A qualitative study of counsellors’ personal experiences of alcoholism

This dissertation aimed to provide an understanding of the impact of alcoholism and how it has affected counsellors who are in recovery from alcoholism. The research also focused on how the participants’ lives are different today, being in recovery. This small scale qualitative phenomenological research study was undertaken using six semi-structured face to face interviews. Counsellors were asked about their experiences of alcoholism and recovery and what impact their experiences may have had on their decision to train as counsellors. The sample included three females and three males who had a minimum of five years of sobriety. Data were analysed using the constant comparative method. The findings from this research indicated a number of factors that contributed to the development of alcohol dependency, including a family history of alcoholism. The outcomes also highlighted the debilitating psychological, physical and social impact of alcoholism. The process of recovery, often preceded by a ‘spiritual awakening,’ reflected the joy of being in recovery and how participants’ lives are different today. Participants predominantly had a positive outlook on life. The findings of this research help to confirm that being in recovery from alcoholism had a major impact on the decision to become a counsellor and also was perceived as having a positive impact on the counsellors’ practice

Mitigating the Distributional Impacts of Climate Change Policy

Under both a cap-and-trade system and a greenhouse gas tax, the government will regulate energy suppliers and distributors, utility companies, and large manufacturers. These parties will bear the statutory incidence of the regulation. However, the financial impacts of regulating greenhouse gas emissions will be borne primarily by consumers. Consumers will bear the economic incidence of the regulation in the form of increased costs ofgasoline, electricity, and home heating fuels and in increased consumer prices for all goods manufactured or distributed using fossil fuels. Greenhouse gas regulation will also generate significant revenue. This Article addresses the question of what should be done with those revenues. Models of the economic incidence of the two systems indicate that while high-income households will bear a larger portion of the distributional impacts because they consume more, low-income households will bear a disproportionateb urden as a percentage of their household income. In view of the political challenges associated with redistribution, the practical challenges associated with calculating the net burdens of environmental regulation, and the central importance ofprotecting the least advantaged in society, this Article proposes that the optimal regulatory regime is one that neutralizes the distributional impacts. The government may achieve this by capturing revenues from a cap-and-trade system or a greenhouse gas tax and using those revenues to issue a rebate that is proportional to household income and scaled according to household size. This Article also suggests that the most efficient method for delivering the rebate is by issuing a refundable tax credit through the income tax system, based on the institutional compatibility of that system with the regulatory and distributional goals of the policy

An investigation into the routes to inpatient care at the Pantang Hospital in Ghana via the criminal justice system

Objectives: To develop knowledge of routes by which patients are admitted to Pantang hospital via the courts or police and to explore the factors that prevent discharge, rehabilitation or transfer to prison of these patients.Setting: Pantang Psychiatric Hospital, Accra, Ghana, West AfricaDesign: A cross-sectional exploratory qualitative study.Participants: Adult patients with a psychiatric diagnosis who had been admitted to hospital following involvement with the criminal justice system and their families; and stakeholders (participants who had experience working with mentally disordered offenders).Methods: A descriptive and ethnographic survey of patients plus interviews with key stakeholders in mental health and criminal justice. Data were analysed using hybrid thematic analysis.Results: Patients arrived at Pantang Psychiatric Hospital following referral by the arresting police authorities, through court referral, or directly from prisons. All participants reported lack of understanding of the mental health and criminal justice systems, and interface between the two. Most patients and family members reported they feared the stigmaof mental illness and patients’ criminal charges would interrupt the patients’ successful reintegration into the community.Conclusion: This study revealed that forensic mental health patients in the Pantang Hospital entered through one of three ways; direct entry through the community-based policing system; on order through the court system; and referrals directly from the prison system. Inadequate staffing and other resources resulted in delays in completing thenecessary psychiatric assessments.Keywords: Inpatient psychiatric care, forensic mental health, stigma, Ghana, psychiatryFunding: The study was funded locally and by a grant received from the Faculty of Forensic Psychiatry, Royal College of Psychiatrists in the UK

Back to the Basics: Socio-Economic, Gender, and Regional Disparities in Canada’s Educational System

