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The Supervision House is introduced as a tool for use in group supervision of masters-level counselors-in-training and novice counselors in the field. Impactful group supervision is a vital forum for counselor development and requires structural elements to maintain group cohesion and enable the sharing of peer experiences and concerns. The Supervision House provides structure in group supervision that helps the counselor reflect on factors that impact them and share strategies that address the developmental tasks of the supervision process. In this article, the rationale for the development of the Supervision House is offered, as well as suggestions on how to implement it in group supervision. Research results from this study highlighting student feedback on the technique are discussed as well as implications for further use in counselor education and supervision of counselors-in-training in their work settings. [ABSTRACT FROM AUTHOR]

In this co-produced paper, we write about a collaboration that developed over more than a decade between a service user advisor and a social work educator within a higher education context. Starting with how we came to work together, the paper outlines early apprehensions about service user involvement, both as we experienced them and as expressed by colleagues, students, and managers. The paper discusses such themes as confidentiality, professional boundaries, and power imbalance. As authors w identify principles that have underpinned our relationship as well as obstacles faced and understandings reached. We emphasise possibilities discovered from this project which may have application for other courses and settings for the service user advisor role. As we write, we are confronting a new challenge as one of us continues in the work and one of us retires from it. [ABSTRACT FROM AUTHOR]

This study compares the survival rates of USOs formed by universities in the UK's West Midlands region between 1983 and 2013 with those from existing studies in the literature. Data were collected from a range of secondary sources to enhance the accuracy of the USO dataset. Survival rates were found to be significantly lower than in previous studies despite the existence of prominent research universities within the region. It is proposed that the difference is in part methodological with the current study including USOs that may have been omitted using different methodologies that rely on institutional memories. [ABSTRACT FROM AUTHOR]

This article will highlight various uses for historical soil survey publications of the United States, discuss their management in libraries, and introduce an inventory to simplify their discovery. This inventory, provided as freely available supplementary material to this article, is a searchable list of publications organized by state. It can be adapted to the needs of individual libraries. [ABSTRACT FROM AUTHOR]

Understanding how economies change through interactions with science and government as different spheres of activity requires both new conceptual tools and methodologies. In this paper, the evolution of the metaphor of a Triple Helix of university–industry–government relations is elaborated into an evolutionary model, and positioned within the context of global economic changes. We highlight how Triple Helix relations are both continuing and mutating, and the conditions under which a Triple Helix might be seen to be unraveling in the face of pressures on each of the three helices – university, industry, and government. The reciprocal dynamics of innovation both in the Triple Helix thesis and in the global economy are empirically explored: we find that footlooseness of high technology manufacturing and knowledge-intensive services counteract the embeddedness prevailing in medium technology manufacturing. The geographical level at which synergy in Triple Helix relations can be expected and sustained varies among nations and regions. [ABSTRACT FROM PUBLISHER]

This paper focuses on the characteristics of biotech firms with various levels of research and development (R&D) activity. It is done by exploring the relationship between R&D intensity, alliances and the extent of regionalization of firms' activities using evidence from a survey of USbased biotechnology firms. We profile two firm prototypes: research-oriented firms and productoriented firms, focusing on their characteristics, strategies and operations. These include activities devoted to exploration and exploitation through alliances with universities (more exploration) and with pharmaceutical companies (exploration and exploitation), and locational needs which facilitate both exploration and exploitation. [ABSTRACT FROM AUTHOR]

Medical culture has portrayed intimate examinations as important in maintaining the sexual and reproductive health of patients. Intimate examinations have also been at the centre of high-profile scandals. Existing literature suggests there is considerable heterogeneity in the use of intimate examinations, as influenced by underlying attitudes. This study sought to ask how doctors make decisions to perform intimate examinations and negotiate the emotional aspects. In-depth interviews were conducted with 38 doctors of different grades and from different areas of clinical practice in the South East of England. Data were analysed thematically using NVivo 9, adopting a constructivist approach. Findings indicate that doctors' emotional constructions of intimate examinations coalesce around feelings of embarrassment, fear and anxiety, and vulnerability. Understandings of gender, sex and power also influence emotional constructions. Doctors utilise varying methods to negotiate emotions, some of which may be detrimental to patient care. These emotional constructions lead doctors to attribute values to intimate examinations and to chaperones that extend beyond responding to indications or following guidelines for examination. Doctors who resolve their own feelings of embarrassment, anxiety and vulnerability may be more likely to perform intimate examinations when indicated, to use chaperones appropriately and to offer the best standards of patient care. [ABSTRACT FROM AUTHOR]

