication and autopoietic meaning-making activity, according to Luhmann's radical constructionist epistemology. This has the potential to generate competing versions of recovery, a key contributor to escalating complexity. Research limitations/implications Findings could be developed further by continued investigation of the relationship between recovery implementation and service fragmentation. Social implications A more judicious, balanced policy-implementation may cultivate optimal conditions for recovery pluralism by avoiding polarisation towards either top-down, policy-based recovery implementation or a proliferation of approaches at the grassroots level. Findings have implications for healthcare settings beyond the scope of mental healthcare, given the prevalence of person-centred care internationally. Originality/value A simplistic view of recovery implementation should be challenged. Recovery should not be considered a “magic bullet” for mental healthcare delivery. Haphazard recovery-implementation may have detrimental effects of escalating complexity, service fragmentation and disrupted care pathways

A Multi-perspective Analysis of Carrier-Grade NAT Deployment

As ISPs face IPv4 address scarcity they increasingly turn to network address translation (NAT) to accommodate the address needs of their customers. Recently, ISPs have moved beyond employing NATs only directly at individual customers and instead begun deploying Carrier-Grade NATs (CGNs) to apply address translation to many independent and disparate endpoints spanning physical locations, a phenomenon that so far has received little in the way of empirical assessment. In this work we present a broad and systematic study of the deployment and behavior of these middleboxes. We develop a methodology to detect the existence of hosts behind CGNs by extracting non-routable IP addresses from peer lists we obtain by crawling the BitTorrent DHT. We complement this approach with improvements to our Netalyzr troubleshooting service, enabling us to determine a range of indicators of CGN presence as well as detailed insights into key properties of CGNs. Combining the two data sources we illustrate the scope of CGN deployment on today's Internet, and report on characteristics of commonly deployed CGNs and their effect on end users

Experiences of care continuity and recovery for people at the interface of primary and secondary mental health care in Wales: a thematic discourse analytic approach

This study explores talk about experiences of care continuity and recovery for people with serious mental health issues at the interface of primary and secondary mental healthcare in Wales. The approach adopted was qualitative, employing a methodology of thematic discourse analysis of talk generated by in-depth, semi-structured interviews. The study was conducted in two phases, the first round involving (n = 16) service users who had transited from secondary to primary care, and the second round involving (n = 16) workers and practitioners involved in supporting service users at the primary-secondary interfac