This study reassessed the extent to which socio-economic background, gender, and region endure as sources of educational inequality in Canada. The analysis utilized the 28,000 student Canadian sample from the data set of the OECD’s 2003 Programme for International Student Assessment (PISA). Results, consistent with previous findings, highlight the uneven distribution of educational achievement in Canada along socio- economic, gender, and regional lines, and point to the continued necessity of policy to mitigate the impact of gender, class, and regional inequalities on the educational out- comes and life chances of young Canadians. Key words: social inequality, educational outcomes, educational aspirations, SES, cultural capital, PISA Dans cet article, les auteurs se demandent dans quelle mesure le statut socioéconomi- que, le sexe et la région demeurent des sources d’inégalité en matière d’éducation au Canada. L’analyse repose sur l’échantillon des 28 000 élèves canadiens tiré de l’ensemble de données du Programme international pour le suivi des acquis des élèves (PISA) de 2003 de l’OCDE. Les résultats, conformes aux conclusions antérieu- res, mettent en évidence la répartition inégale de la réussite scolaire au Canada selon le statut socioéconomique, le sexe et la région et indiquent la nécessité d’atténuer l’impact du sexe, de la classe sociale et des inégalités régionales sur les résultats scolaires et les chances d’épanouissement des jeunes canadiens. Mots clés : inégalité sociale, résultats scolaires, aspirations quant aux études, statut socioéconomique, capital culturel, PISA

Utilizing Game-Based Learning to Promote Mental Health Advocacy in Black and Brown Communities

The aim of this project was to explore the effectiveness of video games and game-based learning as a means of mental health advocacy within People of Color (POC) and their communities. Research has shown that within black and brown communities, a heightened stigma is attached to the discussion of mental health, often preventing those who are affected from seeking treatment. This unwillingness to accept and care for mental illness within communities of color is highly detrimental, especially in the context of conditions such as Alzheimer’s or dementia, where African-Americans and Hispanics are at a significantly higher risk of developing these conditions. Despite higher risks they face lower rates of diagnosis and a general lack in understanding of the effects of dementia and how to provide proper care. These factors can place strain on those providing care to afflicted family members. Using the concept of game-based learning, I wanted to inform audiences, particularly POC, of the ways dementia affects our community by creating a 2D game demo meant to tackle the subject in an engaging and informative way. As part of the project, the demo was paired with an accompanying website and a survey that was issued to players following their completion of the game. Responses from the survey revealed that many found the chosen medium to be an effective means of relaying the struggles of mental illness and allowed them to gain a deeper understanding of the subject presented

The structure and stability of high temperature intermetallic phases for application within coating systems

The reduction of noise and emissions is becoming increasingly important in civil aircraft jet engines as well as requirements for reduced fuel consumption and improved efficiency. This has resulted in the drive towards increasing turbine entry temperatures and the development of thermal barrier coatings (TBCs). Due to the effectiveness of the platinum-modified nickel aluminides currently used as bond coat layers for Ni-based superalloy TBCs, higher temperature ruthenium-containing bond coat layers are being examined as a possible low cost alternative to platinum. Rolls Royce have a patented process, whereby precious metal layers directly react with single crystal substrate alloys to form an aluminium containing surface coating. The aluminium is sourced from the single crystal alloy and the coating so formed has a + structure, but contains other intermetallic phases due to the reaction between the coating and the single crystal substrate. This bond coat layer acts as a diffusion barrier, which limits interdiffusion between the coating and the substrate. The aim of this research was to examine the stability of various phases within platinum and ruthenium-containing multilayer systems formed during the above reaction process and to determine the most stable intermetallics for inclusion in future coating systems. Foil samples were manufactured using multilayer sputter coating methods and the exothermic formation of these phases was examined using differential scanning calorimetry. The identification of the phases formed was carried out using X-ray diffraction. It was found that the interdiffusion between the initial multi-layers had been incomplete during the samples heat treatment, and so more intermetallic phases formed in some samples than aimed for. Hence, from the large number of samples studied it was shown that, as a result of kinetic factors, the reaction onset (or trigger) temperature was not related to the enthalpy of the intermetallic phases formed or the sample compositions within a target phase field. For the β-phase (NiAl) type intermetallic systems, the samples that produced the highest enthalpy values (i.e. the most stable intermetallic compounds) were those with the nominal compositions (in atomic %) of; ‘47Ni53Al’, ‘48Ni6Pt46Al’ and ‘51Ni7Ru42Al’. For the γ΄-phase (Ni3Al) type intermetallic systems, the highest enthalpy values were from samples with nominal compositions of ‘60Ni16Pt24Al’ and ‘74Ni5Ru24Al’EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Patients' perceptions of a pressure ulcer prevention care bundle in hospital : A qualitative descriptive study to guide evidence-based practice