Lack of adherence to health-promoting advice challenges the successful prevention and management of many conditions. The Health Belief Model (HBM) was developed in 1966 to predict health-promoting behaviour and has been used in patients with wide variety of disease. The HBM has also been used to inform the development of interventions to improve health behaviours. Several reviews have documented the HBM's performance in predicting behaviour, but no review has addressed its utility in the design of interventions or the efficacy of these interventions. A systematic review was conducted to identify interventional studies which use the HBM as the theoretical basis for intervention design. The HBM has been used continuously in the development of behaviour change interventions for 40 years. Of 18 eligible studies, 14 (78%) reported significant improvements in adherence, with 7 (39%) showing moderate to large effects. However, only six studies used the HBM in its entirety and five different studies measured health beliefs as outcomes. Intervention success appeared to be unrelated to HBM construct addressed challenging the utility of this model as the theoretical basis for adherence-enhancing interventions. Interventions need to be described in full to allow for the identification of effective components and replication of studies. [ABSTRACT FROM AUTHOR]

In recent years there has been much interest in exploring how to meaningfully involve service users in social work education and training but there has been little attention paid to the emotional experience of such work. Working together involves emotional labour on the part of both the lecturer and the service user which is often overlooked in both the planning and evaluation of such work. Drawing on a collaborative training initiative undertaken by the authors on the subject of mental illness, this paper seeks to unpick some of the unconscious dynamics that can be at play. Using psychodynamic concepts such as transference, projection, reverie and containment, this paper aims to explore the emotional experience of service user and lecturer, as well as students, when working collaboratively. Assumptions and expectations underpinning service users' involvement in social work education will be unpicked with a view to facilitating an alternative understanding of experiences in the classroom and lecture theatre. [ABSTRACT FROM AUTHOR]

This paper examines how Save the Children—an international non-governmental organisation (INGO)—assesses the changes it has brought about in children's lives around the globe. The paper begins with a discussion of the role of INGOs. It moves on to examine how we know we are making a difference and gives an explanation of ‘Global Impact Monitoring’—the framework that Save the Children uses to plan and assess its impact as well as to determine how this impact came about, or to put it another way, to determine ‘best practice’. The paper explains that Save the Children has chosen this system because it reflects a rights-based approach to development and encourages a culture of reflection and learning. The rest of the paper discusses factors that help and hinder the organisation's ability to assess its impact, with practical examples given throughout. The discussion covers a variety of topics, including: how to involve stakeholders (those directly involved in, and those that have an interest in our work, including staff, governments, communities, and most importantly, children and young people) in measuring and analysing what changes Save the Children has created and how these changes came about; how to build monitoring and data analysis into the programme planning cycle; how to ensure sufficient time and resources are allocated for data collection and analysis; how to measure things that are hard, if not impossible, to measure; and, how to measure change at a global level. The paper finishes with a discussion of how to improve things in the future, concentrating on how to build a learning culture within organisations with sufficient resources and incentives to change the way we think about, and practise, development. [ABSTRACT FROM AUTHOR]

This study aimed to assess if there were any identifiable characteristics that could predict a length of inpatient stay of greater than 2 years. This was in respect to patients admitted to the low security Tayside Regional Forensic service, over the course of 10 years, from high security and other sources. A comparison of risk characteristics was also conducted between the two groups. The authors conducted a retrospective cohort study. The control group were formed from the next consecutive admissions to the unit following an admission from a high secure setting. A full case note review and HCR-20's were carried out on all subjects. Regression analysis was utilized to distinguish if a single factor was significant in predicting a length of inpatient stay of more than 2 years. Patients transferred from special hospitals were more likely to have a diagnosis of Schizophrenia, have more serious index offence and more previous convictions. Patients from the high security group had a higher mean HCR-20 score and a significantly earlier age of onset of illness. We were unable to identify a single factor that would predict a length of inpatient stay of more than 2 years. We did identify that patients discharged from high security settings may require a longer inpatient stay and outpatient contact than patients admitted from other sources. We hope to add to the discussion concerning the requirement for long term low and medium secure care. [ABSTRACT FROM AUTHOR]

This paper presents a case study of one of the most intensive biotechnology clusters in Europe, Oxford shire. Its purpose is to examine patterns of development, focusing on the interplay between the characteristics of the industry and its firms, the UK's national innovation system and the locality. It reviews what can be learnt about how this concentration of activity factions by using data from a recently completed study of the Oxford shire biotech industry. It focuses on the rise of entrepreneurial activity, the relationship between growth and the science base, labour markets, milieu effects and formal institutional and physical infrastructural conditions. It concludes that while Oxford shire has marty favourable features its firms are faced with a number of operating problems including the high costs of housing and business property and shortages of skilled people and risk capital. In approach taken, the paper shifts the balance between the conceptualizations of localities as systems of localised networks to localities as systems of material resources. [ABSTRACT FROM AUTHOR]

Explores a series of tensions inherent in the series of European policies that are designed to improve the competitiveness of regions in the face of globalization. Co-existence of interventionist policies intended to overcome problems of lagging regions; Removal of barriers to market integration; Understanding of economic behavior in the face of globalization.

