Analysing Afrikaans-English bilingual children's conversational code switching

It has been observed that children mix languages more often if they have been exposed to mixed speech, especially if they are in bilingual company. Very little research, however, exists on the code switching (CS) of children brought up in multilingual contexts. The study discussed in this paper investigates the grammatical and socio-pragmatic characteristics of the conversational CS of three Afrikaans-English bilingual children and aims to contribute towards a better understanding of child CS. The study was conducted through the analysis of spontaneous conversational CS elicited during multiple play sessions. Data were analysed within the frameworks of the Matrix Language Frame (MLF) model and Conversation Analysis (CA). The study accounts for the different types of CS that occur, and examines which grammatical and/or socio-pragmatic difficulties may drive children to use specific types of CS, while also considering whether the context of an utterance has an influence on how and why CS takes place.Keywords: code switching; child bilingual; Matrix Language Frame model; Conversation Analysi

With flying colours: pilot performance with colour-coded head-up flight symbology

The manipulation of colour in display symbology design has long been recognised as a method to improve operator experience and performance. Recent developments in colour head-up display (HUD) and helmet-mounted display (HMD) technology underline the necessity to understand the human factors considerations of symbology colour coding against conventional monochrome symbology formats. In this low-fidelity desktop human-in-the-loop experiment, the colour of flight symbology on an overlaid symbology set was coded as a redundant cue to indicate the accuracy of professional and non-professional pilots’ flight profile across a range of simulated flight manoeuvres. The main finding of this study was that colour coding flight symbology supported the manual flying performance of both professional and non-professional pilots. Notably, colour-coding of the bank indicator and airspeed tape minimised performance error during turning and altitude change manoeuvres, respectively. The usability of colour coded symbology was also rated higher than the monochrome symbology. We conclude that colour coded HUD/HMD symbology is preferred by the user and may improve performance during low workload manual flying tasks. A fuller understanding of performance and workload effects will require future studies to employ higher workload flying tasks and examine the utility of colour coding within higher fidelity environments

The loss of manual flying skills in pilots of highly automated airliners

Anecdotal and subjective evidence suggests that the manual flying ability of pilots operating highly automated aircraft is declining owing to a lack of opportunity to exercise such skills in the modern air transport environment. However, there is a paucity of objective evidence to support this safety concern. Consequently, the work presented in this thesis aims to provide empirically derived data to evaluate the extent and causes of the speculated manual skills decline and guide possible intervention strategies. Initially a cognitive task analysis is undertaken to determine the cognitive demands of performing manual flight in a large jet transport aircraft. Expert pilots report employing highly refined mental models structures which enable them to predict the aircrafts performance whilst causing minimal burden to their mental capacity. The study concludes that when measuring manual flying performance careful consideration must be given to designing a task which challenges both the cognitive and physical aspects of manual flying skill. Secondly, relatively novel pilot performance measures based upon the frequency analysis of control input data are evaluated. An empirical study finds that these techniques are both reliable and sensitive to manual flying performance. Furthermore, when studying large transport aircraft, such measures of the pilots control strategy are found to contribute valuable information about performance which is missing when just traditional ‘outer-loop’ performance measures are applied. The study concludes that these measures of control strategy are valuable in evaluating manual flying performance. Finally, the manual flying skills of a sample of pilots of highly automated aircraft are evaluated on a challenging manual flying task. A significant proportion exhibit poor manual flying performance as judged by a type rating examiner. Further analysis reveals that the performance of the pilots is significantly influenced by the amount of recent manual handling experience they have accumulated, rather than their longer-term manual flying experience. Significantly, airspeed tracking ability is influenced which is cited elsewhere as a causal factor in many manual flying skill related accidents. The results support the previous anecdotal and subjective concerns relating to the loss of manual flying skills.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The impact of an intervention to increase uptake to structured self-management education for people with type 2 diabetes mellitus in primary care (the embedding package), compared to usual care, on glycaemic control: study protocol for a mixed methods study incorporating a wait-list cluster randomised controlled trial