Background: Pressure ulcers place a significant burden on patients and hospitals. Our team developed and tested a pressure ulcer prevention care bundle (PUPCB) in a cluster randomized trial. As part of the process evaluation conducted alongside the trial, we explored patients’ perceptions of the intervention. Aims: To identify patients’ perceptions and experiences of a PUPCB in hospital. Methods: This qualitative descriptive study explored the perceptions of a subset of patients who participated in a trial testing the PUPCB across four intervention hospitals. A trained interviewer conducted semistructured interviews, which were digitally recorded, transcribed, and analyzed using thematic analysis. Findings: Nineteen patients were interviewed across the four hospitals. Three main themes emerged: (a) importance of personal contact in PUPCB delivery; (b) understanding pressure ulcer prevention (PUP) enhances participation; and (c) individual factors impact patients’ engagement in PUP. Discussion: The extent to which patients adopted the intervention appeared to be influenced by the complexity of education materials, compatibility with patients’ existing knowledge and beliefs, and perceived advantage of the intervention; ability for human interaction; and patient-related facilitators and barriers to participating in PUP care. Linking Evidence to Action: This study found patients accepted a PUPCB that encouraged participation in care, particularly as it involved personal and positive interactions with nurses and provision of information that was easy to understand and resonated with patients

Internet-based guided self-help for post-traumatic stress disorder (PTSD): randomised controlled trial

Background: There are numerous barriers that limit access to evidence-based treatment for posttraumatic stress disorder (PTSD). Internet-based guided self-help is a treatment option that may help widen access to effective intervention, but the approach has not been sufficiently explored for the treatment of PTSD. Methods: 42 adults with DSM-5 PTSD of mild to moderate severity were randomly allocated to internet-based self-help with up to 3 hours of therapist assistance, or to a delayed treatment control group. The internet-based programme included 8 modules that focused on psycho-education; grounding; relaxation; behavioural activation; real-life and imaginal exposure; cognitive therapy and relapse prevention. The primary outcome measure was reduction in clinician-rated traumatic stress symptoms using the clinician administered PTSD scale for DSM-V (CAPS-5). Secondary outcomes were self-reported PTSD symptoms; depression; anxiety; alcohol use; perceived social support; and functional impairment. Results: Post-treatment, the internet-based guided self-help group had significantly lower clinician assessed PTSD symptoms than the delayed treatment control group (between-group effect size Cohen’s d=1.86). The difference was maintained at one-month follow-up and dissipated once both groups had received treatment. Similar patterns of difference between the two groups were found for depression, anxiety and functional impairment. The average contact with treating clinicians was 2½ hours. Conclusions: Internet-based trauma-focused guided self-help for PTSD is a promising treatment option that requires far less therapist time than current first line face-to-face psychological therapy

Does electronic consent improve the logistics and uptake of hpv vaccination in adolescent girls? A mixed methods theory informed evaluation of an intervention

Abstract Background Technological solutions may improve the logistics of obtaining parental consent in school-based immunisation programmes. In 2018/19 a health care organisation in London, England, piloted an electronic consent intervention in the adolescent girls’ HPV vaccination programme. We conducted a mixed-methods evaluation to examine the usability and acceptability of the intervention and assess its impact on consent form returns and HPV vaccine uptake. Methods The intervention was implemented in 14 secondary schools in seven South London boroughs. Each e-consent school was matched with a school that used standard paper consent. Matching was based on location and the proportion of students: i. with English as a second language, ii. receiving free school meals (socio-economic status proxy). Consent form return rates and HPV vaccine uptake were compared quantitatively between intervention and matched schools. Data from immunisation session observations (n=7), school feedback forms (n=14), individual and group interviews with implementers (n=8), parents and adolescents (n=12) and a focus group discussion with adolescents was analysed thematically to document user’s experiences investigate the implementation of the intervention. Results HPV vaccination uptake did not differ between e-consent and matched paper consent schools, but timely consent form return was significantly lower in the e-consent schools (73.3% (n=11) vs 91.6% (n=11), p=0.008). The transition to using the system was not straightforward, whilst schools and staff understood the potential benefits, they found it difficult to adapt to new ways of working which removed some level of control from schools. Part of the reason for lower consent form return in e-consent schools was that some parents found the intervention difficult to access and use. Adolescents highlighted the potential for e-consent interventions to by-pass their information needs. Conclusions The e-consent intervention did not improve consent form return or vaccine uptake due to challenges encountered in transitioning to a new way of working. New technologies require embedding before they become incorporated in everyday practice. The intervention is undergoing further iterative development to improve its usability, ensure schools are appropriately involved and adolescents receive tailored immunisation information. A re-evaluation once stakeholders are accustomed to e-consent may be required to understand its impact.</jats:p