The paper discusses the processes by which local innovation systems develop. Its theme is agenda-setting discourses and the representation of high-tech firms' interests at local and national scales. Using the case study of Oxfordshire, it discusses the relationship between innovation and the development of institutional ensembles. Adopting an historical perspective, it shows how what was a local system has attained greater significance as the political importance of innovation grows in national and regional agendas. To do so, it investigates the plurality of arrangements or coalitions of interests which operate through networks based on The Oxford Trust, a local charitable trust. These networks provide means of co-ordinating resources available to start-up and growing small high-tech firms in Oxfordshire. [ABSTRACT FROM AUTHOR]

Regional Development Agencies have been given the fundamental aim of improving their regions' economic performance and competitiveness. Supporting innovation is a cornerstone of this policy. This paper explores the limitations of region-based strategies arguing that this neglects the importance of policy intervention at the local level, using case studies of Oxfordshire and Cambridgeshire. [ABSTRACT FROM AUTHOR]

Arrests of American girls for assault and weapons charges are rapidly increasing, at rates exceeding those for boys. Yet research on girls' violence is scant. We surveyed a national sample of 213 girls (ages 9-19) via personal interview or an Internet questionnaire, regarding anger precipitants and behaviors, interpersonal relationships, and experiences of discipline at home and school. Girls were categorized as violent (n = 54) if they had been suspended or expelled from school for fighting or bringing a weapon, or charged with a violent offense by the juvenile justice system. The remaining girls (n = 159) were categorized as nonviolent. The anger of violent girls tended to be intense and generalized, while the anger of nonviolent girls was precipitated by specific situations of injustice. Correlates of feeling angry enough to hit or hurt someone were loneliness, unfair treatment by adults, not liked by classmates, and somatic anger symptoms. Violent girls were significantly more likely to dislike school and perceive school discipline as unfair. Both groups of girls held negative views of television violence and curfews. Although girls with well-established patterns of aggression need psychotherapy, school-based interventions such as emotional literacy and violence prevention programs may also be helpful. Mental health nurses are well prepared to serve in a consultative role to schools, assisting in the development and delivery of violence prevention programming. [ABSTRACT FROM AUTHOR]

An individual needs only to have his or her name on the electoral register to be eligible to vote in this country. For the majority of people appearance on this document is determined solely on place of residence. Prior to 1983 individuals with mental disorder were excluded from voting altogether. Curious anomalies in the law continue to prevent certain groups from exercising this right. Mental health care provision has changed since the introduction of the law, which is now outdated and in need of urgent reform. [ABSTRACT FROM AUTHOR]

This paper offers a feminist critique of current community care policy and of the normalization ideology which underpins it. Drawing on experience in services for people with learning difficulties and people who use mental health services, the authors draw a series of parallels between `clients' and women in our society. They discuss the mechanisms whereby groups of people are accorded second class status and the ways in which such oppression is experienced. Strategies for change are discussed with reference to feminist scholarship and the development of the women `a movement. The prevailing philosophy of normalization, which is both apolitical and highly individualistic, is challenged to take more account of collective and communal ways forward and to acknowledge the interdependence of people who need care and their carers. Despite the rhetoric of community care, the work of carers (most of whom are women) is undervalued and unsupported. Mainstream values such as competitiveness and self-reliance are incompatible with the integration of people with disabilities and a theoretical framework which confronts such conflicts of interest is required. [ABSTRACT FROM AUTHOR]

Looks at the links between the development of quality assurance in industry and the history of quality in health and social services. Development of the concept of quality assurance; Theory of continuous improvement; Quality assurance in health and social services; Existing quality assurance strategies in the health care field; Implementation of continuous quality improvement (CQI) in community care services.

Examines the issues involved in interfirm research collaboration. Importance of interfirm cooperation on technological innovation; Awareness on strategic implications of collaborative ventures; Effect of international competition on business planning.