Abstract: Background: Approximately 425 million people globally have diabetes, with ~ 90% of these having Type 2 Diabetes Mellitus (T2DM). This is a condition that leads to a poor quality of life and increased risk of serious health complications. Structured self-management education (SSME) has been shown to be effective in improving glycaemic control and patient related outcome measures and to be cost-effective. However, despite the demonstrated benefits, attendance at SSME remains low. An intervention has been developed to embed SSME called the ‘Embedding Package’. The intervention aims to address barriers and enhance enablers to uptake of SSME at patient, healthcare professional and organisational levels. It comprises a marketing strategy, user friendly and effective referral pathways, new roles to champion SSME and a toolkit of resources. Methods: A mixed methods study incorporating a wait-list cluster randomised trial and ethnographic study, including 66 UK general practices, will be conducted with two intervention start times (at 0 and 9 months), each followed by an active delivery phase. At 18 months, the intervention will cease to be actively delivered and a 12 month observational follow-up phase will begin. The intervention, the Embedding Package, aims to increase SSME uptake and subsequent improvements in health outcomes, through a clear marketing strategy, user friendly and effective referral pathways, a local clinical champion and an ‘Embedder’ and a toolkit of resources for patients, healthcare professionals and other key stakeholders. The primary aim is, through increasing uptake to and attendance at SSME, to reduce HbA1c in people with T2DM compared with usual care. Secondary objectives include: assessing whether there is an increase in referral to and uptake of SSME and improvements in biomedical and psychosocial outcomes; an assessment of the sustainability of the Embedding Package; contextualising the process of implementation, sustainability of change and the ‘fit’ of the Embedding Package; and an assessment of the cost-effectiveness of the Embedding Package. Discussion: This study will assess the effectiveness, cost-effectiveness and sustainability of the Embedding Package, an intervention which aims to improve biomedical and psychosocial outcomes of people with T2DM, through increased referral to and uptake of SSME. Trial registration: International Standard Randomised Controlled Trials Number ISRCTN23474120. Assigned 05/04/2018. The study was prospectively registered. On submission of this manuscript practice recruitment is complete, participant recruitment is ongoing and expected to be completed by the end of 2019

A cross-sectional survey of mental health clinicians’ knowledge, attitudes, and practice relating to tobacco dependence among young people with mental disorders

BACKGROUND: Mental health services in England are smoke-free by law and expected to provide comprehensive support to patients who smoke. Although clinicians’ knowledge in this area is reported to be limited, research exploring the issue in Child and Adolescent Mental Health Services (CAMHS) is lacking. This study aimed to investigate the knowledge, attitudes, and practice of clinicians working within specialist and highly specialist Child and Adolescent Mental Health Services (CAMHS) relating to tobacco dependence, its treatment and its relation to mental disorder. METHODS: A cross-sectional survey of clinicians working across all CAMHS teams of a large UK National Health Service mental health Trust. RESULTS: Sixty clinicians (50% response rate) completed the survey. Less than half (48.3%) believed that addressing smoking was part of their responsibility, and half (50%) asserted confidence in supporting patients in a cessation attempt. Misconceptions relating to smoking were present across all staff groups: e.g. only 40% of respondents were aware of potential interactions between smoking and antipsychotic medications, although psychiatrists were more knowledgeable than non-medical clinicians (91.6% vs 27.1%; OR 3.4, p < .001). Self-reported attendance at smoking-related training was significantly associated with more proactive clinical practice. CONCLUSIONS: There is a need to improve clinicians’ knowledge, capacity and confidence in effectively identifying, motivating, supporting and treating young smokers in the context of treatment for mental disorders. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-014-0618-x) contains supplementary material, which is available to authorized users

Implementing complete smokefree policies in mental health inpatient settings Results from a before and after mixed-methods evaluation : results from a before and after mixed-methods evaluation

Abstract Background Tobacco smoking is extremely prevalent in people with severe mental illness (SMI) and has been recognised as the main contributor to widening health inequalities in this population. Historically, smoking has been deeply entrenched in the culture of mental health settings in the UK, and until recently, smokefree policies tended to be only partially implemented. However, recent national guidance and the government’s tobacco control plan now call for the implementation of complete smokefree policies. Many mental health Trusts across the UK are currently in the process of implementing the new guidance, but little is known about the impact of and experience with policy implementation. Methods This paper reports findings from a mixed-methods evaluation of policy implementation across 12 wards in a large mental health Trust in England. Quantitative data were collected and compared before and after implementation of NICE guidance PH48 and referred to 1) identification and treatment of tobacco dependence, 2) smoking-related incident reporting, and 3) prescribing of psychotropic medication. A qualitative exploration of the experience of inpatients was also carried out. Descriptive statistical analyses were performed, and the feasibility of collecting relevant and complete data for each quantitative component was assessed. Qualitative data were analysed using thematic framework analysis. Results Following implementation of the complete smokefree policy, increases in the numbers of patients offered smoking cessation advice (72% compared to 38%) were identified. While incident reports demonstrated a decrease in challenging behaviour during the post-PH48 period (6% compared to 23%), incidents relating to the concealment of smoking materials increased (10% compared to 2%). Patients reported encouraging changes in smoking behaviour and motivation to maintain change after discharge. However, implementation issues challenging full policy implementation, including covert facilitation of smoking by staff, were reported, and difficulties in collecting relevant and complete data for comprehensive evaluation purposes identified. Conclusions Overall, the implementation of complete smokefree policies in mental health settings may currently be undermined by partial support. Strategies to enhance support and the establishment of suitable data collection pathways to monitor progress are required