Objective: There is evidence from neuroimaging studies of an association between insomnia and early dementia biomarkers, but observational studies have so far failed to show a clear association between insomnia and the later development of dementia. We investigated the association between dementia diagnosis and recording of insomnia symptoms 5–10 years earlier in primary care. Method: A case-control study using data from the Clinical Practice Research Datalink. 15,209 cases with dementia (either Alzheimer's, vascular, mixed or non-specific subtypes) at least 65 years old at time of diagnosis, were matched with the same number of controls on year of birth and gender. We ascertained the presence of insomnia symptoms during a five-year period starting 10 years before the index date. Odds ratios for developing dementia were estimated using logistic regression after controlling for hypnotic exposure and physical and mental health comorbidities. Results: The adjusted odds ratio for dementia in those with previous insomnia was 1.34 (95% CI = 1.20–1.50). Conclusion: There is an association between dementia and previous insomnia. It may be possible to incorporate insomnia into predictive tools for dementia. [ABSTRACT FROM AUTHOR]

Background: Community health workers (CHWs) can play vital roles in increasing coverage of basic health services. However, there is a need for a systematic categorisation of CHWs that will aid common understanding among policy makers, programme planners, and researchers. Objective: To identify the common themes in the definitions and descriptions of CHWs that will aid delineation within this cadre and distinguish CHWs from other healthcare providers. Design: A systematic review of peer-reviewed papers and grey literature. Results: We identified 119 papers that provided definitions of CHWs in 25 countries across 7 regions. The review shows CHWs as paraprofessionals or lay individuals with an in-depth understanding of the community culture and language, have received standardised job-related training of a shorter duration than health professionals, and their primary goal is to provide culturally appropriate health services to the community. CHWs can be categorised into three groups by education and pre-service training. These are lay health workers (individuals with little or no formal education who undergo a few days to a few weeks of informal training), level 1 paraprofessionals (individuals with some form of secondary education and subsequent informal training), and level 2 paraprofessionals (individuals with some form of secondary education and subsequent formal training lasting a few months to more than a year). Lay health workers tend to provide basic health services as unpaid volunteers while level 1 paraprofessionals often receive an allowance and level 2 paraprofessionals tend to be salaried. Conclusions: This review provides a categorisation of CHWs that may be useful for health policy formulation, programme planning, and research. [ABSTRACT FROM AUTHOR]

The literature on universities’ contributions to regional development is broad and diverse. A precise understanding of how regions may draw advantages from various university activities and the role of public policy institutions in promoting such activities is still missing. The aim of this paper is to provide a framework for analysing universities’ contributions to regional economic and societal development in differing national contexts and the policy institutions that underpin them. To do this, we review four conceptual models: the entrepreneurial university model, the regional innovation system (RIS) model, the mode 2 university model and the engaged university model. The paper demonstrates that these four models emphasize very different activities and outputs by which universities are seen to benefit regional economy and society. It is also shown that these models differ markedly with respect to the policy implications and practice. Analysing some of the public policy imperatives and incentives in the UK, Austria and Sweden, the paper highlights that in the UK, policies encourage all four university models. In contrast, in Sweden and Austria, policy institutions tend to privilege the RIS university model, whilst at the same time, there is some evidence for increasing support of the entrepreneurial university model. [ABSTRACT FROM PUBLISHER]

Background aims. Mesenchymal stromal cells (MSC) are pluripotent adult stem cells capable of osteogenesis and chondrogenesis to form bone and cartilage. This characteristic gives them the potential for bone and cartilage regeneration. Synthetic polymers have been studied to examine whether they could be used as a scaffold for tissue engineering. In the current study a two-dimensional (2-D) poly( l-lactic acid) (PLLA) scaffold was treated with chemokine, adhesion and extracellular matrix molecules with the aim of using biologic molecules to improve the attachment of human MSC. Methods. MSC were isolated from human bone marrow and applied to a 2-D PLLA scaffold. Chemokines ligand (CXCL12 and CXCL13), adhesion molecules [P-selectin, vascular cell adhesion molecule (VCAM)-1 and heparin] and extracellular matrix molecules (fibronectin and type IV collagen) were coated on the scaffold and their effects on the number of MSC that adhered were recorded. Results. When used alone CXCL12 and CXCL13 enhanced MSC adhesion, as did VCAM-1, P-selectin, fibronectin and collagen, but not heparin. The effects of VCAM-1, P-selectin and heparin were enhanced by the addition of CXCL12. Incubation of MSC with antibodies to integrins α4 and α5β1 inhibited their adhesion to VCAM-1 and fibronectin-treated PLLA respectively, suggesting that these integrins were involved in the MSC interactions. Conclusions. The use of certain chemokines and adhesion and extracellular matrix molecules, alone or in combination, is beneficial for the attachment of MSC to PLLA, and may be helpful as natural molecules in scaffolds for regenerative medicine. [ABSTRACT FROM AUTHOR]

In Nepal, India, Bangladesh and Pakistan, policy focused on improving access to maternity services has led to measures to reduce cost barriers impeding women's access to care. Specifically, these include cash transfer or voucher schemes designed to stimulate demand for services, including antenatal, delivery and post-partum care. In spite of their popularity, however, little is known about the impact or effectiveness of these schemes. This paper provides an overview of five major interventions: the Aama (Mothers') Programme (cash transfer element) in Nepal; the Janani Suraksha Yojana (Safe Motherhood Scheme) in India; the Chiranjeevi Yojana (Scheme for Long Life) in India; the Maternal Health Voucher Scheme in Bangladesh and the Sehat (Health) Voucher Scheme in Pakistan. It reviews the aims, rationale, implementation challenges, known outcomes, potential and limitations of each scheme based on current available data. Increased use of maternal health services has been reported since the schemes began, though evidence of improvements in maternal health outcomes has not been established due to a lack of controlled studies. Areas for improvement in these schemes, identified in this review, include the need for more efficient operational management, clear guidelines, financial transparency, plans for sustainability, evidence of equity and, above all, proven impact on quality of care and maternal mortality and morbidity. Au Népal, en Inde, au Bangladesh et au Pakistan, la politique centrée sur l'élargissement de l'accès aux services de maternité a débouché sur des mesures de réduction des obstacles financiers qui empêchent les femmes d'avoir accès aux soins, plus précisément des transferts de fonds ou des chèques conçus pour stimuler la demande, notamment de soins prénatals, obstétricaux et du post-partum. Pourtant, en dépit de leur popularité, on sait peu de choses de l'impact de ces programmes. L'article décrit cinq interventions majeures : le programme Aama (des mères) (élément de transfert de fonds) au Népal, le Janani Suraksha Yojana (plan de maternité sans risque) en Inde, le Chiranjeevi Yojana (plan pour une longue vie) en Inde, le projet de chèques de santé maternelle au Bangladesh et le système de chèques Sehat (santé) au Pakistan. Il examine les objectifs, les justificatifs, les obstacles à l'application, les résultats connus, le potentiel et les limites de chaque projet, avec les données disponibles. Un recours accru aux services de santé maternelle a été enregistré depuis le début des projets, mais sans qu'il soit possible de déterminer les améliorations de la santé maternelle, faute d'études contrôlées. L'étude recense les domaines d'amélioration des projets qui ont besoin d'une gestion opérationnelle plus efficace, de directives claires, de transparence financière, de plans de viabilité, de preuves d'équité et, surtout, de confirmer leur impact sur la qualité des soins, et la mortalité et morbidité maternelles. En Nepal, India, Bangladesh y Pakistán, debido a políticas centradas en mejorar el acceso a los servicios de maternidad, se ha intentado reducir las barreras de costo que impiden el acceso de las mujeres a los servicios: específicamente, transferencias de dinero o programas de cupones diseñados para estimular la demanda de los servicios, incluida la atención antes, durante y después del parto. Pese a su popularidad, no se sabe mucho acerca de su impacto o eficacia. En este artículo se resumen cinco intervenciones importantes: el Programa de Madres (transferencias de dinero) en Nepal; el Plan por una Maternidad sin Riesgos y el Plan por una Vida Larga, ambos en India; el Programa de Cupones para Servicios de Salud Materna en Bangladesh; y el Programa de Cupones para servicios de salud, en Pakistán. Se analizan los objetivos, la justificación y los retos de la implementación, los resultados, el potencial y las limitaciones de cada plan según los datos. Desde el inicio de estos planes, ha aumentado el uso de los servicios de salud materna, aunque por falta de estudios controlados no hay evidencia de mejoras en los resultados. Entre las áreas a mejorar figuran: la eficiencia de la administración operativa, directrices claras, transparencia financiera, planes de sostenibilidad, evidencia de equidad y, sobre todo, un impacto comprobado en la calidad de la atención y en las tasas de mortalidad y morbilidad maternas. [ABSTRACT FROM AUTHOR]

The increasing prevalence of sexually transmitted infection (STI) and delays in access to sexual health care among men who have sex with men are a major public health concern in the UK. This qualitative study, involving semi-structured interviews with 24 men recruited from a genitourinary medicine clinic in Brighton, UK, explored their views towards the introduction of home sampling kits for STI into clinical practice. Participants had previously self-sampled for rectal and oropharyngeal specimens and completed a survey on the acceptability of self-sampling. Interviews were audio-recorded, transcribed and analyzed using a framework approach. Participants preferred to access home sampling kits from medical venues rather than gay social venues due to privacy concerns and fear of being ridiculed by peers. Perceived societal homophobia led to skepticism towards accessing home sampling kits in commercial venues. Assurance about specimen delivery and receiving test results from clinics was important. Views about using home sampling kits for HIV testing were mixed. Home sampling kits were viewed as an adjunct to clinics, but clinic attendance was preferred if symptomatic. Home sampling kits could be a viable alternative to meet the increasing demand for sexual health services, but to improve the home sampling kit uptake the method of service provision must be culturally sensitive and acceptable. [ABSTRACT FROM AUTHOR]

Grandparents are increasingly becoming the primary carers of children orphaned by the HIV epidemic in South Africa. Traditional family roles are being reversed as aging family members take responsibility for the physical and psychosocial needs of children. This study uses qualitative research to explore the experiences of grandparents fostering children orphaned by AIDS in Richards Bay, KwaZulu-Natal Province, South Africa. The idea was born after a local HIV support organisation (Richards Bay Family Care) observed a trend within their organisation of grandparents increasingly becoming foster parents for orphans. An exploratory study was conducted in the organisation's three target areas (two rural villages and urban Richards Bay); the ultimate aim was to explore options for improving financial and emotional support for this group. The qualitative research methods included: four focus group discussions with foster-carers and community leaders (including two pocket-chart voting exercises); 12 in-depth interviews with grandparent foster-carers; and ten key-informant interviews, mostly with staff who provide support services. Data analysis was by thematic framework. The needs of the grandparent foster-carers varied: the rural participants were essentially concerned with meeting children's basic needs (housing, food and education), while those in urban areas more often felt pressure to provide emotional and psychological support for orphans. In both groups, women were at the forefront of foster care. Important problems identified by the grandparents were child discipline and a feeling of disharmony in the intergenerational relationship. Government foster care grants were identified as a regular source of income for especially the rural foster-carers. The findings may help programme managers better understand the differences in the needs of urban and rural foster parents. The experiences of grandparents as carers of orphans affected by HIV or AIDS are unique considering their age, frailty and poverty status. More research is needed on the role played by men in fostering children orphaned by AIDS. [ABSTRACT FROM AUTHOR]

This special issue brings together creativity and enterprise through the geographies of the creative industries. In recent years the focus of academic debate has privileged business and corporate economies, and so this issue seeks to contribute both empirically and theoretically to the burgeoning literature of creative industries. Economic geography offers a rich domain through which to engage with these debates, exploring the nuances of creativity and enterprise. Our aim, as well as bringing together a set of interesting papers, is to contribute critically to understanding the organization and spatial structure of creative industries and the broader creative economy. [ABSTRACT FROM AUTHOR]

This study seeks to describe the demographic details, offence details, and psychiatric details and outcomes of individuals referred for court reports to the Tayside Area Forensic Psychiatry Service between January 1, 2001 and December 31, 2001. Information was extracted by a review of the psychiatric casenotes of individuals referred during this period. In all, 232 referrals were received on 172 individuals; 58% of those seen received an Axis I diagnosis while 39% were felt to require inpatient psychiatric treatment. Twelve individuals were considered by the assessing psychiatrist to be unfit to plead and eight were insane at the time of the alleged index offence. One was considered to meet the criteria for diminished responsibility on grounds of mental disorder. A clinically inappropriate placement occurred in nearly 10% of cases, most commonly related to insufficient availability of forensic admission beds. These findings are discussed in the context of the need for expansion of Scottish forensic services to include medium secure units, in line with similar services in England and Wales. [ABSTRACT FROM AUTHOR]

Objective: The difficulties adults have using inhaler devices is well documented but much less is known about how parents administer inhaler devices to young children and the difficulties experienced. The purpose of this article is to explore the underlying concepts and practical issues that parents encounter in administering inhaled asthma medications to their young children. Methods: This is a qualitative study using applied thematic analysis on parental written discourses from asynchronous online discussion forums on the topic of administration and use of asthma inhaler devices to young children. Results: "At a loss of what to do" summarizes the experiences parents described when administering inhaler devices to their young children. Parents describe the problems, the situations, the emotions, the decisions, and the confusion they face. They struggle with their child's resistance and the associated conflict, describing their own and their child's distress. Results highlight the coping strategies used in administration, how parents decide whether to use coercive measures or not, their help-seeking endeavors, together with the assurance they give to themselves and others after administration. Conclusion: The online discussions highlight parents' distress, lack of preparedness, and understanding of administering inhaler devices to young children. While the prevalence of the problem cannot be estimated from our data, it illustrates a need for some healthcare professionals to review their own knowledge and skills in administration of inhaled medication to younger patients, and their provision of patient and family centered care. [ABSTRACT FROM AUTHOR]

Objective: Patient education materials (PEMs) are commonly used for patient education. This study assessed readability, format quality, accuracy, understandability and actionability of printed asthma PEMs available in primary care in Singapore. Methods: Primary care in Singapore is provided by island-wide polyclinics and private general practices. We invited the three polyclinic healthcare groups and private general practices via the Primary Care Research Network to submit asthma-related PEMs. Readability was assessed using Simple Measure of Gobbledegook (SMOG) and Flesch–Kincaid (FK) score. Format quality was assessed using "Clear-print and large-print golden rules" from UK Association for Accessible Formats (UKAAF). Understandability and actionability were evaluated using Patient Education Materials Assessment Tool – Printed. Three pulmonologists assessed content accuracy. Results: Thirty leaflets were assessed. SMOG and FK estimated 93% (mean 9.3, range 5–14, SD 1.8) and 47% (mean 6.8, range 2.4–9.9, SD 2.0) exceeded the recommended sixth-grade reading level, respectively. About a third (37%) were fully concordant with UKAAF guidelines, with poor format quality contributed by small font size, poor text emphasis methods, and not using left-aligned text. Leaflets generally scored well in both understandability (mean 84%) and actionability (mean 72%). Thirteen leaflets were inaccurate, 92% of which contained at least one inaccuracy judged to have potentially harmful consequences to patients, including wrong emergency advice. Conclusion: While understandability and actionability are adequate, current asthma PEMs are limited by inappropriately high reading levels, poor format quality and inaccuracies. Healthcare professionals need to assess patients' reading abilities and ensure PEMs are accurate and suitable for their patients. [ABSTRACT FROM AUTHOR]

Introduction: The study describes the development of the first UK national framework to guide undergraduate education in anesthesia, perioperative medicine, critical care, and pain medicine. Methods: We followed an inclusive process of curriculum design aiming to promote high-level learning amongst students. We conducted telephone interviews with senior anesthetic educators at 33 UK medical schools to establish current provision and practice. We then held a consultative national workshop for educators, using focus group interviews to set broad aims for the final framework and gather information. Result: Anesthesia undergraduate educators demonstrated a conceptual focus that moves beyond simple acquisition of knowledge to one geared to encouraging clinical behavioral change in learners to equip them for practice as new doctors. Respondents also highlighted the opportunities for promoting spiral, integrated, and longitudinal learning within the undergraduate curriculum. We also formulated eight key domains of practice in anesthesia and critical care and mapped 63 of the 106 General Medical Council's Outcomes for Graduates against these domains, and created a brief suggested syllabus. Conclusions: The framework aims to provide support and guidance for medical schools in the development of competent, well-rounded doctors who are able to provide safe, patient-centered care in all areas of medical practice. [ABSTRACT FROM AUTHOR]

Objective: To conduct a comprehensive review and meta-analysis of the effectiveness of meditation on a variety of asthma outcomes. Methods: We searched MEDLINE, EMBASE, CINAHL, PsycINFO and AMED in June 2016 to identify randomized controlled trials (RCTs) investigating the effectiveness of meditation in adults with asthma. No restriction was put on language or year of publication. Study quality was assessed using The Cochrane Risk of Bias Assessment Tool. Meta-analysis was carried out using RevMan 5.3. Results: Four RCTs involving 201 patients met the inclusion criteria. Quality of studies was inconsistent with only one study reporting adequate allocation concealment. Disease-specific quality of life was assessed in two trials; a pooled result involving 62 intervention and 65 control participants indicated a significant improvement in quality of life in the meditation group compared to the control group (SMD 0.40, 95% CI 0.05-0.76). A pooled result from all four studies indicated the uncertain effect of meditation in forced expiratory volume in 1 s (FEV1) (SMD −0.67, 95% CI −2.17 to 0.82). Results from the individual trials suggest that meditation may be helpful in reducing perceived stress and the use of short-term rescue medication. Conclusion: Our review suggests that there is some evidence that meditation is beneficial in improving quality of life in asthma patients. As two out of four studies in our review were of poor quality, further trials with better methodological quality are needed to support or refute this finding. [ABSTRACT FROM AUTHOR]

Objective: In epidemiological studies that aim to investigate the relationship between pet exposure and allergy/asthma, pet exposure is often ascertained by means of a questionnaire, but it is unclear which questionnaire items are used. The objective of this study was to systematically review self-reported pet exposure assessment in questionnaires used in epidemiological studies which explore the associations between pets and allergy/asthma.Methods: A systematic literature search was conducted in PubMed and papers were selected according to pre-specified eligibility criteria. The pet exposure questions used were classified within a framework including direct pet contact, indirect pet contact (e.g. through carers or grandparents) and avoidance behaviour. Authors were contacted when the questions used were not reported in detail.Results: Ninety-six full text papers were systematically reviewed. All studies assessed direct pet contact, but less than half (45%) explicitly assessed whether pets were allowed indoors. The vast majority of studies assessed both pet exposures during the first year of life and after the first year of life. The minority (13%) assessed whether pet(s) were kept at places regularly visited by the child and pet exposurein utero(15%). Even fewer studies assessed indirect contact to pets (n = 8) and avoidance behaviour (n = 10).Conclusions: In epidemiological studies, the ascertainment of pet exposure through questionnaires appears to vary greatly. This variation might partly explain the inconsistent and contradictory results of the effects of pet exposure on the development of allergy and asthma. [ABSTRACT FROM PUBLISHER]

Objective. It is unclear which of the commonly used asthma-specific quality of life (QoL) questionnaires best capture the lived experience of people with asthma. The objective of this study was to explore patients' views on three asthma-specific QoL questionnaires. Methods. Ten adult individuals with asthma were asked to complete three asthma-specific QoL questionnaires (Standardized Juniper Asthma Quality of Life Questionnaire (AQLQ-J-s), Sydney Asthma Quality of Life Questionnaire (AQLQ-S), and Fragebogen zur Lebensqualität bei Asthma (FLA)). Interviews were conducted to elicit patients' views on the questionnaires. Interviews were transcribed verbatim and thematic content analysis was performed. Results. Participants spoke about response format and options, missing and redundant/similar content as well as content that was perceived to be irrelevant. A lack of specificity was named for some items, and issues concerning layout were raised. Despite the diversity of views expressed, participants mostly agreed on the ranking of the questionnaires and, overall, favored the AQLQ-S. Conclusions. Patient involvement highlights shortcomings and strengths of various asthma-specific questionnaires in terms of both format and content. The AQLQ-S was the most positively perceived questionnaire. Future research will need to explore other settings and potentially involve a larger and more diverse sample. [ABSTRACT FROM AUTHOR]

A growing body of research has examined the potential for positive change following challenging and traumatic events, this is known as posttraumatic growth (PTG). Childbirth is a valuable opportunity to extend previous work on PTG as it allows the role of different variables to be considered prospectively. The aim of this study was to prospectively examine correlates of PTG after birth, including sociodemographic and obstetric variables, social support and psychological distress, using a prospective, longitudinal design. A total of 125 women completed questionnaires during their third trimester of pregnancy and 8 weeks after birth. At least a small degree of positive change following childbirth was reported by 47.9% of women; however, average levels of growth were lower than generally reported in other studies. A regression model of age, type of delivery, posttraumatic stress symptoms during pregnancy and general distress after birth significantly predicted 32% of the variance in growth after childbirth. The strongest predictors of growth were operative delivery (β 0.23–0.30) and posttraumatic stress symptoms in pregnancy (β 0.32). These findings emphasise the importance of assessing pre-event characteristics when considering the development of PTG after a challenging event. [ABSTRACT FROM PUBLISHER]

Objectives: To understand the knowledge, skills and confidence of doctors, nurses and other healthcare workers in delivering end-of-life care in community hospitals. Research design: A cross-sectional questionnaire survey was carried out to evaluate doctors', nurses' and other staff's self-reported knowledge and confidence in delivering general aspects of end-of-life care in six community hospitals in the South West and South East of England. Approximately 900 hours of non-participant observation was conducted. Participants: Staff associated with community hospitals were invited to complete a questionnaire and 346 questionnaires were distributed, with 125 returned (response rate 36%). The sample consisted of: medical staff (n = 31), nursing staff (n = 44), health care assistants (n = 22) and other professional workers (n = 28). Results: Staff reported having knowledge, skills and confidence in symptom control but had less expertise in psychological, spiritual and bereavement care. End-of-life care needs to be delivered by a multidisciplinary team. Our findings indicate that further education is required in psychosocial care. [ABSTRACT FROM AUTHOR]